There are three oral medications: Acyclovir, valacyclovir and famciclovir. Valacyclovir and famciclovir are better absorbed and can be dosed less frequently. Acyclovir can be acquired in generic form at a very low cost. Intravenous acyclovir is used for very severe cases that may require hospitalization. These drugs are very safe and do not require laboratory monitoring when used for a short duration. Some patients complain of headache. Encourage hydration while taking these medications.
These medications are prescribed as early as possible for acute and recurrent disease to decrease severity, duration and viral shedding.
Acyclovir given at 36 weeks gestation reduced the risk of recurrence at delivery, the risk of viral shedding at delivery and cesarean section rate for recurrent genital herpes. These are pregnancy category B drugs.
The first episode of acute herpes is treated with acyclovir 400 mg 3 times a day for 7-10 days. Recurrent episodes are treated with 400 mg 3 times a day for 3-5 days. Suppressive therapy is 400 mg twice a day taken for weeks or months.
The first episode is treated with 1 g twice a day for 7-10 days. Recurrent episodes are treated with 500 mg twice a day for 3 days. Suppressive therapy is 500 mg once a day or 1 g once a day for patients was greater than 9 recurrences per year.
First episode is treated with 250 mg 3 times a day for 7-10 days. Recurrent episodes are treated with 125 mg twice a day for 3-5 days. Suppressive therapy is 250 mg twice a day.