Herpes Simplex Treatment & Management

Updated: Mar 01, 2018
  • Author: Folusakin O Ayoade, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Medical Care

Overall, medical treatment of herpes simplex virus (HSV) infection is centered around specific antiviral treatment. While the same medications are active against HSV-1 and HSV-2, the location of the lesions and the chronicity (primary or reactivation) of the infection dictate the dosage and frequency of medication. It is important to note that life-threatening HSV infections in immunocompromised patients and HSV encephalitis require high-dose intravenous acyclovir, often started empirically. [20]

When constitutional effects such as fever occur, symptomatic treatment can be used.

Appropriate wound care is needed, and treatment for secondary bacterial skin infections may be required.

Acyclovir-resistant HSV infections

Acyclovir-resistant HSV infections are often seen in immunocompromised patients (eg, patients with HIV infection). The options for treatment include cidofovir and foscarnet, but both are very nephrotoxic.

Recurrent HSV infections

Options for recurrent HSV infections include no treatment (for infrequent episodes) or episodic treatment with topical agents or oral antiviral agents. Long-term suppressive therapy, which can be continued for up to one year, is also an option. A modest benefit with lower recurrences has been reported using this method. [21, 22]

The best approach is to determine the frequency and severity of recurrent infections and the patient's preference concerning prophylaxis. Options for long-term suppressive therapy include acyclovir 400 mg orally twice daily or valacyclovir 500 mg orally twice daily for up to a year, with reassessment at the end of therapy.



Consultation with a dermatologist may be beneficial in cases of atypical lesions.

In immunocompromised patients with invasive HSV infection, consultation of specialty associated with the organ system affected should be sought early (eg, pulmonologist for possible HSV pneumonitis) in order to aid in diagnosis. Infectious diseases consultation is reasonable for immunocompromised patients with CNS herpes infection.