From the Guidelines
The most appropriate treatment for herpes simplex virus (HSV) infections is antiviral medications, with acyclovir, valacyclovir, and famciclovir being the most commonly prescribed options, as recommended by the 2009 guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 1.
Treatment Options
The treatment for HSV infections depends on the severity and frequency of outbreaks. For initial genital herpes outbreaks, typical regimens include:
- Acyclovir 400mg three times daily for 7-10 days
- Valacyclovir 1g twice daily for 7-10 days
- Famciclovir 250mg three times daily for 7-10 days For recurrent outbreaks, shorter courses are often effective:
- Acyclovir 800mg three times daily for 2 days
- Valacyclovir 500mg twice daily for 3 days
- Famciclovir 1g 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 As noted in the 2009 guidelines, daily anti-HSV suppressive therapy can prevent recurrences and decrease HIV concentration in plasma and anal and genital secretions in HIV-infected persons 1.
Additional Considerations
In addition to medication, patients should keep affected areas clean and dry, avoid touching lesions to prevent spreading the infection, and abstain from intimate contact during outbreaks. For severe infections or in immunocompromised patients, intravenous acyclovir may be necessary, as suggested by the 1998 guidelines for treatment of sexually transmitted diseases 1.
From the FDA Drug Label
The use of VALTREX for treatment of cold sores is based on 2 double‑blind, placebo‑controlled clinical trials in healthy adults and adolescents (aged greater than or equal to 12 years) with a history of recurrent cold sores The efficacy and safety of valacyclovir have not been established in pediatric patients: aged less than 12 years with cold sores aged less than 18 years with genital herpes
The appropriate treatment for herpes simplex virus (HSV) infections is not explicitly stated in the provided drug labels for all age groups.
- For cold sores in adults and adolescents (aged greater than or equal to 12 years), valacyclovir may be used.
- For genital herpes and other forms of HSV infections, especially in pediatric patients, the provided information is insufficient to recommend a specific treatment. No conclusion can be drawn for the treatment of HSV infections in pediatric patients aged less than 12 years or for genital herpes in patients aged less than 18 years 2. Similarly, the efficacy of famciclovir has not been established in pediatric patients 3.
From the Research
Treatment Options for Herpes Simplex Virus (HSV) Infections
The appropriate treatment for herpes simplex virus (HSV) infections includes antiviral medications such as acyclovir, valacyclovir, and famciclovir 4, 5, 6. These medications are effective in reducing the severity and frequency of symptoms, as well as preventing transmission.
Episodic and Suppressive Treatment
Episodic treatment involves taking antiviral medication during an outbreak to reduce the severity and duration of symptoms. Suppressive treatment involves taking antiviral medication daily to prevent outbreaks from occurring 4, 5. The choice of treatment depends on the frequency and severity of outbreaks, as well as the individual's overall health.
Antiviral Medications
- Acyclovir: effective for treating initial genital herpes and mucocutaneous herpes in compromised hosts, but not clinically useful for recurrent labial or genital herpes 7
- Valacyclovir: effective for suppressing recurrent genital herpes and reducing viral shedding 8
- Famciclovir: effective for treating recurrent genital herpes, but may not be as effective as valacyclovir in suppressing viral shedding 8
Treatment Regimens
- For patients with six or more recurrences of genital herpes per year, treatment options include:
- Acyclovir, 400 mg twice daily
- Valacyclovir, 1 g daily
- Famciclovir, 250 mg twice daily 5
- For episodic treatment of recurrent genital herpes, antiviral medication can be taken for a shorter duration, such as 3-5 days 4
Safety and Efficacy
Antiviral medications for HSV infections are generally safe and well-tolerated, but may cause adverse effects such as crystalluria, elevated serum creatinine, and infusion site inflammation 7. The efficacy of these medications in preventing transmission and reducing symptoms has been demonstrated in several studies 4, 5, 6, 8.