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Am Fam Physician. 2002;66(4):654

Patients with recurrent genital herpes may experiment with shorter courses of antiviral medication as they gain experience with the disease. Studies of viral replication have shown that active viral reproduction ends in the first few days of recurrent infections, well before the resolution of genital lesions or clinical symptoms. Wald and associates conducted a randomized, double-blind, placebo-controlled trial of higher-dose, shorter-course acyclovir in the treatment of recurrent genital herpes.

The study enrolled 131 patients with recurrent genital herpes (i.e., at least three documented outbreaks in the year before the study). Patients were randomized to treatment with either acyclovir at 800 mg or placebo, three times daily for two days. At least one recurrence occurred during follow-up in 64 percent of participants, and 50 percent of participants had two or more episodes of infection. With each recurrence, lesions were cultured for herpes simplex virus every other day until resolution.

Acyclovir was more than twice as likely as placebo (27 percent versus 10.6 percent) to completely abort recurrence of the herpes virus infection. In patients who developed active lesions, viral shedding was reduced by more than one half with acyclovir (25 hours versus 58.5 hours with placebo), and the duration of skin lesions also decreased (four days versus six days with placebo). These results were comparable with results published elsewhere for standard antiviral regimens. There was no significant difference in the likelihood of a subsequent herpes outbreak with the shorter-course regimen. The higher-dose, shorter-course regimen of acyclovir (800 mg three times daily for two days) promoted better compliance than standard dosing (200 mg five times daily for five days) but had the same overall cost because the total drug dosage was similar.

The authors conclude that a shorter course of higher-dose acyclovir for recurrent genital herpes is effective in aborting recurrences, decreasing viral shedding, and speeding clinical resolution of outbreaks.

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