Genital herpes suppressive therapy

When valacyclovir is used as suppressive therapy in immunocompetent individuals with genital herpes, the risk of heterosexual transmission to susceptible partners is reduced. Instruct patients to use safer sex practices with suppressive therapy (see current Centers for Disease Control and Prevention Sexually Transmitted Disease Treatment Guidelines). 

HIV-infected patients In HIV-infected patients with CD4 cell count at least 100 cells/mm, the recommended dosage of valacyclovir for chronic suppressive therapy of recurrent genital herpes is 500 mg twice daily. The safety and efficacy of therapy with valacyclovir beyond 6 months in patients with HIV infection have not been established. 

In a randomized, placebo-controUed study in 455 patients oral famciclovir (125 or 250 mg tds or 250 mg bd) used to suppress recurrent genital Herpes simplex infections, the toxicity profile of famciclovir was comparable to placebo (4). The only serious adverse effects reported as being possibly related to famciclovir were raised bilirubin concentration and lipase activity in one patient after 10 months of treatment with famciclovir 125 mg tds. However, these laboratory abnormalities resolved on therapy after 7 days and did not recur during the rest of the study. 

Cost and the potential for adverse effects preclude available antiviral agents from being recommended routinely for use as suppressive therapy in all patients with recurrent genital herpes. Patients with frequent (greater than six per year) and physically or psychologically distressing recurrences, however, are candidates for suppressive therapy. " ... 

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