Herpes Simplex in Emergency Medicine Guidelines

Updated: Jun 26, 2017
  • Author: Melissa Kohn, MD, MS, FACEP, EMT-T/PHP; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Guidelines

Guidelines Summary

The 2015 CDC STD Guidelines on herpes infection are as follows: [12]

The first clinical episode of genital herpes is treated as follows:

  • Acyclovir 400 mg orally three times a day for 7-10 days OR
  • Acyclovir 200 mg orally five times a day for 7-10 days OR
  • Valacyclovir 1 g orally twice a day for 7-10 days OR
  • Famciclovir 250 mg orally three times a day for 7-10 days

*Treatment can be extended if healing is incomplete after 10 days of therapy.

Suppressive therapy for recurrent genital herpes is as follows:

  • Acyclovir 400 mg orally twice a day OR
  • Valacyclovir 500 mg orally once a day* OR
  • Valacyclovir 1 g orally once a day OR
  • 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 is as follows:

  • Acyclovir 400 mg orally three times a day for 5 days OR
  • Acyclovir 800 mg orally twice a day for 5 days OR
  • Acyclovir 800 mg orally three times a day for 2 days OR
  • Valacyclovir 500 mg orally twice a day for 3 days OR
  • Valacyclovir 1 g orally once a day for 5 days OR
  • Famciclovir 125 mg orally twice daily for 5 days OR
  • Famciclovir 1 gram orally twice daily for 1 day OR
  • Famciclovir 500 mg once, followed by 250 mg twice daily for 2 days

Severe disease (HSV meningoencephalitis, disseminated infection, pneumonitis) is treated as follows:

  • 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
  • HSV encephalitis requires 21 days of intravenous therapy; impaired renal function warrants an adjustment in acyclovir dosage