Herpes Simplex Virus Disease

Prevention of Exposure
(1) HIV-infected persons should use latex condoms during every act of sexual intercourse to reduce the risk of exposure to herpes simplex virus (HSV) and to other sexually transmitted pathogens (AII). They should specifically avoid sexual contact when herpetic lesions (genital or orolabial) are evident (AII).

Prevention of Disease
(2) Prophylaxis of initial episodes of HSV disease is not recommended (DIII).

Prevention of Recurrence
(3) Because acute episodes of HSV infection can be treated successfully, chronic therapy with acyclovir is not required after lesions resolve. However, persons who have frequent or severe recurrences may be administered daily suppressive therapy with oral acyclovir or famciclovir (AI) (66, 67). Intravenous foscarnet or cidofovir can be used to treat infection due to acyclovir-resistant isolates of HSV, which are routinely resistant to ganciclovir as well (AII).

Notes

Pediatric Note
(4) The recommendations for the prevention of initial disease and recurrence apply to children as well as to adolescents and adults.

Note Regarding Pregnancy
(5) Oral acyclovir prophylaxis in late pregnancy is a controversial strategy recommended by some experts to prevent neonatal herpes transmission. However, such prophylaxis is not routinely recommended. For patients who have frequent, severe recurrences of genital HSV disease, acyclovir prophylaxis may be indicated (BIII). No pattern of adverse pregnancy outcomes has been reported after acyclovir exposures.

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