From the Guidelines
Episodic treatment of HSV2 with valtrex (valacyclovir) is a recommended approach for managing outbreaks, with a regimen of 500 mg taken orally twice daily for 3-5 days for recurrent episodes. This treatment should be initiated at the earliest sign of an outbreak, such as tingling, itching, or lesions, to maximize effectiveness 1. The goal of episodic treatment is to reduce the duration and severity of outbreaks, although it does not cure HSV2 infection or prevent transmission to partners.
Key Considerations
- For the first episode, the recommended regimen is valacyclovir 1 gram taken orally twice daily for 7-10 days 1.
- Patients with frequent recurrences (more than 6 per year) may benefit from daily suppressive therapy instead of episodic treatment 1.
- Common side effects of valacyclovir include headache, nausea, and abdominal pain, and adequate hydration should be maintained while taking the medication.
- Valacyclovir works by inhibiting viral DNA synthesis, preventing the herpes virus from replicating.
Patient Education
- Patients should be aware of both episodic and suppressive therapy approaches to manage chronic HSV-2 infection and should be offered suppressive therapy if appropriate 1.
- Patients should avoid sexual contact during outbreaks and consider using barrier methods even when symptoms are not present, as asymptomatic viral shedding can occur.
- Suppressive therapy can be considered to prevent transmission in various populations, including men who have sex with men (MSM), women who have sex with women, and transgender persons, although it is not effective in decreasing the risk of transmission among persons with HIV/HSV-2 coinfection 1.
From the FDA Drug Label
Recurrent Episodes: VALTREX is indicated for treatment of recurrent episodes of genital herpes in immunocompetent adults. The efficacy of treatment with VALTREX when initiated more than 24 hours after the onset of signs and symptoms has not been established
- Episodic treatment for HSV2 with valtrex is indicated for immunocompetent adults.
- The treatment should be initiated within 24 hours after the onset of signs and symptoms for maximum efficacy.
- Valtrex is effective for the treatment of recurrent episodes of genital herpes in immunocompetent adults 2.
From the Research
Episodic Treatment for HSV2 with Valtrex
- Valtrex (valacyclovir) is an effective treatment for episodic genital herpes, with studies showing its efficacy in reducing the duration of symptoms and accelerating healing 3, 4, 5, 6, 7.
- A 3-day course of valacyclovir (500 mg twice daily) has been shown to be equivalent to a 5-day course in terms of efficacy, with median times to lesion healing, pain duration, and episode length being similar between the two regimens 3.
- Single-day famciclovir therapy (1000 mg twice daily) has been compared to 3-day valacyclovir therapy (500 mg twice daily) and found to be noninferior in reducing time to healing of nonaborted genital herpes lesions 4.
- Valacyclovir 1000 mg once daily has been shown to be as effective as 500 mg twice daily in the episodic treatment of recurrent genital herpes, with equivalent outcomes in terms of lesion healing, time to cessation of pain, and safety 5.
- Valacyclovir has also been compared to aciclovir in the treatment of recurrent genital herpes, with studies showing that valacyclovir 500 mg twice daily is equivalent in efficacy to aciclovir 200 mg five times daily 6.
- In patients with HIV, valacyclovir has been shown to be effective and safe for the suppression and episodic treatment of herpes simplex virus, with a safety profile similar to that of acyclovir 7.
Treatment Regimens
- 3-day course of valacyclovir (500 mg twice daily) 3
- 5-day course of valacyclovir (500 mg twice daily) 3
- Single-day famciclovir therapy (1000 mg twice daily) 4
- Valacyclovir 1000 mg once daily 5
- Valacyclovir 500 mg twice daily 5, 6
- Aciclovir 200 mg five times daily 6