Management of HSV-2 Reactive IgG

Clinical Assessment and Management

The American College of Physicians recommends that symptomatic patients with HSV-2 infection be offered suppressive therapy as the preferred management approach, with valacyclovir 1 g orally twice daily for 7-10 days as the preferred regimen for the first clinical episode with active lesions 1, 3
For recurrent episodes, the Centers for Disease Control and Prevention recommends valacyclovir 500 mg orally twice daily for 5 days, initiated during prodrome or within 24 hours of lesion onset, to reduce the duration and severity of symptoms 1, 3
Suppressive therapy with valacyclovir 1 g orally once daily reduces HSV-2 transmission to susceptible heterosexual partners by 50% 4
The Centers for Disease Control and Prevention recommends that asymptomatic patients with positive serology alone do not require antiviral therapy, but may consider suppressive therapy to reduce transmission risk to susceptible partners in discordant couples 1, 2, 4

The American Academy of Family Physicians recommends comprehensive education on HSV-2 infection, including disease education, transmission prevention, and the importance of disclosure of HSV-2 status to partners, to reduce transmission risk 1, 2, 4
Patients should be advised to abstain from sexual contact when prodromal symptoms or lesions are present, and to use condoms consistently during all sexual exposures to reduce transmission risk 1, 2, 4

The Centers for Disease Control and Prevention recommends routine type-specific serologic testing for HSV-2 in all persons seeking HIV care, and higher antiviral doses for HIV-infected patients with severe mucocutaneous lesions 4
The American College of Obstetricians and Gynecologists recommends that screening of pregnant women for HSV-2 is not recommended, and that safety of systemic acyclovir during pregnancy has not been fully established 1, 3

The Centers for Disease Control and Prevention recommends monitoring for adverse events, including nausea, headache, and renal impairment, in patients receiving antiviral therapy for HSV-2 infection 4
No laboratory monitoring is needed for episodic or suppressive therapy unless substantial renal impairment exists, but renal function should be monitored at initiation and once or twice weekly during treatment with high-dose IV acyclovir 4