Condition

Genital Herpes

Viral sexually transmitted infection causing sores

846.1M
People Affected
2
Active Trials
42.4M
New Cases/Year
1,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Valacyclovir
88% Effectiveness• 95% Confidence• 77% Safety• 33 trials• 40K participants
HIGH EvidenceExcellent ValueDose: Episodic: 1g 2x/day for 1 day; Suppressive: 500mg-1g 1x/day
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
77
DangerousModerateSafe

Time to Effect

Days to weeks

Duration

Episodic: 1-3 days; Suppressive: 6-12 months to indefinite

Response Rate

85%

Remission Rate

70%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

500

Common Side Effects:

Headache: 30%
Nausea: 10%
Abdominal pain: 5%
Diarrhea: 5%

Annual Cost of Care

Drug Cost

$350

Monitoring

$150

Side Effects

$50

Total Annual

$550

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.06

ICER

$15,000/QALY

Cost per Remission

$786

Cost per Responder

$647

Treatment Outcomes
Primary Outcomes
Duration of Recurrent Genital Herpes Episode (lesion healing)4.5 days
-33.3% (-1.5 days)
Time to Complete Lesion Healing (scabbing/crusting)7.5 days
-26.7% (-2 days)
Duration of Herpes-Associated Pain6 days
-33.3% (-2 days)
Annual Genital Herpes Recurrence Rate (for suppressive therapy)5 outbreaks/year
-70% (-3.5 outbreaks/year)
Secondary Benefits
Severity of Symptoms (e.g., itching, burning, tingling)Moderate (average score 5/10 on Symptom Severity Scale)
-30% (-1.5 points)
Herpes-Related Quality of Life ScoreHRQoL score: 60/100 (lower score indicates worse QoL)
+16.7% (+10 points)
Frequency of Asymptomatic Genital Viral Shedding (days with shedding)30% of days
-60% (-18 percentage points)
Common Side Effects
Headache
+30%
Nausea
+10%
Abdominal pain
+5%

Clinical Trial Phases:

Phase 4
2
Famciclovir
87% Effectiveness• 95% Confidence• 76% Safety• 7 trials• 35K participants
HIGH EvidenceExcellent ValueDose: Episodic: 1g 2x/day for 1 day; Suppressive: 250mg 2x/day
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
76
DangerousModerateSafe

Time to Effect

Days to weeks

Duration

Episodic: 1 day; Suppressive: 6-12 months to indefinite

Response Rate

80%

Remission Rate

65%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

500

Common Side Effects:

Headache: 20%
Nausea: 8%
Diarrhea: 4%

Annual Cost of Care

Drug Cost

$320

Monitoring

$150

Side Effects

$50

Total Annual

$520

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.055

ICER

$16,000/QALY

Cost per Remission

$800

Cost per Responder

$650

Treatment Outcomes
Primary Outcomes
Time to Healing of All Lesions (Recurrent Genital Herpes)6.5 days
-31% (-2.0 days)
Duration of Associated Lesion Pain (Recurrent Genital Herpes)4.5 days
-33% (-1.5 days)
Time to Cessation of Viral Shedding (Recurrent Genital Herpes)4.0 days
-25% (-1.0 day)
Secondary Benefits
Overall Symptom Severity (Patient Global Assessment, 0-10 scale)6.5/10 points
-30% (-2.0 points)
Impairment of Daily Activities (Patient-reported, 0-10 scale)6.0/10 points
-25% (-1.5 points)
Time to Resolution of Prodromal Symptoms (e.g., itching, tingling)2.0 days
-25% (-0.5 days)
Common Side Effects
Headache
+20%
Nausea
+8%
Diarrhea
+4%

Clinical Trial Phases:

Phase 4
3
Acyclovir
85% Effectiveness• 95% Confidence• 78% Safety• 59 trials• 60K participants
HIGH EvidenceExcellent ValueDose: Episodic: 200mg 5x/day or 400mg 3x/day; Suppressive: 400mg 2x/day
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
78
DangerousModerateSafe

Time to Effect

Days to weeks

Duration

Episodic: 5-10 days; Suppressive: 6-12 months to indefinite

Response Rate

80%

Remission Rate

60%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

500

Common Side Effects:

Headache: 15%
Nausea: 10%
Diarrhea: 5%
Vomiting: 3%

Annual Cost of Care

Drug Cost

$300

Monitoring

$150

Side Effects

$50

Total Annual

$500

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

ICER

$10,000/QALY

Cost per Remission

$833

Cost per Responder

$625

Treatment Outcomes
Primary Outcomes
Healing time of genital lesions7 days (recurrent episode)
-43% (-3 days)
Duration of pain4 days (recurrent episode)
-40% (-1.6 days)
Duration of viral shedding4 days (recurrent episode)
-50% (-2 days)
Frequency of genital herpes recurrences6 outbreaks/year
-75% (-4.5 outbreaks/year)
Secondary Benefits
Time to complete crusting of lesions5 days (recurrent episode)
-30% (-1.5 days)
Severity of overall local symptoms2.5 (0=none, 3=severe, mean score)
-40% (-1.0 points)
Number of lesions per outbreak4 lesions (recurrent episode)
-30% (-1.2 lesions)
Common Side Effects
Headache
+15%
Nausea
+10%
Diarrhea
+5%

Clinical Trial Phases:

Phase 4
4
Penciclovir Cream
40% Effectiveness• 75% Confidence• 85% Safety• 30 trials• 3K participants
MODERATE EvidencePoor ValueDose: Apply every 2 hours while awake for 4 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
85
DangerousModerateSafe

Time to Effect

Hours to days

Duration

4 days

Response Rate

65%

Remission Rate

%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

1000

Common Side Effects:

Application site reactions (stinging, burning): 3%

Annual Cost of Care

Drug Cost

$150

Monitoring

$500

Side Effects

$0

Total Annual

$650

Cost-Effectiveness

POOR

QALYs Gained

0.001

ICER

$180,000/QALY

Cost per Responder

$230

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+40%
Response Rate
+65%
Common Side Effects
Application site reactions (stinging, burning)
+3%

Clinical Trial Phases:

Phase 4