In case of doubt, follow up and wait for the viral culture. At present, there is no curative treatment available for genital herpes. Acyclovir - After absorption, the drug is phosphorylated to acyclovir triphosphate which is an inhibitor of virus DNA polymerase. The latter is essential to DNA synthesis. The first step of the phosphorlation requires virus specific enzyme thymidine kinase which is only present in infected cells.
Oral treatment is superior to topical.
A more convenient regime is to give 400 mg bd. Treatment should be stopped after 6-12 months for reassessment of disease activity. Since the drug is quite expensive, cost has to be considered. The drug is usually reserved for patients with severe attacks or patients who are immunocompromised. The mechanism of action is very similar to that of acyclovir.