For the treatment of immunocompetent subjects acyclovir only plays a minor role. Herpes simplex: For genital primary infections, oral acyclovir entails a considerably faster healing rate than a placebo or an acyclovir ointment. For herpes simplex keratitis, local or oral therapy is successful. Herpes simplex encephalitis and herpes simplex neonatorum must be treated intravenously. Patients with frequently relapsing herpes simplex (labial or genital) benefit from long-term, prophylactic acyclovir administration. However, treatment of an isolated (labial or genital) herpes relapse is not indicated.

The effect of acyclovir against most forms of the varicella-zoster disease is marginal. A herpes zoster of the cornea should be treated as early as possible with high doses of acyclovir. Acyclovir only brings limited benefit for zosters (and varicella) in other localisations. Specialists do not agree on its advantages as far as post-herpetic neuralgias are concerned.

The case is different for immunocompromised subjects (chemotherapy, HIV infection, lymphoma) whose herpes simplex and varicella-zoster infections should all be treated with oral or parenteral acyclovir.

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