Herpes Simplex Virus-2
Background
Herpes Virus Types
- HHV-1: Herpes Simplex Virus-1
- HHV-2: Herpes Simplex Virus-2
- Herpes B virus
- Varicella zoster virus
- Varicella (Chickenpox)
- Herpes zoster (Shingles)
- Herpes zoster ophthalmicus
- Herpes zoster oticus (Ramsay Hunt syndrome)
- HHV-6 (Roseola infantum)
- HHV-8 (Kaposi’s sarcoma)
- Epstein-Barr virus
- Cytomegalovirus
Clinical Features
- multiple painful lesions
- no buboes (occasionally shoddy lymphadenopathy)
- more common in Black patients
- starts with small clumps of blisters that may have been preceded with local pain, tingling, itching, and burning
- +/- constitutional symptoms (fever, fatigue, myalgias, headaches)
Differential Diagnosis
Sexually transmitted diseases
- Chancroid
- Chlamydia trachomatis
- Granuloma inguinale
- Hepatitis B
- Herpes Simplex Virus-2
- HIV
- Human papillomavirus
- Lymphogranuloma venereum
- Neisseria gonorrhoeae
- Trichomonas
- Syphilis
Evaluation
- Clinical diagnosis if visible lesions present.
Management
Initial Episode[1][2]
- Acyclovir 400mg PO q8hrs x 7-10 days or 200mg PO 5x/day x 7-10 days OR
- Valacyclovir 1g PO q12hrs x 7-10 days OR
- Famciclovir 250mg PO q8hrs x 7-10 days
Recurrence[1]
- Acyclovir 400mg PO q8hrs x 5 days or 800mg PO q12hrs x 5 days or 800mg PO q8hrs x 2 days OR
- Valacyclovir 500mg PO q12hrs x 3 days or 1g PO qd x 5 days OR
- Famciclovir 125mg PO q12hrs for 5 days or 1g PO q12hrs for 1 day or 500mg PO once then 250mg PO q12hrs for 2 days
Suppressive Therapy[1]
- Acyclovir 400mg PO q12hrs daily OR
- Famciclovir 250mg PO q12hrs daily OR
- Valacyclovir 500mg-1g PO daily (500mg may be less effective)
Disposition
- Generally outpatient
See Also
References
- ↑ 1.0 1.1 1.2 Workoski KA and Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommen and Reports. 2015; 64(3):1-140.
- ↑ https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf