Genital Herpes: Treatment Guidelines

, Withington Hospital and University of Manchester


Medscape General Medicine. 1997;1(2) 

In This Article


Table 1. Antiviral Regimens for Genital Herpes, 1993

  • First clinical episode of genital herpes: Acyclovir 200mg PO 5 times a day for 7-10 days or until clinical resolution is attained.

  • First clinical episode of herpes proctitis: Acyclovir 400mg PO 5 times a day for 10 days or until clinical resolution is attained.

  • Recurrent episodes:

    • Famciclovir 125mg PO bid for 5 days*

    • Valacyclovir 500mg PO bid for 5 days*

    • Acyclovir 200mg PO 5 times a day, 400mg PO tid, OR 800mg PO bid for 5 days.

  • When treatment is begun during the prodrome or within 2 days of lesion onset, some patients with recurrent disease experience limited benefit from therapy. Because early treatment can seldom be administered, most immunocompetent patients with recurrent disease do not benefit from acyclovir treatment, and it is not generally recommended.

  • Daily Suppressive Therapy: Acyclovir 400mg bid or acyclovir 200mg PO 3-5 times a day. (The goal of the 200-mg regimen is to identify the lowest dose that provides relief from frequently recurring symptoms.)

    Daily suppressive therapy can reduce the frequency of HSV recurrences by 75% among patients with frequent recurrences--that is, 6 or more per year. Suppressive treatment with oral acyclovir does not totally eliminate symptomatic or asymptomatic viral shedding or the potential for transmission. Safety and efficacy have been documented among persons receiving daily therapy for as long as 5 years. Acyclovir-resistant strains of HSV have been isolated from some persons receiving suppressive therapy, but these strains have not been associated with treatment failure among immunocompetent patients. After 1 year of continuous suppressive therapy, acyclovir should be discontinued to allow assessment of the patient's rate of recurrent episodes.

  • IV acyclovir 5-10mg/kg body weight every 8 hours for 5-7 days or until clinical resolution is attained.

* Available after the 1993 CDC Guidelines.

Data from Centers for Disease Control and Prevention.[22]