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Thirty-two episodes of herpes simplex virus infection in four immunodeficient patients with frequent recurrences were successfully treated with oral acyclovir, one capsule five times a day for 5 days. In 23 of these episodes, the treatments were extended for 1 to 6 months using two to five capsules a day with the aim of suppressing expected recurrences. In these patients, who routinely had more than one recurrence per month before treatment, there were only six outbreaks during more than 60 patient-months of suppressive therapy. Infection always recurred after treatments were completed, but the time to recurrence was shorter after treatments with two acyclovir capsules per day than after treatments with five capsules per day (p less than 0.001).

Herpes simplex viruses cause common mucocutaneous infections, but many aspects of their epidemiology and transmission are incompletely defined. Although the incidence of oral herpes remains relatively unchanged, the incidence of genital herpes is increasing significantly. Definitive diagnosis of herpes remains dependent on virus isolation, but techniques involving direct examination of clinical specimens are increasingly sensitive and may simplify and speed diagnosis. With the advent of acyclovir, effective therapy and suppression of infection are feasible for immunodeficient and selected normal patients. Unanswered questions remain regarding the long-term safety of acyclovir and the potential for emergence of clinically significant drug resistance. No effective vaccines are yet available for herpes virus infections. Promising strategies for vaccine development include preparation of immunogenic proteins, engineering of specially attenuated live virus strains, and incorporation of selected herpes genes into live vaccinia virus vectors.