Episodic Valacyclovir Retreatment for Recurrent HSV-2 Genital Herpes
Re-treatment with valacyclovir for a new recurrent HSV-2 genital herpes episode is appropriate when a new outbreak begins, even if it occurs about a month after a prior episode. [1] CDC recommends episodic antiviral therapy for recurrent HSV-2 genital herpes episodes using valacyclovir dosing regimens that are started at the onset of symptoms. [1]
Medication Selection Algorithm
Episodic antiviral therapy for recurrent HSV-2 genital herpes can use any of the following CDC-recommended options. [1]
- Valacyclovir (example: 500 mg orally twice daily for 3 days). [1]
- Valacyclovir (alternative: 1 g orally once daily for 5 days). [1]
Monotherapy vs Combination Therapy
Episodic treatment is recommended as antiviral monotherapy for the recurrent episode. [1] No routine addition of another antiviral is recommended for a typical recurrent episode treated with valacyclovir per CDC episodic regimens. [1]
Initiation Thresholds
Episodic antiviral therapy should be initiated at the onset of symptoms for the recurrent episode. [1] A minimum waiting period after a prior course is not specified by CDC for episodic treatment of a later recurrence. [1]
Dosing After a New Recurrence
CDC episodic valacyclovir regimens for recurrent HSV-2 genital herpes are the following. [1]
- Valacyclovir 500 mg orally twice daily for 3 days. [1]
- Valacyclovir 1 g orally once daily for 5 days. [1]
Common Pitfalls to Avoid
Starting episodic therapy late after the episode progresses reduces clinical benefit because antiviral therapy is recommended at symptom onset. [1] Using suppressive therapy instead of episodic therapy may be more appropriate when recurrence frequency is high, since suppressive therapy reduces recurrences compared with no suppression. [1]
Targets or Goals of Therapy
Episodic therapy aims to partially control signs and symptoms during each recurrent episode. [1] Suppressive therapy aims to reduce the frequency of genital HSV-2 recurrences and may reduce transmission to partners. [1]
Need for Medical Reassessment
Clinical reassessment is indicated for atypical, severe, or non-resolving lesions, or if immunocompromise or antiviral resistance is suspected. [1]