When Suppressive Antiviral Therapy Fails to Control Recurrent Genital Herpes

This protocol applies to patients with recurrent genital herpes who are not pregnant and not living with HIV, and whose episodes have remained poorly controlled despite a prior suppressive antiviral regimen.

Clinical Scenario

Recurrent genital herpes in an immunocompetent patient — not pregnant, not living with HIV. Oral antiviral agents are effective at reducing the duration and severity of recurrent episodes, but in this situation the current suppressive approach has not delivered adequate control of recurrence frequency.

Previous Treatment & Why It Was Insufficient

Prior therapy: Suppressive antiviral therapy (oral, dosed daily or twice daily).

Goal not met: Substantial reduction in recurrence frequency — the intended outcome of suppressive therapy — was not achieved, warranting escalation to a next-stage regimen.

Next-Stage Approach (Partial)

For patients whose recurrences remain poorly controlled, a second-stage antiviral regimen is indicated. The specific agents, criteria for selection, and complete dosing details are contained in the full structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

Oral aciclovir, valaciclovir and famciclovir are effective at reducing the duration and severity of recurrent genital herpes.
Second stage therapy for poorly controlled patients.

DOI: 10.1111/jdv.20450

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