Presented by: Simon Barton. Chelsea and Westminster Hospital, London, UK.

Evidence-based reviews and clinical guidelines of antiviral therapy in the treatment of genital herpes do not differentiate between the efficacy of different antiviral drugs. Studies of famciclovir and valaciclovir have shown these to provide clinical and virological benefit significantly better than placebo, and similar to aciclovir in efficacy. Although suggestions have been made that there may be differential effects (e.g. due to longer intracellular half-lives), or the irreversible effect on DNA chains, no studies have shown these hypotheses to be more than theoretical differences. However, a recently published study by Wald et al.1 has presented data on the comparison of the clinical and virological effects of famciclovir and valaciclovir as daily suppressive therapy in patients with recurrent genital herpes. This study has reported a significant difference between the two drugs with respect to the time to the first virologically confirmed recurrence, and in the percentage of days on which viral shedding occurred. The results of this study and its implications for current practice and future research will be discussed.

Reference
1. Wald A, Selke S, Warren T, Aoki FY, Sacks S, Diaz-Mitoma F et al. Sex Transm Dis 2006;33:529–533.