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January 15, 1997

Famciclovir for Genital Herpes-Reply

Author Affiliations

University of British Columbia Vancouver
University of Manitoba Winnipeg
Children's Hospital of Eastern Ontario Ottawa
McMaster University Hamilton, Ontario
University of Alberta Edmonton

JAMA. 1997;277(3):210-211. doi:10.1001/jama.1997.03540270036016

In Reply.  —Dr Goldman raises important aspects of episodic therapy for genital herpes. We have previously identified the high background frequency of completely nonlesional episodes without treatment1 and have found it to be quite variable, ranging as high as 40%2 depending on study design. Therefore, interpretation of aborted episode results must be undertaken carefully.Dr Goldman defines aborted episodes in his letter as avoidance of vesicular and ulcerative lesions, a definition stemming from the study by Spruance et al3 that compared high-dose and low-dose valacyclovir hydrochloride with placebo. This definition allows for macule/papule/edema formation within the definition of "aborted" and does not address the issue of viral shedding or possible transmission from these nonvesicular lesions. In fact, only about half of the nonvesicular episodes were truly nonlesional. Because this observation is clinically linked with lesion healing, corrections for multiple comparisons (eg, the Bonferroni correction) seem especially important.To demonstrate