When is chronic suppressive therapy indicated?

Once an episode of recurrent HSV infection (whether oral or genital) has begun, initiation of antiviral therapy often provides only mild symptomatic improvement. If antiviral therapy is initiated during the prodromal phase, the response may be somewhat better. In patients with frequently recurrent or severe disease, especially with genital herpes, chronic suppressive therapy may be considered. After 1 year on therapy, a “drug holiday” may be given to assess the continued need for treatment, since the natural history of recurrent infection is to decrease in frequency with time.