From the Guidelines
The management of genital herpes simplex virus (HSV) involves both antiviral medications and supportive care, with first-line treatment for initial outbreaks being oral acyclovir, valacyclovir, or famciclovir, and suppressive therapy for frequent recurrences using acyclovir, valacyclovir, or famciclovir. The goal of treatment is to reduce the severity and duration of symptoms, as well as to prevent recurrences. According to the guidelines from the CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America 1, daily anti-HSV therapy can prevent most recurrences of genital herpes, and this is recommended for persons who have frequent or severe recurrences.
Treatment Options
- First-line treatment for initial outbreaks: oral acyclovir 400mg three times daily for 7-10 days, valacyclovir 1g twice daily for 7-10 days, or famciclovir 250mg three times daily for 7-10 days
- Recurrent episodes: same medications at similar doses but for a shorter duration of 3-5 days, ideally started within 24 hours of symptom onset
- Suppressive therapy for frequent recurrences (more than 6 per year): acyclovir 400mg twice daily, valacyclovir 500mg daily (or 1g daily for those with more than 10 outbreaks yearly), or famciclovir 250mg twice daily
Supportive Measures
- Keeping the affected area clean and dry
- Wearing loose-fitting clothing
- Taking sitz baths with warm water
- Using over-the-counter pain relievers like acetaminophen or ibuprofen
- Abstaining from sexual activity during outbreaks
- Disclosing HSV status to sexual partners
The use of antiviral medications, such as acyclovir, valacyclovir, and famciclovir, can reduce the frequency of recurrences by greater than or equal to 75% among patients who have frequent recurrences 1. Additionally, daily suppressive therapy with oral acyclovir or famciclovir can be effective in preventing recurrences, and valacyclovir is also an option 1. However, the choice of medication and treatment regimen should be individualized based on the patient's specific needs and medical history.
From the FDA Drug Label
For both treatment groups the median time to lesion healing was 9 days, the median time to cessation of pain was 5 days, and the median time to cessation of viral shedding was 3 days. 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 Patients should be advised to initiate therapy at the first sign or symptom of an episode. If medical management of a genital herpes recurrence is indicated, patients should be advised to initiate therapy at the first sign or symptom of an episode.
Management for Genital HSV includes:
- Initiation of therapy at the first sign or symptom of an episode
- Treatment with antiviral medications such as valacyclovir or acyclovir
- Maintenance of adequate hydration
- Avoidance of contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners
- Use of safer sex practices in combination with suppressive therapy 2 2 3
From the Research
Management of Genital Herpes Simplex Virus (HSV)
The management of genital HSV involves various treatment options, including episodic therapy, suppressive therapy, and topical treatment.
- Episodic Therapy: Episodic therapy is usually recommended for patients with infrequent symptomatic recurrences and where transmission is not a concern 4. This type of therapy can be effective in reducing the severity and duration of symptoms.
- Suppressive Therapy: Suppressive therapy is considered for patients with frequent recurrences, and it has been shown to be safe and effective in reducing the frequency of recurrences 5, 6. The dosage and frequency of suppressive therapy can vary depending on the patient's needs and medical history.
- Topical Treatment: Topical treatment with acyclovir can be beneficial in reducing the severity of symptoms, but it may not prevent the onset of recurrent episodes 7, 8.
Treatment Options
Various antiviral medications are available for the treatment of genital HSV, including:
- Acyclovir: Acyclovir is a commonly used medication for the treatment of genital HSV, and it can be administered orally or intravenously 6, 7, 8.
- Valacyclovir: Valacyclovir is another antiviral medication that has been shown to be effective in suppressing recurrent genital HSV infections 5.
- Famciclovir: Famciclovir is also used for the treatment of genital HSV, and it has been shown to be effective in reducing the severity and duration of symptoms 4.
Special Considerations
The management of genital HSV in certain populations, such as pregnant women and immunocompromised individuals, requires special consideration.
- Pregnancy: The management of genital HSV in pregnancy is controversial, and studies are ongoing to determine the best course of treatment 7.
- Immunocompromised Individuals: Immunocompromised individuals, such as those with HIV, may require suppressive therapy to prevent recurrent episodes, and they may be at risk of developing resistance to antiviral medications 7.