Herpes Isolation Requirements During Active Outbreaks
Yes, herpes requires isolation during active outbreaks to prevent transmission, particularly for herpes gladiatorum (HG) and herpes rugbiorum (HR), where 3-8 days of isolation is strongly recommended until lesions are fully crusted. 1
Isolation Requirements by Type of Herpes
- For herpes gladiatorum (wrestling-associated herpes) and herpes rugbiorum (rugby-associated herpes), isolation for 3-8 days during primary outbreaks is recommended with suspension of competition until lesions are fully crusted 1
- Athletes with active herpes lesions should be excluded from competition until all lesions are fully crusted or until a physician provides written documentation that the condition is non-infectious 1
- For genital herpes, patients should abstain from sexual activity when lesions or prodromal symptoms are present to prevent transmission 1
- Herpes can be transmitted even during asymptomatic periods through viral shedding, requiring ongoing precautions beyond visible outbreaks 1
Diagnostic Confirmation
- Diagnosis involves clinical recognition combined with laboratory confirmation through cell culture, histologic examination, or rapid diagnostic tests such as direct fluorescent antibody staining, enzyme immunoassay, or polymerase chain reaction (PCR) 1
- PCR testing has been shown to be 11-71% more sensitive than viral culture for detecting HSV in genital ulcers 1
- Type-specific testing can differentiate between HSV-1 and HSV-2, which has prognostic importance as HSV-1 tends to cause fewer recurrences than HSV-2 1
Treatment During Isolation Period
- Valacyclovir (500 mg daily or twice daily for 7 days) given within 24 hours of symptom onset can shorten the duration of HSV PCR clearance from lesions by 21% (from 8.1 days with placebo to 6.4 days with valacyclovir) 1
- First-line treatments for active herpes outbreaks include:
Criteria for Ending Isolation
- Athletes may return to competition when all lesions are fully crusted 1
- Alternatively, a physician's written statement indicating the condition is non-infectious can allow return to activities 1
- Treatment may be extended if healing is incomplete after the initial course of therapy 1
Prevention Strategies
- For athletes with history of recurrent herpes infections, suppressive antiviral therapy should be considered 1
- Cleaning of wrestling mats with freshly prepared bleach solution (1 quarter cup of bleach in 1 gallon of water) for a minimum contact time of 15 seconds at least daily and preferably between matches 1
- Regular examination of athletes for vesicular or ulcerative lesions before practice or competition 1
- For genital herpes, condom use is recommended during all sexual exposures with new or uninfected partners 1
Special Considerations
- Immunocompromised patients, including those with HIV, may experience more severe herpes infections requiring longer treatment courses 1, 3
- Herpes can be particularly severe in immunocompromised hosts, resulting in chronic, persistent, active infection 3
- Pregnant women with active genital herpes lesions at delivery should be offered cesarean section to prevent neonatal transmission 4
Common Pitfalls
- Failure to recognize that herpes can be transmitted even during asymptomatic periods through viral shedding 1
- Delayed initiation of antiviral therapy, which is most effective when started within 24 hours of symptom onset 1, 2
- Relying solely on topical therapy, which is substantially less effective than systemic treatment 1, 2
- Competitors often do not recognize or may deny possible infection, highlighting the importance of thorough examination 1
Proper isolation during active herpes outbreaks, combined with appropriate antiviral therapy and preventive measures, is essential for reducing transmission risk and managing this chronic viral infection effectively.