I would like to offer the following in response to the letter by Dr Slade et al. The purpose of my article was to report the success I had in using imiquimod to treat a patientwith human immunodeficiency virus and a chronic herpetic ulcer that did not respond to acyclovir, valacyclovir hydrochloride, and famciclovir. I was not using imiquimod to influence the number of future outbreaks of herpes. Since publication of the article, 3 patients with foscarnet-unresponsive herpes simplex virus 2 infections of the penis were treated with imiquimod. As soon as the lesions began to respond (healing of the ulcer) to the imiquimod, the reintroduction of 1 g of valacyclovir hydrochloride (twice daily) was instituted. The lesions on all the patients completely cleared within 3 weeks of beginning the imiquimod treatment. All the patients continued taking 500 mg of valacyclovir hydrochloride twice daily. Interestingly, none of the 3 patients complained of pain or discontinued application of imiquimod. With the recognized toxic effects of intravenous foscarnet, I am using topical imiquimod and valacyclovir for patients who have acyclovir-resistant herpes simplex virus.
Gilbert J. Imiquimod and Genital Herpes—Reply. Arch Dermatol. 2002;138(4):534-535. doi:10.1001/archderm.138.4.533