From the Guidelines
Treatment for a genital herpes outbreak should prioritize antiviral medications such as acyclovir, valacyclovir, or famciclovir, with dosing strategies that maximize patient adherence, as recommended in the 2021 Centers for Disease Control and Prevention sexually transmitted infections treatment guidelines 1. When managing a genital herpes outbreak, it is essential to consider the most practical treatment regimens, including first clinical episode, episodic therapy, and suppressive therapy.
- The most effective treatment regimens for genital herpes outbreaks are those that are FDA-approved and have feasible dosing strategies, such as acyclovir (400mg three times daily for 7-10 days), valacyclovir (1000mg twice daily for 7-10 days), or famciclovir (250mg three times daily for 7-10 days) 1.
- These medications work best when started within 24-48 hours of symptom onset, as they inhibit viral replication and can shorten the duration and severity of the outbreak.
- For pain management, over-the-counter pain relievers like acetaminophen or ibuprofen can help, along with warm baths with Epsom salts.
- Keeping the affected area clean and dry is important; wear loose-fitting cotton underwear and avoid tight clothing that may irritate lesions.
- Applying a cold compress can also provide relief.
- For those with frequent outbreaks (more than six per year), daily suppressive therapy with lower doses of antivirals may be recommended, as studied and recommended for genital HSV-2 infection, and also applicable to genital HSV-1 infection 1.
- During outbreaks, avoid sexual contact to prevent transmission to partners, as the virus is highly contagious when lesions are present.
- Stress management and maintaining overall health can help reduce the frequency of recurrences, as emotional stress and weakened immunity can trigger outbreaks.
From the FDA Drug Label
The median time to lesion healing was 4 days in the group receiving VALTREX 500 mg versus 6 days in the placebo group, and the median time to cessation of viral shedding in subjects with at least 1 positive culture (42% of the overall trial population) was 2 days in the group receiving VALTREX 500 mg versus 4 days in the placebo group The median time to cessation of pain was 3 days in the group receiving VALTREX 500 mg versus 4 days in the placebo group. In a third trial, subjects were randomized to receive VALTREX 500 mg twice daily for 5 days (n = 398) or VALTREX 500 mg twice daily for 3 days (and matching placebo twice daily for 2 additional days) (n = 402) The median time to lesion healing was about 4½ days in both treatment groups. The median time to cessation of pain was about 3 days in both treatment groups.
Treatment for genital herpes outbreak:
- Valacyclovir (PO) is effective in treating genital herpes outbreaks, with a recommended dose of 500 mg twice daily for 5 days or 500 mg twice daily for 3 days.
- The median time to lesion healing is approximately 4 days with valacyclovir treatment, compared to 6 days with placebo.
- The median time to cessation of pain is approximately 3 days with valacyclovir treatment, compared to 4 days with placebo.
- The median time to cessation of viral shedding is approximately 2 days with valacyclovir treatment, compared to 4 days with placebo 2
From the Research
Treatment Options for Genital Herpes Outbreak
- The treatment of genital herpes outbreaks can be managed through antiviral therapy, which provides symptom relief and prevents transmission 3.
- Available antiviral agents for the treatment of genital herpes include acyclovir, valacyclovir, and famciclovir, all of which are safe and effective for episodic and daily suppressive treatment 3.
Antiviral Therapy
- Valacyclovir is an effective drug for the suppression of recurrent episodes of genital herpes in immunocompetent and immunocompromised individuals 4.
- Valacyclovir has been shown to be more effective than acyclovir and equally effective as famciclovir in hastening the healing of zoster-associated pain and postherpetic neuralgia (PHN) 5.
- The choice of antiviral therapy may be influenced by factors such as cost, ease of dosing, and acyclovir resistance 3.
Suppressive Therapy
- Suppressive therapy is required for patients with frequent and/or severe episodes of genital herpes, especially in immunocompromised patients 6.
- Valacyclovir 500 mg twice daily maintains the benefits of acyclovir treatment in terms of clinical efficacy and safety 6.
- Alternative therapies in case of clinical failure are discussed, and the development of new strategies is moving in three directions: improvement in antiviral therapy or identification of new drug targets, local immune therapy, and vaccination 6.
Dosage and Administration
- Valacyclovir dosages of ≥ 500 mg daily are recommended for suppression of genital herpes recurrences in immunocompetent individuals 4.
- Once daily valacyclovir (1000 mg, 500 mg, and 250 mg) has been shown to produce statistically significant suppression of disease recurrence, as has twice daily valacyclovir 250 mg and acyclovir 400 mg 4.