Antivirals are used for both genital and non-genital recurrences
The mainstay of treatment for HSV is antiviral therapy with acyclovir. Famciclovir and valacyclovir can be used as well (TABLE).11 These antivirals inhibit viral DNA replication, shorten duration of symptoms, increase lesion healing, and decrease viral shedding time.12 They are generally safe; the main adverse effects of oral therapy are nausea, vomiting, and diarrhea.
In general, non-genital recurrences of HSV are treated the same as genital recurrences.13 Dosing during prodromal symptoms, or at the first sign of a recurrence is recommended for maximum efficacy.13 Suppressive therapy can be effective in patients who experience frequent recurrences and is generally recommended for 6 months to a year or longer.
Patients should also be warned that because of increased genital viral shedding during sacral recurrences, they should avoid sexual contact during outbreaks.14
Our patient began taking oral valacyclovir 1 g daily and had no recurrences over the next year.
CORRESPONDENCE
Robert T. Brodell, MD, Department of Dermatology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216; rbrodell@umc.edu