Genitourinary medicine physicians have two main treatment options for the management of recurrent genital herpes: patient-initiated episodic or continuous suppressive therapy. As well as effective disease control, important factors in selecting a regimen include patient acceptability and potential improvements in quality of life. Traditionally suppressive therapy has been favoured by many genitourinary physicians who have often been sceptical of the benefits of episodic therapy. This view has been challenged by several recent studies demonstrating the efficacy and the comparable psychological benefits of very short patient-initiated episodic therapy compared with suppressive therapy. In this article, we review the theory and development of episodic therapy, and discuss the recent evidence that suggests the benefits of ultra short episodic therapies for recurrent genital herpes may be much greater than previously demonstrated.