From the Guidelines
For acute treatment of HSV type 2, antiviral medications such as valacyclovir 1 gram orally twice daily for 7-10 days, acyclovir 400 mg orally three times daily for 7-10 days, or famciclovir 250 mg orally three times daily for 7-10 days are recommended. These medications work by inhibiting viral DNA polymerase, preventing HSV replication. Treatment should begin as soon as possible after symptom onset for maximum effectiveness. Patients should also be advised to keep the affected area clean and dry, avoid touching lesions to prevent spread, abstain from sexual activity until lesions completely heal, and use pain relievers like acetaminophen or ibuprofen for discomfort.
Key Considerations
- For severe cases or immunocompromised patients, intravenous acyclovir may be necessary.
- Routine liver enzyme monitoring is not required for standard courses of these antiviral medications in patients with normal liver function, as stated in various guidelines 1. However, patients with pre-existing liver disease or those on prolonged therapy may benefit from baseline and periodic liver function tests.
- Recurrent episodes may benefit from suppressive therapy if they occur frequently, with options including daily oral acyclovir, valacyclovir, or famciclovir 1.
Additional Guidance
- The most recent and highest quality study, from 2009 1, recommends discussing the option for suppressive therapy with every HSV-2-infected patient and using daily anti-HSV therapy for those with frequent or severe recurrences.
- Suppressive therapy with valacyclovir should be 500 mg twice daily in HIV-infected persons, or twice-daily regimens with acyclovir or famciclovir should be used 1.
From the Research
Treatment of HSV Type 2
- The treatment of HSV type 2 can be managed with antiviral medications such as acyclovir and valacyclovir 2, 3.
- A 2-day course of acyclovir (800 mg given by mouth 3 times per day) has been shown to be effective in reducing the duration of lesions, episode, and viral shedding, and increasing the proportion of aborted episodes 2.
- Valacyclovir is also an effective treatment option for HSV type 2, and it has been approved for a 3-day course in the episodic treatment of recurrent genital herpes 3.
Liver Enzymes Monitoring
- There is no direct evidence in the provided studies that suggests liver enzymes should be checked during the treatment of HSV type 2 with acyclovir or valacyclovir.
- However, it is generally recommended to monitor liver function tests in patients taking antiviral medications, especially if they have pre-existing liver disease or are taking other medications that can affect liver function 4, 5.
Antiviral Therapy
- Standard-dose and high-dose antiviral therapy have been shown to reduce the frequency of HSV-2 shedding, with high-dose valacyclovir being more effective than standard-dose valacyclovir 6.
- The choice of antiviral therapy and dosing regimen should be based on individual patient characteristics and preferences, as well as evidence-based guidelines 4.