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Stephen L. Sacks, MD, FRCPC
University of British Columbia Vancouver

Fred Y. Oaki, MD
University of Manitoba Winnipeg

Francisco Diaz-Mitoma
Children's Hospital of Eastern Ontario Ottawa

John Sellors, MD
McMaster University Hamilton, Ontario

Stephen D. Shafran, MD
University of Alberta Edmonton

JAMA. 1997;277(3):210-211.

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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 . . . [Full Text PDF of this Article]

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