Single-day treatment for orolabial and genital herpes: a brief review of pathogenesis and pharmacology

Sapna Modi¹, Livia Van¹, Aron Gewirtzman², Natalia Mendoza², Brenda Bartlett², Anne Marie Tremaine², Stephen Tyring³

¹Baylor College of Medicine, Houston, TX, USA; ²Center for Clinical Studies, Houston, TX, USA; ³Department of Dermatology, University of Texas Health Science Center, Houston, TX, USA

Abstract: Herpes simplex virus (HSV) infection is a highly prevalent condition responsible for significant morbidity and occasional mortality each year. Approximately half of all patients infected by HSV will experience at least one recurrence in their lifetime. For these recurrences, traditional therapy has included both suppressive and episodic treatment with nucleoside analogs. In regards to episodic treatment, 2- to 5-day oral regimens are best studied and most commonly reported. As with any medical condition having a well-understood mechanism of action and targeted treatment, therapeutic intervention is only as effective as allowed by patient compliance. Based on these concerns, recent studies have focused on shorter, less complicated, and more affordable options. This review delineates the evidence for single-day treatments of orolabial and genital herpes. Randomized, double-blind studies of both valacyclovir and famciclovir as single-day episodic therapy for HSV have been reported in the literature. Although no head-to-head studies between the drugs have been performed, both regimens produced significant improvement in healing time and symptom resolution over placebo. Single-day therapy for HSV infection is appealing for multiple reasons. First, it simplifies the regimen, increasing likelihood of patient compliance. Additionally, it allows complete delivery of the medication at the onset of symptoms, when viral replication is highest and intervention has greatest effect. Lastly, the reduced number of pills necessary for single versus multiple day therapy decreases the overall cost of treatment per episode, an important factor in modern-day healthcare.

Keywords: famciclovir, genital herpes, orolabial herpes, patient-initiated episodic therapy, single-day, antiviral