Treatment to prevent recurrent genital herpes

Purpose of review Genital herpes is the leading cause of genital ulcer disease worldwide and is among the most common sexually transmitted diseases. Recurrent genital herpes is associated with major medical and psychosocial morbidities; therefore, suppressive therapy is required, especially in patients with frequent and/or severe episodes. Recent findings A recent meta-analysis evaluated prophylactic regimens in immunocompetent hosts, and proposed four alternatives with similar efficacies: three twice-daily regimens (i.e. acyclovir 400 mg, valaciclovir 250 mg and famciclovir 250 mg) and one once-daily regimen (valaciclovir 500 mg). Immunocompromised patients may have more prolonged, frequent and severe episodes of genital herpes. Valaciclovir 500 mg twice daily maintains the benefits of acyclovir treatment in terms of clinical efficacy and safety. Alternative therapies in case of clinical failure are discussed. Development of new strategies is moving in three directions: improvement in antiviral therapy or identification of new drug targets; local immune therapy; and vaccination. Many prophylactic and therapeutic vaccination approaches have been explored, but no effective vaccine is presently available. Summary In 2007 control of herpes recurrence remains an important goal because of the impact it has on the quality of life of millions of people and its relationship with transmission of other sexually transmitted diseases, especially HIV infection.