What are the characteristics of Herpes Simplex Virus (HSV) 2 vesicles?

From the Guidelines

HSV-2 vesicles should be treated with antiviral medications such as valacyclovir (1g twice daily for 7-10 days for first episodes; 500mg twice daily for 3-5 days for recurrent episodes) to reduce the severity and duration of outbreaks, as recommended by the most recent guidelines 1. The management of genital HSV-2 infection should consider several factors, including frequency and severity of HSV recurrences, the risk for HSV-2 transmission to susceptible partners, and the potential for interactions between HIV and HSV-2 that might result in increased HIV in plasma and genital secretions. Some key points to consider in the treatment of HSV-2 vesicles include:

• The use of antiviral medications to reduce the severity and duration of outbreaks
• The importance of keeping the affected area clean and dry to promote healing
• The use of loose-fitting clothing to prevent friction and irritation
• The need to avoid sexual contact during outbreaks to prevent transmission, as the virus is highly contagious when vesicles are present
• The consideration of episodic therapy or daily therapy to prevent recurrences, depending on the individual patient's needs and circumstances, as outlined in the guidelines 1. It is also important to note that treatment for individual recurrences does not influence the natural history of genital HSV-2 infection and does not reduce the risk for HSV-2 transmission to sex partners, a major concern of persons with genital herpes 1.

From the Research

HSV 2 Vesicles

• HSV-2 is a highly prevalent virus that can cause genital herpes, characterized by vesicular and erosive localized painful genital lesions 2
• The clinical spectrum of HSV-2 disease ranges from mild to severe conditions, particularly in immunocompromised individuals and neonates 3
• Current treatments for HSV-2 infections, such as acyclovir, valacyclovir, and famciclovir, target viral DNA polymerase but have limited efficacy and are susceptible to resistance 4, 5, 6
• Suppressive antiviral therapy with acyclovir, valacyclovir, or famciclovir can decrease the number of patients with at least one recurrence of genital herpes per year, but the evidence is of low quality due to risk of bias and inconsistency 2
• Novel drugs such as helicase primase inhibitors (HPIs) are emerging as a promising alternative for the management of HSV-2 infections, showing high efficacy and the potential to overcome resistance 3

Treatment Options

• Daily antiviral therapy with famciclovir and valacyclovir has been shown to be effective in reducing both symptomatic and asymptomatic reactivation of HSV-2 4
• Valacyclovir appears to be somewhat better than famciclovir for suppression of genital herpes and associated shedding 4
• Acyclovir, valacyclovir, and famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes, and are useful as suppressive therapy for individuals with frequent genital herpes recurrences 6

Prevention of Transmission

• Antiviral therapy can be used to prevent the transmission of genital herpes, but further research is required to clarify the safety and efficacy of these agents in preventing transmission 5, 6
• The use of antiviral therapy for the prevention of transmission is recommended as part of a comprehensive management strategy for genital herpes simplex virus infections 5