Early valacyclovir may suppress genital herpes.(News)

PHILADELPHIA -- Early valacyclovir suppressive therapy, given within 60-120 days of initial infection, effectively reduces genital herpes recurrences and improves patients' psychological adjustment, according to results of a pilot study.

"Suppressive therapy has been previously studied in patients who have had genital herpes for a year or more. However, we know that the first year is the time of me most out breaks, so, in our study, we started therapy in patients soon after their initial infection," Terri Warren said at a meeting on STD prevention sponsored by the Centers for Disease Control and Prevention.

In the double blind, randomized trial of 75 heterosexual men and women with confirmed genital herpes simplex virus type 2 (HSV-2), 47% of the 38 valacyclovir treated patients remained free of outbreaks for up to 6 months, compared with 27% of 59 controls who received placebo. The mean number of outbreaks for treated patients was 0.9 vs. 2 for controls.

"Primary care physicians are reluctant to start patients on suppressive therapy, perhaps because herpes is perceived as a trivial condition in comparison with diabetes or cardiovascular disease." But the study findings raise the question: "Why make people have outbreaks before you help them--especially within the first year of infection?" asked Ms. Warren, a nurse-practitioner and owner of the Westwood Clinic, Portland, Ore. Ms. Warren served as coprincipal investigator of the study with Dr. Hunter Handsfield of the University of Washington, Seattle.

Ms. Warren also noted that the greatest amount of viral shedding and psychological distress occur in the first year of having herpes.

"The old theory about suppressive therapy was that you needed a certain number of outbreaks before you should initiate therapy. The new theory is that patients who are HSV positive have amounts of viral shedding equal to patients with recognized, recurrent outbreaks. Thus, you don't need to have a patient with out breaks to use suppressive therapy and reduce shedding," she said.

Ms. Warren acknowledged the current pilot study did not gather data on sub-clinical shedding. Furthermore, patients on suppressive therapy should be counseled that their partners may not be protected against transmission.