Post-Exposure Prophylaxis for Genital Herpes
Currently, there is no recommended post-exposure prophylaxis regimen for genital herpes after a known exposure. Unlike HIV, there are no established guidelines supporting the use of antiviral medications as post-exposure prophylaxis for herpes simplex virus (HSV) infections 1.
Understanding Genital Herpes Transmission
- Genital herpes is a common sexually transmitted infection caused by herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) 2
- Many cases are acquired from persons who do not know they have genital HSV or who are asymptomatic at the time of sexual contact 1
- Asymptomatic viral shedding is common and can lead to transmission even without visible lesions 1
Prevention Strategies After Potential Exposure
- Abstain from sexual activity if either partner has visible lesions 1
- Use condoms consistently during all sexual exposures, though this provides only partial protection 1
- Consider daily suppressive therapy for the infected partner in serodiscordant relationships to reduce transmission risk 3, 4
Treatment Options for Established Infections
First Clinical Episode
- Valacyclovir 1 g orally twice daily for 7-10 days 3, 5
- Acyclovir 400 mg orally three times daily for 7-10 days 1, 6
- Acyclovir 200 mg orally 5 times daily for 7-10 days 1
Recurrent Episodes
- Valacyclovir 500 mg orally twice daily for 5 days 3, 5
- Acyclovir 800 mg orally twice daily for 5 days 1, 6
- Acyclovir 400 mg orally three times daily for 5 days 1, 6
Suppressive Therapy
- Valacyclovir 1 g orally once daily (for frequent recurrences ≥6 per year) 3, 5
- Acyclovir 400 mg orally twice daily 1, 6
Special Populations
Immunocompromised Patients
- Higher doses or longer courses of antivirals may be needed 3
- For HIV-infected patients, consider acyclovir 400 mg orally 3-5 times daily until clinical resolution 3, 7
Severe Disease
- For severe disease requiring hospitalization, acyclovir 5-10 mg/kg IV every 8 hours for 5-7 days 1, 3
Important Clinical Considerations
- Treatment is most effective when started during the prodromal period or within 1 day after onset of lesions 3
- Topical acyclovir is substantially less effective than oral therapy and is not recommended 1, 3
- Systemic antiviral drugs control symptoms but do not eradicate latent virus or prevent all recurrences 1, 5
Common Pitfalls to Avoid
- Delaying treatment beyond 72 hours of symptom onset significantly reduces effectiveness 3
- Treating based solely on positive serology without clinical symptoms is not recommended 5
- Assuming that treatment will prevent all future recurrences or transmission 1, 8
Patient Education
- Counsel patients about the natural history of HSV infection, potential for recurrent episodes, and asymptomatic viral shedding 1, 3
- Advise patients to inform healthcare providers who care for them during pregnancy about HSV infection 1
- Provide medication or a prescription so patients can initiate treatment at the first sign of prodrome or genital lesions 3