title: Valacyclovir and acyclovir for suppression of shedding of herpes simplex virus in the genital tract.
abstract: BACKGROUND
  Valacyclovir exhibits better oral absorption and higher, more prolonged serum concentrations than oral acyclovir. The efficacy of valacyclovir and acyclovir on genital herpes simplex virus (HSV) shedding was assessed in a double-blind, 3-period crossover trial.
  
  
  METHODS
  Sixty-nine immunocompetent participants with genital HSV-2 received oral valacyclovir, acyclovir, and matching placebo in random order for 7-week periods. Participants provided daily genital mucosal swabs for HSV detection by viral culture and polymerase chain reaction (PCR).
  
  
  RESULTS
  HSV was detected at least once in 62 (90%) participants by culture and in 68 (98%) by PCR. During placebo, the total HSV shedding rate was 15.4% of days by culture (PCR, 40.2%); the subclinical shedding rate was 6.6% by culture (PCR, 27.1%). Both antivirals were associated with lower HSV shedding by culture (relative risk [RR], 0.03 [95% confidence interval [CI], 0.01-0.07] for valacyclovir and RR, 0.05 [95% CI, 0.03-0.10] for acyclovir) and PCR (RR, 0.18 [95% CI, 0.12-0.26] for valacyclovir and RR, 0.20 [95% CI, 0.15-0.28] for acyclovir), compared with placebo. No significant differences in frequency and quantity of HSV were detected by PCR between the valacyclovir and acyclovir arms.
  
  
  CONCLUSIONS
  Although the suppression of viral replication is not complete, valacyclovir and acyclovir are highly effective in suppressing the frequency and quantity of genital HSV shedding.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington 98122, USA. rachnag@u.washington.edu.
authors.forename: Rachna
authors.initials: R
authors.lastname: Gupta
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Krantz
authors.forename: Stacy
authors.initials: S
authors.lastname: Selke
authors.forename: Terri
authors.initials: T
authors.lastname: Warren
authors.forename: Mauricio
authors.initials: M
authors.lastname: Vargas-Cortes
authors.forename: Gerri
authors.initials: G
authors.lastname: Miller
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000032:analysis; D004311:Double-Blind Method; D005260:Female; D005835:Genitalia / Q000821:virology*; D006558:Herpes Genitalis / Q000188:drug therapy* / Q000821:virology; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000821:virology; D016896:Treatment Outcome; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D017201:Virus Shedding / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir