Famciclovir reduces viral mucosal shedding in HSV-seropositive persons

Sex Transm Dis. 2007 Nov;34(11):900-7. doi: 10.1097/OLQ.0b013e318063c749.


Objective: Many cases of herpes simplex virus (HSV) infection occur through asymptomatic shedding from persons without evidence of clinical disease. This study explores whether famciclovir reduces HSV shedding in HSV-2 seropositive persons with or without a history of symptomatic genital herpes.

Study design: One hundred twenty-seven HSV-2 seropositive participants were randomly assigned to 42 days of famciclovir, followed by 14 days of washout and 42 days of placebo, or vice versa. All subjects swabbed the genital/perianal area; those with HSV-1 infection also swabbed the oral area daily for HSV DNA PCR.

Results: Famciclovir reduced genital and oral HSV shedding from 11.4% of days during the placebo period to 4.7% of days during famciclovir therapy. The reduction was greater in participants with a history of genital herpes (74%) than in those without such a history (30%). In multivariate analyses, famciclovir protected against total (clinical and subclinical) genital shedding among persons with a clinical history of genital herpes (RR, 0.23; 95% CI, 0.15-0.35; P < 0.001). Among HSV-2 seropositive participants without a history of genital herpes, 60% had HSV detected in the genital area at least once during the study. Famciclovir therapy did not result in a statistically significant reduction in total HSV shedding in participants without a history of genital herpes.

Conclusion: Famciclovir therapy decreases genital HSV shedding in HSV-seropositive persons, especially those with a history of genital herpes. Overall, antiviral drugs may have varying effects on symptomatic and asymptomatic viral shedding, depending on the clinical history of the disease.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 2-Aminopurine / administration & dosage
  • 2-Aminopurine / analogs & derivatives*
  • 2-Aminopurine / pharmacology
  • 2-Aminopurine / therapeutic use
  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / pharmacology
  • Antiviral Agents / therapeutic use*
  • Cross-Over Studies
  • DNA, Viral / analysis
  • Double-Blind Method
  • Famciclovir
  • Female
  • Herpes Genitalis / blood
  • Herpes Genitalis / drug therapy*
  • Herpes Genitalis / virology*
  • Herpesvirus 2, Human*
  • Humans
  • Male
  • Middle Aged
  • Mucous Membrane / virology
  • Polymerase Chain Reaction
  • Treatment Outcome
  • Virus Shedding / drug effects
  • Washington


  • Antiviral Agents
  • DNA, Viral
  • 2-Aminopurine
  • Famciclovir