Chronic suppression for six months compared with intermittent lesional therapy of recurrent genital herpes using oral acyclovir: effects on lesions and nonlesional prodromes.

Forty-seven patients with frequently recurrent genital herpes were treated with 200 mg of acyclovir or placebo capsules taken orally three times daily for six months; the drug was then withdrawn. Active lesional events were treated with open-labeled 200-mg acyclovir capsules five times daily for five days during the six months of suppression and for six months thereafter if the patient returned to the clinic for culture and treatment. During the six months of treatment, seven of 24 acyclovir recipients and none of 23 placebo recipients reported no lesions (P less than 0.01), while 17 of 24 acyclovir and none of 23 placebo recipients failed to return for lesion assessment (P less than 0.0001). The median time to first recurrence was 72 days in the acyclovir recipients vs. 14 days in placebo recipients (P less than 0.0001). Home-recorded prodromes without lesion development were common in both groups but occurred more often in the acyclovir-treated group (P less than 0.05). During follow-up all patients experienced lesional episodes, and no differences could be detected between the acyclovir- and the placebo-treated groups. Resistance to acyclovir was not encountered either before, during, or after suppression by this drug. Adverse events were not significantly different between the groups. We conclude that suppression by oral acyclovir of frequently recurrent genital herpes remains effective for at least six months. Nonlesional prodromes have undetermined significance but are more common during acyclovir suppression.