Treatment of Herpes Simplex Virus (HSV) 1

Introduction to Treatment

The Centers for Disease Control and Prevention recommends oral antiviral medications such as acyclovir, valacyclovir, or famciclovir for HSV-1 infections, which should be initiated at the first sign of symptoms to effectively reduce duration and severity of outbreaks 1, 2

For first clinical episodes of HSV-1, the Centers for Disease Control and Prevention recommends regimens including Acyclovir 400 mg orally three times a day for 7-10 days, Acyclovir 200 mg orally five times a day for 7-10 days, Famciclovir 250 mg orally three times a day for 7-10 days, or Valacyclovir 1 g orally twice a day for 7-10 days 1, 2
Treatment may be extended if healing is incomplete after 10 days of therapy, as recommended by the Centers for Disease Control and Prevention 1
For herpes proctitis or oral infection, higher dosages of acyclovir (400 mg orally five times a day) may be required, according to the Centers for Disease Control and Prevention 1, 3

For recurrent episodes, treatment options include Acyclovir 400 mg orally three times a day for 5 days, Acyclovir 800 mg orally twice daily for 5 days, or Acyclovir 800 mg orally three times a day for 2 days, as recommended by the Centers for Disease Control and Prevention 4
Famciclovir 1500 mg as a single dose or 750 mg twice daily for 1 day, or Valacyclovir 2 g twice daily for 1 day, may also be effective for recurrent episodes, according to the Journal of Clinical Virology 5, 6
Treatment should be initiated at the first sign of prodrome or within 1 day of lesion onset for maximum effectiveness, as recommended by the Centers for Disease Control and Prevention 4

For patients with frequent recurrences (≥6 per year), suppressive therapy is recommended by the Centers for Disease Control and Prevention, including Acyclovir 400 mg orally twice daily, or Valacyclovir 500 mg once daily, or Valacyclovir 1 g once daily for patients with ≥10 recurrences per year 4, 2, 5
Suppressive therapy reduces frequency of recurrences by ≥75% and reduces asymptomatic viral shedding, according to the Centers for Disease Control and Prevention 4, 2
Safety has been documented for acyclovir for up to 6 years and valacyclovir/famciclovir for 1 year, as reported by the Centers for Disease Control and Prevention 4

For immunocompromised patients, longer courses of therapy are often required, and closer monitoring is necessary as healing may be slower, according to the Centers for Disease Control and Prevention 2
Higher doses may be needed for patients with apparent resistance to standard therapy, as recommended by the Centers for Disease Control and Prevention 2

Topical acyclovir is substantially less effective than oral therapy and is not recommended by the Centers for Disease Control and Prevention 1, 2
Antiviral medications do not eradicate latent virus or affect the risk, frequency, or severity of recurrences after treatment is discontinued, according to the Centers for Disease Control and Prevention 1, 2
Patient education about the natural history of HSV infection, potential for recurrent episodes, asymptomatic viral shedding, and methods to reduce transmission is an essential component of management, as recommended by the Centers for Disease Control and Prevention 1, 2
For herpes labialis (cold sores), single-day high-dose therapy has shown effectiveness in reducing healing time, according to the Journal of Clinical Virology 5, 6