Acyclovir in genital herpes

There is little doubt about the value of oral acyclovir in the treatment of the initial infection of genital herpes, but in recurrent genital herpes, both oral and topical treatments have been disappointing.

In the initial infection of genital herpes:

• oral acyclovir - if started within six days of the rash, acyclovir orally reduces time to healing, pain and virus shedding. Dosage - 200mg five times daily for 5 days
  
  
• Acyclovir cream - less effective than oral and does not affect systemic symptoms. Dosage - 5% cream five times a day for 5 days started within five days of the onset of symptoms

Recurrent episodes of genital herpes (e.g. > 10 episodes per year) may require continuous acyclovir therapy (400 mg bd).

Reference:

• (1) NEJM (1983) 308, 961-21.
• (2) J Antimicrob Chemother (1983) 12 Suppl.B: 79 -88.
• (3) Evidence-based Medicine (1997), 2(2), 43.