How well do antivirals shorten genital herpes pain duration?
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Q: How well do antivirals shorten genital herpes pain duration? Evidence-based answer: Oral and intravenous (IV) acyclovir each shorten the duration of pain for a first primary outbreak of herpes by about 50%; topical acyclovir shortens it by about 25% (strength of recommendation [SOR]: B, small randomized controlled trials [RCTs] with some methodological flaws). Oral valacyclovir and famcyclovir are equivalent to oral acyclovir. Adding topical acyclovir to oral acyclovir doesn't produce additional benefit (SOR: B, RCTs). Patients with severe disease may require IV acyclovir (SOR: C, expert opinion). General treatment measures that may improve patient comfort include keeping lesions clean and dry, avoiding tight clothing, taking analgesics, and using ice packs or taking warm baths (SOR: C, expert opinion). Evidence for using complementary and alternative medicine to treat genital herpes is lacking or conflicting [SOR: C, narrative review of clinical trials].
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