suppressive antiviral medication should be counseled that they may still transmit HSV to their sexual partners.

may be satisfied with a reduction to 1 or 2 recurrences per year, and this reduction may be accomplished in some patients with a once-daily dose. Regardless of the competitive marketplace for “me too” drugs, the long-term suppressive antiviral agents have offered insights into the pathogenesis of HSV recurrences. The dose-response relationship observed in a study population suggests that a threshold level of nucleoside analog must be present in latently infected cells at the critical time of HSV reactivation. Once viral thymidine kinase is synthesized, the drug is activated, viral replication is diminished, and clinical disease is aborted. Despite what pharmaceutical companies promote, the nucleotide (activated triphosphate) intracellular half-life may not be relevant for suppression of recurrences. 4,6 Patients may still shed infectious virus asymptomatically while receiving suppressive therapy indicating that the threshold nucleoside level necessary for clinical suppression does not completely shut down viral replication. 9 Importantly, patients receiving