What is the recommended treatment for herpes simplex infection?

From the Guidelines

The recommended treatment for herpes simplex infection typically involves antiviral medications such as acyclovir, valacyclovir, or famciclovir, with the goal of reducing morbidity, mortality, and improving quality of life. For a first episode of genital herpes, oral acyclovir 400mg three times daily, valacyclovir 1g twice daily, or famciclovir 250mg three times daily for 7-10 days is recommended, as stated in the 2022 guidelines for the diagnosis and management of genital herpes 1.

Key Considerations

• For recurrent outbreaks, the same medications can be used but for a shorter duration of 3-5 days, ideally started within 24 hours of symptom onset.
• For oral herpes (cold sores), topical acyclovir 5% cream applied 5 times daily for 4 days can help.
• Patients with frequent recurrences (more than 6 episodes per year) may benefit from suppressive therapy with daily acyclovir 400mg twice daily, valacyclovir 500mg daily, or famciclovir 250mg twice daily, as supported by the 2021 ECCO guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease 1.

Additional Recommendations

• In addition to medication, patients should keep the affected area clean and dry, avoid touching lesions to prevent spreading the infection, and abstain from intimate contact during outbreaks.
• Pain can be managed with acetaminophen or ibuprofen, and applying cool compresses may provide relief.
• The option for suppressive therapy should be discussed with every HSV-2-infected patient, especially those with frequent or severe recurrences, as recommended by the 2009 guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 1.

From the FDA Drug Label

Herpes Simplex Infections in Immunocompromised Patients Acyclovir for Injection is indicated for the treatment of initial and recurrent mucosal and cutaneous herpes simplex (HSV-1 and HSV-2) in immunocompromised patients Initial Episodes of Herpes Genitalis Acyclovir for Injection is indicated for the treatment of severe initial clinical episodes of herpes genitalis in immunocompetent patients. Herpes Simplex Encephalitis Acyclovir for Injection is indicated for the treatment of herpes simplex encephalitis Neonatal Herpes Simplex Virus Infection Acyclovir for Injection is indicated for the treatment of neonatal herpes infections. The recommended treatment for herpes simplex infection is Acyclovir for Injection. The dosage is:

• 5 to 15 mg/kg every 8 hours 2 Key Indications:
• Herpes simplex infections in immunocompromised patients
• Initial episodes of herpes genitalis
• Herpes simplex encephalitis
• Neonatal herpes simplex virus infection
• Varicella-zoster infections in immunocompromised patients

From the Research

Treatment Options for Herpes Simplex Infection

The treatment for herpes simplex infection typically involves antiviral medications. Some of the key treatment options include:

• Aciclovir: This is still considered the standard therapy for severe herpes simplex virus (HSV) and varicella virus infections 3.
• Valaciclovir: The prodrug of aciclovir, which has been shown to be effective in the treatment of herpes genitalis and acute herpes zoster 3, 4.
• Famciclovir: The prodrug of penciclovir, which has also been shown to be effective in the treatment of herpes genitalis and acute herpes zoster 3, 4.
• Foscarnet: This is used to treat aciclovir-resistant HSV strains, often seen in immunocompromised patients 3.

Treatment Approaches

The approach to treatment can vary depending on the clinical characteristics and patient preference. Some of the treatment approaches include:

• Intermittent episodic therapy: This involves treating each episode of herpes simplex infection as it occurs 5.
• Intermittent suppressive therapy: This involves taking antiviral medication only during periods of high risk of recurrence 5.
• Chronic suppressive therapy: This involves taking antiviral medication continuously to prevent recurrences 5.

Specific Treatment Regimens

Some specific treatment regimens that have been shown to be effective include:

• Acyclovir 400 mg 3 times a day or valacyclovir 500 to 1000 mg twice a day for 3 to 5 days for recurrent herpes labialis (RHL) and recurrent intraoral HSV infections 6.
• Valacyclovir 500 mg twice a day for suppressing erythema multiforme triggered by HSV 6.
• Topical acyclovir 5% cream to reduce the duration of lesions if applied early 6.