Herpes Simplex Virus-2
Contents
Background
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]
- Acyclovir OR
- 400mg PO q8hrs x 7-10 days
- or 200mg PO 5x/day x 7-10 days
- Valacyclovir 1g PO q12hrs x 7-10 days OR
- Famciclovir 250mg PO q8hrs x 7-10 days
Recurrence[1]
- Acyclovir OR
- 400mg PO q8hrs x 5 days
- or 800mg PO q12hrs x 5 days
- or 800mg PO q8hrs x 2 days
- Valacyclovir OR
- 500mg PO q12hrs x 3 days
- or 1g PO qd x 5 days
- Famciclovir
- 125mg PO q12hrs for 5 days
- or 1g PO q12hrs for 1 day
- or 500mg PO once, followed by 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