Diagnosis

• The clinical diagnosis of genital herpes is both insensitive and nonspecific
• The typical painful multiple vesicular or ulcerative lesions are absent in many infected persons
• The clinical diagnosis of genital herpes should be confirmed by laboratory testing. Both virologic tests and type-specific serologic tests for HSV should be available in clinical settings that provide care for patients with STDs or those at risk for STDs.
  • Virologic Tests
  • Type-specific Serologic Tests

Treatment

• Antiviral chemotherapy offers clinical benefits to most symptomatic patients and is the mainstay of management
• Systemic antiviral drugs partially control the symptoms and signs of herpes episodes when used to treat first clinical episodes and recurrent episodes or when used as daily suppressive therapy. However, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued.
• Randomized trials indicate that three antiviral medications provide clinical benefit for genital herpes: acyclovir, valacyclovir, and famciclovir
  • Valacyclovir is the valine ester of acyclovir and has enhanced absorption after oral administration
  • Famciclovir, a pro-drug of penciclovir, also has high oral bioavailability
  • Topical therapy with antiviral drugs offers minimal clinical benefit, and its use is not recommended.
  
  First Clinical Episode of Genital Herpes
• Many patients with first-episode herpes present with mild clinical manifestations but later develop severe or prolonged symptoms. Therefore, most patients with initial genital herpes should receive antiviral therapy.
  Recommended Regimens
  Acyclovir 400 mg orally three times a day for 7--10 days,
       OR
  Acyclovir 200 mg orally five times a day for 7--10 days,
       OR
  Famciclovir 250 mg orally three times a day for 7--10 days,
       OR
  Valacyclovir 1 g orally twice a day for 7--10 days.
  
  Recurrent Episodes of HSV Disease
  Episodic Therapy for Recurrent Genital Herpes
  • Effective episodic treatment of recurrent herpes requires initiation of therapy within 1 day of lesion onset, or during the prodrome that precedes some outbreaks. The patient should be provided with a supply of drug or a prescription for the medication with instructions to self-initiate treatment immediately when symptoms begin.

  Recommended Regimens
  Acyclovir 400 mg orally three times a day for 5 days,
       OR
  Acyclovir 200 mg orally five times a day for 5 days,
       OR
  Acyclovir 800 mg orally twice a day for 5 days,
       OR
  Famciclovir 125 mg orally twice a day for 5 days,
       OR
  Valacyclovir 500 mg orally twice a day for 3--5 days,
       OR
  Valacyclovir 1.0 g orally once a day for 5 days.

  Suppressive Therapy for Recurrent Genital Herpes

  Recommended Regimens
  Acyclovir 400 mg orally twice a day,
       OR
  Famciclovir 250 mg orally twice a day,
       OR
  Valacyclovir 500 mg orally once a day,
       OR
  Valacyclovir 1.0 gram orally once a day.

  Severe Disease

  • IV acyclovir therapy should be provided for patients who have severe disease or complications that necessitate hospitalization
  • The recommended regimen is acyclovir 5--10 mg/kg body weight IV every 8 hours for 2--7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days total therapy

References

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