Patient Management/Treatment

Antiviral chemotherapy offers clinical benefits to most symptomatic patients and is the mainstay of management. In addition, counseling regarding the natural history of genital herpes, sexual and perinatal transmission, and methods to reduce transmission is integral to clinical management.

HSV systemic antiviral chemotherapy partially controls symptoms of herpes episodes when used to treat first clinical and recurrent episodes, or when used as daily suppressive therapy. It does not eradicate the virus and does not affect the risk, frequency, or severity of recurrences after the drug is discontinued.

HSV systemic antiviral chemotherapy includes three oral medications: acyclovir, valacyclovir, and famciclovir. Topical antiviral treatment is of minimal clinical benefit, and it is not recommended.

Management of First Clinical Episode

Many patients with first episode herpes present with mild clinical manifestations but later develop severe or prolonged symptoms. Therefore, patients with first clinical episode genital herpes should receive antiviral therapy. Antiviral therapy may have a drastic effect in initial HSV infection, especially if symptoms are of less than 7 days’ duration and there is no history of oral HSV.

CDC-recommended regimens for treatment of first clinical episode of genital herpes are as follows:

Treatment may be extended if healing is incomplete after 10 days of therapy. Factors to weigh when considering treatment include severity of symptoms, immune status, pregnancy, history of complications, and cost.

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