From the Guidelines
The recommended management for active Herpes Simplex Virus (HSV) lesions includes prompt antiviral therapy, proper specimen collection, and supportive care, with a focus on reducing morbidity, mortality, and improving quality of life. For first-episode genital herpes, oral acyclovir 400mg three times daily, valacyclovir 1g twice daily, or famciclovir 250mg three times daily for 7-10 days is recommended 1. For recurrent episodes, the same medications can be used but for a shorter duration of 5 days, with valacyclovir potentially given as a 2-day regimen (500mg twice daily) 1.
Key Considerations
- When swabbing lesions for laboratory confirmation, it's best to collect specimens from fresh vesicles within the first 3-4 days of symptoms using a viral transport medium.
- PCR testing is preferred over viral culture due to its higher sensitivity.
- Lesions should be kept clean and dry, with pain managed using acetaminophen or ibuprofen.
- Patients should avoid touching lesions and wash hands frequently to prevent autoinoculation or transmission.
- Antiviral therapy works by inhibiting viral DNA synthesis and is most effective when started within 72 hours of symptom onset, significantly reducing viral shedding, healing time, and symptom duration.
Additional Recommendations
- Daily anti-HSV suppressive therapy can be considered for persons who have frequent or severe recurrences, with options including oral acyclovir, valacyclovir, or famciclovir 1.
- Suppressive therapy with valacyclovir should be 500 mg twice daily in HIV-infected persons 1.
- The option for suppressive therapy should be discussed with every HSV-2-infected patient, as it can prevent recurrences and decrease HIV concentration in plasma and anal and genital secretions 1.
From the Research
Recommended Management for HSV Active Lesions
The recommended management for Herpes Simplex Virus (HSV) active lesions includes swabbing and laboratory analysis.
- Swabbing of the lesion is necessary to collect a sample for laboratory analysis 2.
- Laboratory analysis can be done using various methods such as viral culture, PCR, antigen detection, or type-specific serology 2.
Laboratory Analysis Methods
The following methods can be used for laboratory analysis:
- Viral culture: Although viral culture has been the test of choice for HSV genital infection, PCR has been shown to have a higher rate of HSV detection 2.
- PCR: PCR is a diagnostic standard method for HSV infections of the central nervous system and can be used to diagnose genital herpes in people with active mucocutaneous lesions 2.
- Antigen detection: Antigen detection can be used as an alternative method, but HSV type determination is of importance 2.
- Type-specific serology: Type-specific serology based on glycoprotein G can be used to detect asymptomatic individuals, but widespread screening for HSV antibodies is not recommended 2.
Treatment and Management
The treatment and management of HSV active lesions include:
- Antiviral therapy: Valaciclovir is an effective drug for the suppression of recurrent episodes of genital herpes in immunocompetent and immunocompromised individuals 3, 4.
- Counseling: Counseling on natural history, transmission, treatment, and management of sexual partners is an integral part of management of genital herpes 5.
- Alternative therapeutic options: In cases of acyclovir resistance, alternative antiviral treatments can be used, but cross-resistance to different antivirals has been described 6.