What are the drugs of choice for treatment of HSV?

There are three systemic antiviral agents routinely used for the treatment of HSV: acyclovir, valacyclovir, and famciclovir (Table 25-1). Valacyclovir is the L-valyl ester of acyclovir with a bioavailability 3 to 5 times greater than acyclovir. Famciclovir is the diacetyl-6-deoxy analog of penciclovir. It is well absorbed and has a long intracellular half-life. Both valacyclovir and famciclovir offer the advantage of less frequent dosing compared to acyclovir. All three drugs are generally safe and highly effective because of their very specific antiviral activity. The antiviral drug is preferentially taken up by infected cells, where it must be converted to its active form by the viral enzyme thymidine kinase. The active form preferentially inhibits viral DNA synthesis, with little impact on host cell metabolism.

Cernik C, Gallina K, Brodell RT: The treatment of herpes simplex infections: an evidence-based review, Arch Intern Med 168: 1137–1144, 2008.