A meta-analysis to assess the efficacy of oral antiviral treatment to prevent genital herpes outbreaks

J Am Acad Dermatol. 2007 Aug;57(2):238-46. doi: 10.1016/j.jaad.2007.02.008. Epub 2007 Apr 9.


Background: Efficacy of oral antiviral therapies, ie, acyclovir, valacyclovir (VACV), and famciclovir, for suppression of recurrent genital herpes was studied at different doses and regimens.

Objective: We sought to compare the clinical efficacies of the different oral antiviral drugs prescribed prophylactically to suppress recurrent genital herpes.

Methods: MEDLINE and EMBASE databases were searched for articles on genital herpes and selected antiviral drugs. The selected trials were: parallel randomized clinical trials testing prophylactic oral antiviral treatment of genital herpes versus placebo in immunocompetent and nonpregnant patients.

Results: Fourteen randomized clinical trials were selected, including a total of 6158 patients. The global relative risk of developing at least one recurrence during the study was reduced by 47% (95% confidence interval 45%-49%) in antiviral drug groups compared with the placebo. The best evaluated regimens, with comparable efficacies, were given twice daily, ie, acyclovir (400 mg twice daily), VACV (250 mg twice daily), and famciclovir (250 mg twice daily), or once daily (VACV 500 mg).

Limitations: The only end point available for all the studies was the number of patients presenting at least one recurrence of genital herpes during the observation period.

Conclusion: The results of this first meta-analysis confirmed the high clinical efficacy of oral acyclovir, VACV, or famciclovir for prophylaxis against recurrent genital herpes.

Publication types

  • Meta-Analysis

MeSH terms

  • 2-Aminopurine / administration & dosage
  • 2-Aminopurine / analogs & derivatives*
  • 2-Aminopurine / therapeutic use
  • Acyclovir / administration & dosage*
  • Acyclovir / analogs & derivatives*
  • Acyclovir / therapeutic use
  • Administration, Oral
  • Antiviral Agents / administration & dosage*
  • Antiviral Agents / therapeutic use
  • Disease Outbreaks*
  • Drug Administration Schedule
  • Famciclovir
  • Herpes Genitalis / drug therapy*
  • Herpes Genitalis / epidemiology
  • Humans
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Risk
  • Treatment Outcome
  • Valacyclovir
  • Valine / administration & dosage
  • Valine / analogs & derivatives*
  • Valine / therapeutic use


  • Antiviral Agents
  • 2-Aminopurine
  • Valine
  • Valacyclovir
  • Famciclovir
  • Acyclovir