From the Guidelines
Treatment for herpes type 2 (genital herpes) should prioritize antiviral medications such as acyclovir, valacyclovir, and famciclovir to manage symptoms and reduce outbreaks, as recommended by the most recent guidelines 1. The primary goal of treatment is to reduce the frequency and severity of outbreaks, as well as to decrease viral shedding and transmission risk.
- The recommended dosing regimens for initial outbreaks are:
- Acyclovir: 400mg three times daily for 7-10 days
- Valacyclovir: 1000mg twice daily for 7-10 days
- Famciclovir: 250mg three times daily for 7-10 days
- For suppressive therapy, the recommended dosing regimens are:
- Acyclovir: 400mg twice daily
- Valacyclovir: 500-1000mg daily
- Famciclovir: 250mg twice daily These medications work by inhibiting viral DNA replication, preventing the virus from multiplying, as noted in earlier studies 1. While there's no cure for herpes, proper treatment can significantly reduce symptoms, shorten outbreaks, and decrease viral shedding, ultimately improving the patient's quality of life, as supported by the latest evidence 1. Patients should also avoid triggers like stress, illness, and excessive sun exposure, and should abstain from sexual activity during outbreaks to prevent transmission. It is essential to prioritize dosing strategies that are most feasible for patient adherence, as emphasized in the 2021 Centers for Disease Control and Prevention sexually transmitted infections treatment guidelines 1.
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. Results supporting efficacy were replicated in a second trial.
The treatment for herpes type 2 (HSV-2) with valacyclovir (PO) is 500 mg twice daily for 5 days or 500 mg twice daily for 3 days. This treatment has been shown to reduce the median time to lesion healing, cessation of viral shedding, and cessation of pain compared to placebo 2.
- Lesion healing: 4 days with valacyclovir vs 6 days with placebo
- Cessation of viral shedding: 2 days with valacyclovir vs 4 days with placebo
- Cessation of pain: 3 days with valacyclovir vs 4 days with placebo
From the Research
Treatment Options for Herpes Type 2
- Antiviral medications such as famciclovir, valacyclovir, and acyclovir have been shown to be effective in reducing the symptoms and frequency of herpes type 2 outbreaks 3, 4, 5, 6.
- Valacyclovir appears to be somewhat better than famciclovir for suppression of genital herpes and associated shedding 3.
- Daily suppressive therapy with valacyclovir has been shown to reduce the risk of sexual transmission of herpes simplex virus type 2 (HSV-2) in HSV-2-serodiscordant heterosexual couples by 48% 7.
- However, daily suppressive therapy with acyclovir did not decrease the risk of HSV-2 transmission from HSV-2/HIV-1 coinfected persons to susceptible partners 7.
Antiviral Medications
- Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis, and the only antiviral drug approved for a 3-day course in the episodic treatment of recurrent genital herpes, as well as the only antiviral drug approved for once daily dosing for suppressive therapy 6.
- Acyclovir, valacyclovir, and famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes, and are useful as suppressive therapy for individuals with frequent genital herpes recurrences 4.
- High doses of oral acyclovir, valacyclovir, and famciclovir have been shown to speed the healing of herpes zoster, and data suggests that these agents also decrease associated acute and chronic pain in people of 50 years of age or older 4.