Episodic therapy for genital herpes provides symptomatic relief from the discomfort of individual recurrences. Initial studies of antiviral medications given for 5 days indicated the safety and efficacy of this approach. However, dosing multiple times per day was inconvenient and probably resulted in poor adherence in clinical practice. The observations by Dr. Spruance that antiviral replication is rapidly controlled by the host in oral herpes outbreaks has lead to design of studies that evaluated shorter courses for oral herpes as well as for genital herpes. Currently used short regimens for the episodic therapy of genital herpes include valacyclovir for 3 days, acyclovir for 2 days and famciclovir for 1 day; 1-day valacyclovir has also undergone evaluation. These regimens are safe, effective and convenient to use; their availability may increase the use of antiviral products in public STD clinics that have relied on short therapeutic courses to document adherence. Despite the convenience of this approach to both patients and providers, episodic therapy is unlikely to have a major effect on viral shedding, on transmission to sexual partners, or on natural history of the disease. In addition, in immunocompromised hosts, the use of episodic therapy is associated with emergence of acyclovir-resistance.

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