How are herpes simplex virus (HSV) infections treated?

Updated: Feb 16, 2018
  • Author: Sean P McGregor, DO, PharmD; Chief Editor: William D James, MD  more...
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Answer

Most herpes simplex virus (HSV) infections are self-limited and treatment is not always indicated or necessary. However, antiviral therapy shortens the course of the symptoms and may prevent dissemination and transmission.

Intravenous, oral, and topical antiviral medications are available for treatment of HSV infection and are most effective if used at the onset of symptoms. Oral therapy can be given at the time of the episode or as long-term suppressive therapy.

Treatment of herpes labialis and herpes genitalis generally consists of episodic courses of oral acyclovir, valacyclovir, and famciclovir. Oral antiviral medications may be used (off label) as therapy for other uncomplicated HSV conditions (eg, herpetic whitlow), and the same doses as those used for herpes genitalis treatment are commonly recommended.

Complicated HSV infections, cutaneous and/or visceral dissemination, neonatal HSV infection, and severe infections in those who are immunocompromised should be treated promptly with intravenous acyclovir.

In patients who are immunocompromised and have recurrent HSV infections, acyclovir-resistant HSV strains have been identified, and treatment with intravenous foscarnet or cidofovir may be used.


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