Suppressive antiviral therapy for genital herpes

Suppressive antiviral therapy for genital herpes simplex virus (HSV) infection reduces viral shedding, which decreases recurrences by 70 to 80% and halves the rate of transmission. Suppressive therapy is beneficial for patients experiencing several recurrences per year, when a recurrence would be particularly inconvenient, and during late pregnancy.

For suppressive antiviral therapy for genital herpes in nonpregnant patients and pregnant patients before 36 weeks gestation, useOng, 2023Workowski, 2021:

Suppressive antiviral therapy for genital herpes may be continuous, or interrupted at 6-monthly intervals to determine the need for ongoing therapy – recurrences usually become less frequent and less severe with time. Advise patients that recurrences may occur after stopping therapy; ensure patients planning to interrupt suppressive therapy can start episodic therapy if required. Suppressive therapy can be restarted if patients have frequent recurrences. Reassure patients that long-term suppressive antiviral therapy is safe.

For patients with recurrences of genital herpes despite suppressive antiviral therapy, review the diagnosis. If the diagnosis of genital herpes is confirmed, a higher dosage of suppressive antiviral therapy may be required; a reasonable regimen isOng, 2023Workowski, 2021:

Seek expert advice for patients with immune compromise who have frequent, severe recurrences of genital herpes, or for patients who are immunocompetent with proven recurrence despite a higher dosage of suppressive antiviral therapy – resistant HSV is a possibility.