What is the recommended treatment for Herpes Simplex Virus (HSV) 1 and 2 infections?

From the Guidelines

The recommended treatment for Herpes Simplex Virus (HSV) 1 and 2 infections typically involves antiviral medications, with acyclovir, valacyclovir, and famciclovir being the primary options, as prioritizing patient adherence to dosing regimens is crucial 1.

Treatment Regimens

For initial genital herpes outbreaks, the following regimens are standard:

• Acyclovir 400mg three times daily for 7-10 days
• Valacyclovir 1000mg twice daily for 10 days
• Famciclovir 250mg three times daily for 7-10 days For recurrent outbreaks, shorter courses are effective:
• Acyclovir 800mg three times daily for 2 days
• Valacyclovir 500mg twice daily for 3 days
• Famciclovir 1000mg twice daily for 1 day

Suppressive Therapy

For patients with frequent recurrences (more than 6 per year), suppressive therapy may be recommended:

• Acyclovir 400mg twice daily
• Valacyclovir 500mg daily
• Famciclovir 250mg twice daily It's essential to note that although episodic and suppressive therapy for genital HSV-1 infection have not been studied as comprehensively as for genital HSV-2, the same medication dosages and frequencies are recommended for genital HSV-1 infection 1.

Resistance and Alternate Therapy

If lesions persist in a patient receiving acyclovir treatment, resistance of the HSV strain to acyclovir should be suspected, and alternate therapy, such as foscarnet or topical cidofovir gel, may be necessary 1.

Quality of Life and Prevention

Patients should also be advised to avoid triggers like stress, illness, and sun exposure, and to maintain good hygiene during outbreaks to prevent spreading the infection, as these measures can improve quality of life and reduce morbidity.

From the FDA Drug Label

The median time to lesion healing was 4 days in the group receiving VALTREX 500 mg versus 6 days in the placebo group, and the median time to cessation of viral shedding in subjects with at least 1 positive culture (42% of the overall trial population) was 2 days in the group receiving VALTREX 500 mg versus 4 days in the placebo group The median time to cessation of pain was 3 days in the group receiving VALTREX 500 mg versus 4 days in the group receiving placebo

The recommended treatment for Herpes Simplex Virus (HSV) 1 and 2 infections is valacyclovir (PO).

• Treatment should be initiated as soon as possible after a diagnosis of herpes zoster or at the earliest sign or symptom of a cold sore (e.g., tingling, itching, or burning) or genital herpes.
• Dosage: 500 mg twice daily for 5 days for genital herpes or 500 mg once daily for suppressive therapy.
• Note: VALTREX is not a cure for cold sores or genital herpes, and patients should be counseled to use safer sex practices in combination with suppressive therapy with VALTREX 2.

From the Research

Treatment Options for HSV-1 and 2 Infections

• The first-line treatment for Herpes Simplex Virus (HSV) 1 and 2 infections is Acyclovir (ACV) 3, 4, 5.
• Long-term administration of ACV can lead to the development of ACV-resistance, especially in immunocompromised patients 3, 5.
• In cases of ACV unresponsive herpetic keratitis and herpes simplex encephalitis, drug-resistance typing is recommended 3.
• Combination therapy should be considered when viruses with distinct phenotype/genotype are identified at one or at distinct body sites 3.

Alternative Treatment Options

• Cidofovir and foscarnet can serve as alternative treatments for ACV-resistant HSV infections 5, 6.
• Novel antiviral drugs, such as helicase primase inhibitors (HPIs), are emerging as a promising alternative, showing high efficacy and the potential to overcome resistance 4.
• Gene therapy is still in its early stages, and vaccine development has been challenging 4.

Second-Line Treatments

• A systematic review found that 91.97% of proposed interventions were effective as potential managements for resistant strains of HSV 7.
• Various second-line treatments, including nectin, amenamevir, and monoclonal antibodies, have shown efficacy in treating resistant HSV strains 7.
• Immunocompromised patients are the most affected by drug-resistant variants of HSV, and second-line treatments can provide additional options for managing these infections 7.