The effectiveness of valacyclovir in preventing reactivation of herpes gladiatorum in wrestlers

Objective: To determine whether nucleoside analogues can suppress recurrent outbreaks of herpes simplex virus type 1 (HSV-1) in wrestlers, commonly called herpes gladiatorum. Design: Double-blind and open study using valacyclovir over two wrestling seasons from 1996 through 1998. Setting: Wrestling community in the Minneapolis-St. Paul area of Minnesota. Participants: Volunteer sample of 42 male wrestlers from 13 to 31 years of age. For inclusion, patients had to have recurrent herpes gladiatorum and be active in a wrestling program. Intervention: Participants were treated during the first half of the season in a double-blind study using valacyclovir 500 mg a day, and in the second half as an open study with all wrestlers using valacyclovir 1,000 mg. Main Outcome Measures: Outbreak of herpes gladiatorum based on clinical appearance or culture. Results: Participants were divided into two groups based on time interval since primary outbreak of herpes gladiatorum: less than 2 years or more than 2 years. For patients in whom primary outbreak was less than 2 years ago, outbreaks occurred in 21% (3/14) of those receiving valacyclovir 500 mg per day and 8% (2/25) of those receiving valacyclovir 1,000 mg per day. For patients in whom primary outbreak was more than 2 years ago, outbreaks occurred in 0% (0/7) of those receiving valacyclovir 500 mg per day and 0% (0/12) of those receiving valacyclovir 1,000 mg per day. Conclusion: For patients with a history of herpes gladiatorum of more than 2 years, valacyclovir 500 mg daily suppresses recurrent outbreaks. Further studies need to be performed to determine proper dosing regimen for suppression of outbreaks in patients with a disease duration of less than 2 years.