Recurrent genital herpes: using the ciclovirs to best effect

It is rare for a class of drugs to continue to do well over the long term. Yet the commonly available antiviral ciclovirs (aciclovir, valaciclovir [Valtrex] and famciclovir [Famvir]) have stood the test of time. No untoward side effects or evidence of cumulative toxicity have become apparent after up to 20 years of use. Resistance of herpes simplex virus (HSV) to the ciclovirs is effectively limited to infection in patients who are severely immunocompromised, and is rare even in that setting. In practice, the failure of lesions to respond to oral ciclovir therapy is a strong indication that the lesions are not due to HSV infection. Recent advances in treatment regimens have improved patient acceptability, including the option of single-day episodic therapy. In addition, suppressive ciclovir therapy has been shown to reduce HSV transmission.