Guidelines Summary
The 2021 CDC STD Guidelines on herpes infection are as follows [16] :
The first clinical episode of genital herpes is treated as follows:
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Acyclovir 400 mg orally three times a day for 7-10 days OR
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Valacyclovir 1 g orally twice a day for 7-10 days OR
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Famciclovir 250 mg orally three times a day for 7-10 days
Acyclovir 200 mg orally five times a day for 7-10 days (No longer recommended due to the frequency of dosing)
*Treatment can be extended if healing is incomplete after 10 days of therapy.
Suppressive therapy for recurrent genital herpes is as follows:
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Acyclovir 400 mg orally twice a day OR
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Valacyclovir 500 mg orally once a day* OR
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Valacyclovir 1 g orally once a day OR
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Famciclovir 250 mg orally twice a day
*Valacyclovir 500 mg once a day might be less effective than other valacyclovir or acyclovir dosing regimens in persons who have very frequent recurrences (ie, ≥10 episodes per year).
Episodic therapy for recurrent genital herpes in immunocompetent persons is as follows:
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Acyclovir 400 mg orally 3 times a day for 5 days OR
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Acyclovir 800 mg orally twice a day for 5 days OR
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Valacyclovir 500 mg orally twice a day for 3 days OR
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Valacyclovir 1 g orally once a day for 5 days OR
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Famciclovir 125 mg orally twice daily for 5 days OR
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Famciclovir 1 gram orally twice daily for 1 day OR
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Famciclovir 500 mg once, followed by 250 mg twice daily for 2 days
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Acyclovir 800 mg orally 3 times a day for 2 days (No longer recommended due to frequency of dosing)
Episodic therapy for recurrent genital herpes in immunocompromised patients is as follows [17] :
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Acyclovir 400 mg orally 3 times daily for 5 days
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Valaciclovir 500 mg orally twice daily for 5 days
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Famciclovir 500 mg orally twice daily for 5 days
Suppressive therapy for recurrent genital herpes in immunocompromised patients is as follows:
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Acyclovir 400-800mg orally 2-3 times daily
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Famciclovir 500mg orally twice daily
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Valacyclovir 1g orally twice daily
Severe disease (HSV meningoencephalitis, disseminated infection, pneumonitis) is treated as follows:
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Acyclovir 5-10 mg/kg IV every 8 hours for 2-7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 total days of therapy
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HSV encephalitis requires 21 days of intravenous therapy; impaired renal function warrants an adjustment in acyclovir dosage
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Dosing may need to be adjusted based on patient's renal function
Sexual partners should be considered for counseling and evaluation. Those partners who are symptomatic should be treated as such. Asymptomatic partners should be counseled and offered testing. Preventative treatment for asymptomatic partners is not recommended.
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Cutaneous vesicles characteristic of herpes simplex virus infection.
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Herpes labialis.
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Penile infection with herpes simplex virus type 2.
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Tzanck smear showing a multinucleated giant cell.
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Herpes simplex virus dendritic ulcer with fluorescein staining.
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Genital herpes infection.
