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Evidence summaries

Antiviral Treatment for the First Episode of Genital Herpes

Systemic antiviral therapy appears to be effective for shortening symptoms of the first episode of genital herpes compared with placebo, but it appears not to postpone recurrence. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study limitations (unclear risk of bias).

Systemic antiviral therapy is recommended for the first episode of genital herpes.

The recommendation is strong because shortening the duration symptoms, which may be severe, is important for a large majority of patients, and adverse effects are very uncommon. The cost of treatment is low.

A Cochrane review [Abstract] 1 included 26 studies with a total of 2084 men and women experiencing their first episode of genital herpes. Oral acyclovir, when compared to placebo, reduced the duration of symptoms (mean difference (MD) -3.22, 95% CI -5.91 to -0.54; 2 trials, I²=52%). Oral valacyclovir showed a similar length of symptom duration when compared to acyclovir in two studies. Two studies reported no evidence of a reduction in the number of median days to recurrence following treatment with oral acyclovir versus placebo.

    References

    • Heslop R, Roberts H, Flower D et al. Interventions for men and women with their first episode of genital herpes. Cochrane Database Syst Rev 2016;(8):CD010684. [PubMed]

Primary/Secondary Keywords