Herpes simplex virus infection requires treatment with acyclovir, valacyclovir or famciclovir administered intravenously or orally. Topical use of these medications doesn’t provide the adequate efficacy.
Skin and mucous membranes HSV infections
In immunosuppressed patients:
- Acute symptomatic first or recurrent infection:
- intravenous acyclovir (5 mg/kg every 8 hours) or oral acyclovir (400 mg 4 times a day),
- famciclovir (500 mg twice a day or three times a day),
- or valacyclovir (500 mg twice a day).
Treatment lasts from 7 to 14 days.
See also: Neonatal herpes
- Prevention of disease reactivation:
- IV acyclovir (5 mg/kg q8h) or oral valacyclovir (500 mg twice a day) or acyclovir (400–800 mg 3–5 times per day) for 30 days is used in individuals after transplantation.
- Longer-term anti-HSV therapy is used for persons with continued immunosuppression. In HIV-infected persons, oral acyclovir (400–800 mg twice a day), valacyclovir (500 mg twice a day), or famciclovir (500 mg twice a day) is considered to reduce clinical and subclinical reactivations of HSV-1 and HSV-2.
In otherwise healthy individuals
- Genital herpes
- a) Primary infection:
- oral acyclovir (200 mg 5 times per day or 400 mg three times a day),
- valacyclovir (1 g twice a day),
- or famciclovir (250 mg twice a day).
The therapy lasts for 7–14 days.
- In case of severe disease or when neurologic complications are observed intravenous acyclovir (5 mg/kg every 8 hours for 5 days) is given.
- b) Symptomatic recurrent genital herpes:
- Short-course (1- to 3-day) oral administration of acyclovir (800 mg three times a day for 2 days), valacyclovir (500 mg twice a day for 3 days), or famciclovir (750 or 1000 mg twice a day for 1 day, a 1500-mg single dose) is considered effective.
- Oral and labial HSV infections
- a) First episode:
- oral acyclovir (200 mg) is administered 4 or 5 times per day,
- oral famciclovir (250 mg twice a day) or valacyclovir (1 g twice a day) may also be used.
- b) Recurrent disease:
- oral famciclovir (a 1500-mg single dose or 750 mg twice a day for 1 day)
- or valacyclovir (a 2-g single dose or 2 g twice a day for 1 day).
- 6-times-daily topical application of penciclovir or acyclovir cream may effectively speed healing of the lesions.
- c) Suppression of reactivation of herpes labialis:
- oral administration of acyclovir (400 mg twice a day) for 5-10 days effectively prevents reactivation of HSV infection associated with
- sun exposure.
- Herpetic whitlow:
- oral acyclovir (200 mg) is given 5 times daily for 7–10 days.
- HSV proctitis:
- oral acyclovir (400 mg 5 times per day) is helpful.
- Herpetic eye infections:
- Topical trifluorothymidine, vidarabine, idoxuridine, acyclovir, penciclovir,and interferon may be effectively used. Debridement may be needed.
Central nervous system infections
- HSV encephalitis:
- intravenous acyclovir (30 mg/kg per day) is given for 10 days.
- HSV aseptic meningitis:
- intravenous acyclovir (15–30 mg/kg per day) may be used.
Neonatal HSV infections
- oral acyclovir (60 mg/kg per day, divided into 3 doses) is given for 21 days.
Internal organs infections
- HSV esophagitis:
- intravenous acyclovir (15 mg/kg per day).
- oral therapy with valacyclovir or famciclovir may also be effective.
- HSV pneumonitis:
- intravenous acyclovir (15 mg/kg per day) may be administered.
Disseminated HSV infections:
- intravenous acyclovir (5 mg/kg every 8 hours) is administered.
- intravenous foscarnet (40 mg/kg every 8 hours) should be administered. Topical application of trifluorothymidine or 5% cidofovir gel may be also effective.