HSV-1 Infection in Sexually Active Young Women

Clinical Presentation

HSV-1 accounts for 5-30% of first-episode genital herpes cases, though it causes significantly fewer recurrences compared to HSV-2, in sexually active young women, according to the Centers for Disease Control and Prevention 1, 2
Type-specific identification has important prognostic value since HSV-1 genital infections recur much less frequently than HSV-2, as recommended by the Centers for Disease Control and Prevention 1, 3

The recommended treatment regimens for first-episode genital herpes include valacyclovir 1 g orally twice daily for 7-10 days, or acyclovir 400 mg orally three times daily for 7-10 days, or acyclovir 200 mg orally five times daily for 7-10 days, or famciclovir 250 mg orally three times daily for 7-10 days, as recommended by the Centers for Disease Control and Prevention 1, 3
Treatment may be extended beyond 10 days if healing is incomplete, according to the Centers for Disease Control and Prevention 1, 3

Genital herpes is incurable but controllable with antiviral therapy, and HSV-1 genital infections recur much less frequently than HSV-2, which has important implications for long-term prognosis, as recommended by the Centers for Disease Control and Prevention 1, 3
Asymptomatic viral shedding can occur, though less frequently with HSV-1 than HSV-2, according to the Centers for Disease Control and Prevention 1, 3
Condom use should be encouraged with all sexual partners, as recommended by the Centers for Disease Control and Prevention 1, 3
Childbearing-aged women must inform obstetric providers due to neonatal transmission risk, according to the Centers for Disease Control and Prevention 1, 3

Type-specific serologic testing to differentiate HSV-1 from HSV-2 for prognostic counseling is recommended, as suggested by the Centers for Disease Control and Prevention 1, 3

Episodic therapy for recurrences can be shorter: 5 days of valacyclovir 500 mg twice daily, as recommended by the Centers for Disease Control and Prevention 3, 4
Suppressive therapy is rarely needed for HSV-1 genital infections due to infrequent recurrences, but if recurrences are frequent (≥6 per year), daily valacyclovir 500 mg to 1 g can reduce recurrence frequency by ≥75%, according to the Centers for Disease Control and Prevention 3, 4