What antiviral treatments are effective for managing acute genital herpes outbreaks?

Effective antiviral treatments for managing acute outbreaks of genital herpes include oral aciclovir, valaciclovir, and famciclovir. These oral antivirals should be started within 5 days of the onset of the first episode or while new lesions are forming to maximize efficacy. First-line treatment options in primary care are aciclovir 400 mg three times daily for 5 days, or valaciclovir 500 mg twice daily for 5 days. Second-line options include aciclovir 200 mg five times daily for 5 days or famciclovir 250 mg three times daily for 5 days. Treatment duration may be extended up to 10 days if new lesions appear or healing is incomplete. For immunocompromised individuals or those with untreated HIV infection, higher doses and longer courses are recommended, such as aciclovir 400 mg five times daily for 7–10 days, valaciclovir 500–1000 mg twice daily for 10 days, or famciclovir 250–500 mg three times daily for 10 days. If new lesions continue to develop after 3–5 days of treatment, specialist advice should be sought. Topical antiviral treatments are not recommended as they are less effective than oral therapy and do not reduce transmission or recurrence rates. Episodic short-course oral antiviral regimens are preferred for recurrent episodes, with options including aciclovir 800 mg three times daily for 2 days, famciclovir 1000 mg twice daily for 1 day, or valaciclovir 500 mg twice daily for 3 days, offering convenience and cost-effectiveness. These oral antivirals reduce the duration and severity of episodes and suppress viral shedding, improving quality of life and reducing anxiety about recurrences. Self-initiated treatment within 24 hours of prodromal symptoms or lesion onset is likely to be effective. Overall, oral aciclovir, valaciclovir, and famciclovir are the mainstay of acute genital herpes management, with dosing tailored to episode severity and patient immune status NICE CKS Kinghorn 1993Conant et al. 1996Tyring 1998.