From the Guidelines
Treatment for a 16-year-old with HSV-1 infection typically involves antiviral medications such as oral acyclovir, valacyclovir, or famciclovir, along with counseling on the chronic nature of the infection, prevention of transmission, and management of symptoms. The most recent and highest quality study, 1, published in 2022, provides guidance on the diagnosis and management of genital herpes, including HSV-1 infection. According to this study, dosing strategies that are most feasible for patient adherence should be prioritized, and the same medication dosages and frequencies are recommended for genital HSV-1 infection as for genital HSV-2 infection.
Some key points to consider in the treatment and counseling of a 16-year-old with HSV-1 infection include:
- Antiviral medications: oral acyclovir (400 mg three times daily for 7-10 days for initial outbreaks, or 400 mg twice daily for 5 days for recurrent episodes), valacyclovir (1 gram twice daily for 7-10 days for initial outbreaks, or 500 mg twice daily for 3 days for recurrent episodes), or famciclovir (250 mg three times daily for 7-10 days for initial outbreaks) 1
- Topical treatments: docosanol 10% cream can help with oral lesions
- Pain management: acetaminophen or ibuprofen and saltwater rinses can provide symptomatic relief
- Counseling: address the chronic nature of HSV-1, explain that outbreaks typically become less frequent over time, and educate on triggers like stress, illness, sun exposure, and hormonal changes
- Safe sex practices: essential to prevent transmission of HSV-1 through oral-genital contact even without visible lesions
- Psychological support: crucial to address potential feelings of shame or anxiety, and emphasize that HSV-1 is extremely common, affecting a majority of the population by adulthood.
It's also important to note that suppressive antiviral therapy can be considered for patients with frequent or severe recurrences, as it can reduce the frequency and severity of outbreaks, as well as reduce the risk of transmission to others 1. However, the decision to initiate suppressive therapy should be made on a case-by-case basis, taking into account the individual patient's needs and preferences.
From the FDA Drug Label
The efficacy and safety of VALTREX have not been established in: ... Patients aged less than 18 years with genital herpes. VALTREX is indicated for the treatment of cold sores (herpes labialis) in pediatric patients aged greater than or equal to 12 years.
The patient is 16 years old and has HSV 1 infection.
- Treatment: Valacyclovir is indicated for the treatment of cold sores (herpes labialis) in pediatric patients aged greater than or equal to 12 years 2.
- Counseling: Patients should be advised to initiate treatment at the earliest symptom of a cold sore (e.g., tingling, itching, or burning) and that treatment for cold sores should not exceed 1 day (2 doses) and that their doses should be taken about 12 hours apart 2.
- Key points:
- Valacyclovir is not a cure for cold sores.
- Patients should be informed that they should avoid contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners.
- Safer sex practices should be used.
- The patient should be counseled to use safer sex practices in combination with treatment.
From the Research
Treatment for HSV 1 Infection
- The treatment for Herpes Simplex Virus (HSV) 1 infection typically involves antiviral medications, such as nucleoside analogues, which can help reduce the duration, severity, and frequency of recurrences 3.
- For immunocompetent patients, standard oral acyclovir (ACV) therapy can be initiated at a dose of 200 mg orally, five times a day for the first 3 to 5 days 4.
- In cases where the patient does not respond to oral ACV, the dose can be increased to 800 mg five times a day, or alternative regimens such as topical trifluridine (TFT) or intravenous foscarnet can be considered 4.
Counseling for Patients with HSV 1 Infection
- Patients with HSV 1 infection should be counseled on the natural history of the disease, transmission, treatment, and management of sexual partners 5.
- It is essential to discuss the potential impact of genital herpes on pregnancy and sexual health, as well as the importance of safe sex practices to reduce the risk of transmission 3, 5.
- Patients should also be informed about the availability of episodic or suppressive therapy to manage symptoms and reduce the frequency of recurrences 5.
Management of HSV 1 Infection in Special Populations
- In immunocompromised patients, HSV 1 infection can be more severe and require alternative treatment regimens, such as intravenous foscarnet or cidofovir 4.
- Pregnant women with a history of genital herpes should receive antiviral prophylaxis with acyclovir from 36 weeks of gestation until delivery to reduce the risk of neonatal herpes 3.