Episodic:

 
Episodic therapy MUST be commenced within 24 hours of symptom onset.

• Aciclovir 400mg tds for 5 days
• Aciclovir 800mg tds for 2 days
• Famciclovir 500mg stat followed by 250mg bd for 3 doses (total 1250mg)
• Valaciclovir 500mg bd for 3 days

Suppressive:

• Aciclovir 400 mg bd
• Famciclovir 250 mg bd
• Valaciclovir 500 mg once daily*

* in patients who have frequent recurrences (10 or more per year) once daily therapy may be insufficient. These patients may require twice daily therapy as 500mg bd.

Education and counseling may be useful for psychosocial effects of reactivation and reccurrences

Note: Patients with culture-proven genital herpes who have > 6 episodes annually are likely to experience substantial reduction in frequency of outbreaks on suppressive therapy
All patients should be given information on advantages and disadvantages of suppressive therapy the context of their overall clinical care.

Treatment may be interrupted at 6 months to evaluate natural history. A single episode after stopping suppressive therapy is not necessarily an indication for recommencement of therapy.