Background:
Genital herpes (GH) due to HSV-2 is the most prevalent sexually transmitted infection (STI), affecting about 45 million Americans. STD and other health department clinics have focused principally on bacterial STIs. Recently, better understanding of the high incidence and prevalence of HSV-2 in patients attending STD clinics, combined with accurate HSV-2 antibody testing, as well as the significant role of HSV-2 as a facilitator of HIV transmission, has raised interest in improving GH management.

Objective:
To assess the efficacy of single-day famciclovir in patients with recurrent GH, including aborted lesion rates, and to highlight the importance of these data to public health systems.

Method:
Patients with recurrent genital herpes were enrolled in a multicenter, multinational, randomized, double-blind, placebo-controlled study comparing single-day famciclovir (1000 mg bid; n=163) with placebo (n=166). Patients initiated famciclovir treatment within 6 hours of prodromal symptom onset. Healing was defined as loss of crusts and reepithelialization of lesions. Aborted lesions were those not progressing beyond papule stage.

Result:
Lesion healing time decreased (P< .001) in famciclovir-treated versus placebo-treated patients (median time, days) for both nonaborted lesions (4.3 vs 6.1) and all lesions (3.5 vs 5.0). Famciclovir almost doubled the proportion of patients with aborted lesions versus the placebo group (23.3% vs 12.7%; P= .003). Adverse events were infrequent in both groups.

Conclusion:
Single-day famciclovir therapy represents well-tolerated, efficacious treatment for recurrent GH. If taken early in the course of an outbreak, almost one quarter of patients can avoid subsequent painful vesicles and ulcers.

Implications:
Single-day therapy for recurrent GH represents an opportunity to improve drug compliance and simplify the patient-education messages required for existing multi-day treatment regimens. In addition, the first of two doses can be directly administered in the clinic, and patients can receive reinforcement for the importance of initiating treatment at the first sign or symptom of a subsequent outbreak.