Medscape is available in 5 Language Editions – Choose your Edition here.


Herpes Simplex in Emergency Medicine Follow-up

  • Author: Rahul Sharma, MD, MBA, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM  more...
Updated: Oct 27, 2015

Further Outpatient Care

Oral medication (see Medication): Topical acyclovir is only minimally helpful in patients with primary disease and is probably ineffective in recurrent episodes.

Burroughs Wellcome Co maintains a registry for monitoring outcome in pregnant women exposed to acyclovir; physicians should register patients at (800) 722-9292, extension 58465.


Further Inpatient Care

Admission for patients with herpes simplex is necessary in the following instances:

  • Encephalitis
  • Severe gingivostomatitis causing decreased ability to tolerate oral fluids
  • Immunocompromised patients with severe or disseminated disease


HSV-2 is an STD. Patients and all sexual contacts should be tested and treated for accompanying STDs.

Practice abstinence when lesions are present.

Always use condoms because of the potential for asymptomatic viral shedding.

Health care personnel (especially medical, dental) should use universal precautions (eg, gloves) to prevent herpetic whitlow.

Experimental vaccines are currently in clinical trials.

Use sunscreen to decrease herpes labialis recurrences.



Encephalitis: Rare complication of herpetic infection; commonly HSV-1 (hypothesized to spread to the brain via neural routes after primary or recurrent infection)

Neonatal infections: Range from mild localized infection to a fatal disseminated disease; HSV-2 usually spread via the maternal genital tract; congenital infections possible

Compromised host: Progressive and disseminated disease possible

Genital infection: Acute urinary retention



Genital HSV-2 infection has a high recurrence rate. More than 85% of patients with one symptomatic episode will experience another. Recurrences may be frequent; 38% of the population with genital herpes have more than 6 recurrences per year; 20% have more than 10 recurrences per year.


Patient Education

Antiviral therapy may decrease the clinical manifestations of the disease but does not cure it.

Initiate antiviral therapy as soon as possible after the patient notes symptoms.

Consider prophylaxis for patients who have more than 6 recurrences per year.

Educate patient that HSV-2 is an STD. Follow deterrence measures.

Referral to support groups: The American Social Health Association (ASHA) operates the National Herpes Hotline (919-361-8488), which provides educational materials and counseling for patients.

For excellent patient education resources, visit eMedicine's Sexually Transmitted Diseases Center and Teeth and Mouth Center. Also, see eMedicine's patient education articles Genital Herpes and Oral Herpes.

Contributor Information and Disclosures

Rahul Sharma, MD, MBA, FACEP Medical Director and Associate Chief of Service, NYU Langone Medical Center, Tisch Hospital Emergency Department; Assistant Professor of Emergency Medicine, New York University School of Medicine

Rahul Sharma, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Association for Physician Leadership, Phi Beta Kappa, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Weiss, MD, DTM&H Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Professor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Oncology Association of Practices, Southern Clinical Neurological Society, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Lawrence C Brilliant, MD Clinical Assistant Professor, Department of Primary Care and Community Services, MCP Hahnemann University; Attending Physician, Department of Emergency Medicine, Doylestown Hospital

Lawrence C Brilliant, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

  1. Mell HK. Management of oral and genital herpes in the emergency department. Emerg Med Clin North Am. 2008 May. 26(2):457-73, x. [Medline].

  2. Biggs WS, Williams RM. Common gynecologic infections. Prim Care. 2009 Mar. 36(1):33-51, viii. [Medline].

  3. Ahmad FA, Storch GA, Miller AS. Impact of an Institutional Guideline on the Care of Neonates at Risk for Herpes Simplex Virus in the Emergency Department. Pediatr Emerg Care. 2015 Aug 21. [Medline].

  4. Amel Jamehdar S, Mammouri G, Sharifi Hoseini MR, Nomani H, Afzalaghaee M, Boskabadi H, et al. Herpes simplex virus infection in neonates and young infants with sepsis. Iran Red Crescent Med J. 2014 Feb. 16 (2):e14310. [Medline].

  5. Tronstein E, Johnston C, Huang ML, Selke S, Magaret A, Warren T, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA. 2011 Apr 13. 305(14):1441-9. [Medline].

  6. [Guideline] Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006 Aug 4. 55:1-94. [Medline].

  7. Frenkl TL, Potts J. Sexually transmitted infections. Urol Clin North Am. 2008 Feb. 35(1):33-46; vi. [Medline].

  8. Pasternak B, Hviid A. Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects. JAMA. 2010 Aug 25. 304(8):859-66. [Medline].

  9. Johnson R. Herpes gladiatorum and other skin diseases. Clin Sports Med. 2004 Jul. 23(3):473-84, x. [Medline].

  10. Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. 1994 Dec 1. 121(11):847-54. [Medline].

  11. Clark JL, Tatum NO, Noble SL. Management of genital herpes. Am Fam Physician. 1995 Jan. 51(1):175-82, 187-8. [Medline].

  12. Cockerell C. Diagnosis and treatment of cutaneous herpes simplex virus infections. West J Med. 1996 Jun. 164(6):518-20. [Medline].

  13. Hill J, Roberts S. Herpes simplex virus in pregnancy: new concepts in prevention and management. Clin Perinatol. 2005 Sep. 32(3):657-70. [Medline].

  14. Hirsch MS. Herpes simplex virus. Mandell GL, ed. Mandell, Douglas, and Bennet's Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone; 1995. 1336-45.

  15. Holland-Hall C. Sexually transmitted infections: screening, syndromes, and symptoms. Prim Care. 2006 Jun. 33(2):433-54. [Medline].

  16. Patel R, Rompalo A. Managing patients with genital herpes and their sexual partners. Infect Dis Clin North Am. 2005 Jun. 19(2):427-38, x. [Medline].

  17. Rooney JF, Straus SE, Mannix ML. Oral acyclovir to suppress frequently recurrent herpes labialis. A double-blind, placebo-controlled trial. Ann Intern Med. 1993 Feb 15. 118(4):268-72. [Medline].

  18. Whitley RJ, Gnann JW Jr. Acyclovir: a decade later. N Engl J Med. 1992 Sep 10. 327(11):782-9. [Medline].

  19. Wu JJ, Pang KR, Huang DB. Advances in antiviral therapy. Dermatol Clin. 2005 Apr. 23(2):313-22. [Medline].

  20. Patel EU, Frank MA, Hsieh YH, Rothman RE, Baker AE, Kraus CK, et al. Prevalence and factors associated with herpes simplex virus type 2 infection in patients attending a Baltimore City emergency department. PLoS One. 2014. 9 (7):e102422. [Medline].

Cutaneous vesicles characteristic of herpes simples virus infection
Herpes labialis
Penile infection with herpes simplex virus type 2
Tzanck smear showing a multinucleated giant cell
Herpes simplex virus dendritic ulcer with fluorescein staining.
Genital herpes infection
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.