Recurrent Acyclovir-Resistant Genital Herpes in an Immunocompetent Patient

Abstract

Acyclovir has been widely used over the past decade as an effective and safe drug for the treatment of infections with herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2)¹. Resistance to acyclovir was initially noted only in studies of HSV infection in vitro and in animal models,^2-4 then it was found in immunocompromised patients, and it has now become a well-documented clinical challenge to the care of patients infected with the human immunodeficiency virus (HIV)^4-12. Acyclovir resistance has not been a problem to date in the treatment of immunocompetent people with HSV infection. Although we identified acyclovir-resistant isolates in a study of long-term suppressive treatment for genital herpes in normal hosts and later studies documented occasional shedding of acyclovir-resistant virus by immunocompetent patients before, during, or after therapy, no correlation has been established between such isolates and clinical outcomes^13-17.