Is it meaningful to treat patients with recurrent herpetic infections?

The introduction of acyclovir a safe and efficacious antiviral agent has revolutionised the treatment of recurrent orolabial and genital herpes. The treatment of each recurrence with topical or oral acyclovir is of limited benefit. However, long term suppression with oral acyclovir is highly effective. Patients should be considered for therapy on the basis of the frequency and severity of recurrence, and any associated psychosexual morbidity. Treatment should be commenced at a dose of 200 mg qds. Subsequent reduction in dose may be possible. Treatment should continue for 1 year then be stopped in order to ascertain if the frequency of recurrence still warrants suppression. The reasons for failure to respond to long term suppression or relapse include malabsorption and the emergence of drug resistant strains.