SOURCE: Sands-Lincoln M, Goldmann DR. Antiviral drugs to prevent clinical recurrence in patients with genital herpes. Am J Med 2016;129:1264-1266.
For now, herpes has outsmarted us. Antivirals can reduce the duration of acute attacks, decrease the number of days of viral shedding, and reduce the frequency of recurrences, but they do not eradicate the latent virus or alter the the natural course of disease. Once antiviral treatment ends, the frequency and severity of attacks resumes unaltered.
However, the good news is that the three currently approved antivirals (acyclovir, famciclovir, valacyclovir) can produce a major, albeit imperfect, effect on recurrences when administered daily as prophylaxis. The literature suggests recurrences can be reduced by as much as 70-80% in patients presenting with frequent recurrences.
Long-term data (one to six years) support the safety and efficacy of the antivirals, each of which has demonstrated similar benefit.
In the absence of head-to-head clinical trials, no substantial differences in efficacy or tolerability among the three potential treatments has been demonstrated.
Our experience with antivirals against influenza has taught us that problematic levels of resistance can occur quickly, but similar trends for genital herpes have not been observed.