- Valaciclovir 500 mg orally, 12-hourly for 5 to 10 days
- aciclovir 200 mg orally, 5 times daily for 5 to 10 days.
Episodic treatment is indicated for infrequent recurrences (i.e. intervals of more than six to eight weeks). Episodic therapy should be initiated early on by the patient at the first sign of prodrome or very early lesions.
- Valaciclovir 500 mg orally, 12-hourly for 5 days
- famciclovir 500 mg stat and 250 mg twice daily for 3 doses
- aciclovir 200 mg orally, 5 times daily for 5 days.
Suppressive therapy is indicated in significant, frequent disease.
- Valaciclovir 500 mg orally, daily
- famciclovir 250 mg orally, 12-hourly
- aciclovir 200 mg orally, 8-hourly.
For immunocompetent individuals having at least 10 out-breaks per year, or immunosuppressed individuals:
- valaciclovir 1 g orally, per day
- famciclovir 500 mg orally, 12-hourly
- aciclovir 400 mg orally, 12-hourly.
There is no evidence that vitamins, zinc, lysine or other complementary remedies are any more effective than placebo in the prevention of recurrences.
Aciclovir (category B3) is not recommended for routine use during pregnancy. However, it may be used in individual cases when the patient's condition requires it.
Perinatal transmission, with disseminated HSV infection in the neonate, is most likely to occur with vaginal delivery at the time of, or shortly after, primary maternal infection. The risk is much lower with recurrent HSV lesions or asymptomatic infection at the time of delivery in a woman with a history of genital herpes because passive cross-placental transfer of maternal antibodies provides good protection for the baby. A woman with a history of genital herpes, or who has had a partner with herpes, should alert her obstetrical team to this situation. The decision whether to proceed to vaginal delivery depends on the presence of lesions at term, availability and results of virological tests, and the outcome of discussion between the obstetrician and the mother.
Medicines in pregnancy.