ObjectiveTo determine whether nucleoside analogues can suppress recurrent outbreaks of herpes simplex virus type 1 (HSV-1) in wrestlers, commonly called herpes gladiatorum.DesignDouble-blind and open study using valacyclovir over two wrestling seasons from 1996 through 1998.SettingWrestling community in the Minneapolis-St. Paul area of Minnesota.ParticipantsVolunteer 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.InterventionParticipants 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 MeasuresOutbreak of herpes gladiatorum based on clinical appearance or culture.ResultsParticipants 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.ConclusionFor 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.