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Three oral antiviral medications are approved to treat genital herpes simplex virus infections: acyclovir, famciclovir, and valacyclovir. The drugs are equally effective and well tolerated, with rare side effects consisting mainly of mild headache or nausea. That makes cost and convenience important in choosing among them.
For recurrent episodes, educate patients to start therapy within 1 day of lesion onset of during the prodrome that precedes some outbreaks, or to consider chronic suppressive therapy. Suppressive therapy reduces the frequency of genital herpes recurrences by 80% in patients with six of more outbreaks per year. Rather than recommending suppressive therapy on the basis of the number of HSV recurrences per year, talk to patients about their concerns and preferences. Even a few outbreaks can be psychologically distressing to some patients. In general, suppressive therapy is underused. Reevaluate suppressive therapy after 1 year, because recurrences tend to decrease over time. Suppressive therapy also cuts the risk of transmission by about hall, based on recent study results.
Treat HSV-related pain with …