Current Thinking on Genital Herpes

Annika M. Hofstetter; Susan L. Rosenthal; Lawrence R. Stanberry


Curr Opin Infect Dis. 2014;27(1):75-83. 

In This Article

Antiviral Therapy

The mainstay of HSV therapy over the past few decades has been three antiviral medications: acyclovir, famciclovir and valacyclovir. These nucleoside analogues, which inhibit viral DNA polymerase, can be given during symptomatic primary infection (i.e. 7–10 days) or recurrence (i.e. 1–5 days) as well as daily for suppressive therapy.[112] Although such regimens have been shown to reduce the severity of lesions and lower shedding rates, they do not eliminate shedding or transmission risk.[55,113–116] Therefore, novel approaches are needed. Topical microbicides (e.g. 1% tenofovir, 3% SPL7013 gels) may be an option given promising animal model, in-vitro, and clinical data, including a recent trial demonstrating that 1% tenofovir gel reduced HSV-2 infection risk by 51%.[117–120] A clinical trial examining its impact on shedding among HSV-2 seropositive women is also underway.[121] Helicase-primase inhibitors of HSV replication are another possibility.[122] A recent clinical trial demonstrated the safety and efficacy of one helicase-primase inhibitor, ASP2151, in treating recurrent genital herpes.[123] Its use may be particularly valuable for individuals who have failed traditional therapy or possess rare acyclovir-resistant HSV. Its efficacy among immunocompromised patients, for whom resistance is more common,[124] and impact on viral shedding should be examined further.