From the Guidelines
Topical treatments for genital Herpes Simplex Virus (HSV) infection are not recommended as first-line therapy.
Available Options
- Topical acyclovir is substantially less effective than systemic therapy and its use is discouraged 1.
- However, for cases of acyclovir-resistant genital herpes, topical cidofovir gel 1% may be effective when applied to the lesions once daily for 5 consecutive days 1.
- Other options such as imiquimod and brincidofovir have been suggested in case reports, but more evidence is needed to support their use 1.
Important Considerations
- Systemic antiviral drugs such as acyclovir, valacyclovir, and famciclovir are the preferred treatment options for genital HSV infection 1.
- For severe cases caused by proven or suspected acyclovir-resistant strains, alternate therapy such as foscarnet may be administered 1.
From the Research
Topical Treatments for Genital Herpes Simplex Virus (HSV) Infection
- Topical antiviral agents such as idoxuridine (IDU) 15% in dimethyl sulfoxide (DMSO), interferons, and penciclovir have shown significant clinical benefit against genital HSV infection 2
- Penciclovir cream has been shown to decrease the duration of lesions, pain, and viral shedding in patients with genital HSV infection 2, 3
- Acyclovir cream is effective in treating recurrent genital and labial herpes, with efficacy maximized by early patient-initiated treatment at the onset of prodromal symptoms 4
- However, topical acyclovir therapy is relatively or totally ineffective for treatment of first-episode genital herpes and is therefore discouraged 5
- Other topical treatments that have shown promise include alpha-interferon, which has shown synergism with other anti-HSV drugs, and (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine (HPMPC), which is effective against acyclovir-resistant strains of HSV 2
- Ascorbic acid has also shown promising effects against HSV, although further research is needed to confirm its efficacy 2