Post-Exposure Prophylaxis for Genital Herpes

Understanding Genital Herpes Transmission

• Many cases of genital herpes are acquired from persons who do not know they have genital HSV or who are asymptomatic at the time of sexual contact, according to the Centers for Disease Control and Prevention (CDC) 2
• Asymptomatic viral shedding is common and can lead to transmission even without visible lesions, as reported by the CDC 3

Prevention Strategies After Potential Exposure

• The CDC recommends abstaining from sexual activity if either partner has visible lesions 3
• The CDC also recommends using condoms consistently during all sexual exposures, though this provides only partial protection 3

Treatment Options for Established Infections

• For the first clinical episode, the CDC recommends valacyclovir 1 g orally twice daily for 7-10 days or acyclovir 400 mg orally three times daily for 7-10 days 2
• For recurrent episodes, the CDC recommends valacyclovir 500 mg orally twice daily for 5 days or acyclovir 800 mg orally twice daily for 5 days 2

Special Populations

• For immunocompromised patients, higher doses or longer courses of antivirals may be needed, according to the CDC 4
• For severe disease requiring hospitalization, the CDC recommends acyclovir 5-10 mg/kg IV every 8 hours for 5-7 days 3

Important Clinical Considerations

• Treatment is most effective when started during the prodromal period or within 1 day after onset of lesions, as reported by the CDC 4
• Systemic antiviral drugs control symptoms but do not eradicate latent virus or prevent all recurrences, according to the CDC 2

Patient Education

• Patients should be counseled about the natural history of HSV infection, potential for recurrent episodes, and asymptomatic viral shedding, as recommended by the CDC 3
• Patients should be advised to inform healthcare providers who care for them during pregnancy about HSV infection, according to the CDC 3