Does acyclovir help herpes simplex virus cold sores if treatment is delayed?

When herpes simplex virus (HSV) type 1 lesions are in the papule or vesicle stage, there is no benefit to starting oral acyclovir (strength of recommendation [SOR]: C, based on expert opinion). However, topical acyclovir 5% cream applied 5 times a day decreases pain and the duration of hard crust (SOR: B, extrapolated from randomized controlled trials [RCTs]). If started at the onset of symptoms (during the prodrome stage), acyclovir (400 mg 5 times daily for 5 days) decreases pain and healing time to loss of crust and valacyclovir (2 g twice daily for 1 day) reduces the lesion duration and time to healing and may prevent lesion development (SOR: A, based on RCTs)

Step Up-Not On-The Step 2 Clinical Skills Exam: Directors of Clinical Skills Courses (DOCS) Oppose Ending Step 2 CS

Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration. The authors, elected representatives of the Directors of Clinical Skills Courses, an organization comprising clinical skills educators in the United States and beyond, believe abolishing the national clinical skills examinations would have a major negative impact on the clinical skills training of medical students, and that forfeiting a national clinical skills competency standard has the potential to diminish the quality of care provided to patients. In this Perspective, the authors offer important additional background information, outline key concerns regarding the consequences of ending these national clinical skills examinations, and provide recommendations for moving forward: reducing the costs for students, exploring alternatives, increasing the value and transparency of the current examinations, recognizing and enhancing the strengths of the current examinations, and engaging in a national dialogue about the issue