Herpes Simplex Virus

In immunosuppressed persons, primary and recurrent herpes simplex lesions are usually more severe, more persistent, more symptomatic and more resistant to treatment. The early vesicular lesions (blisters) may be transient or never seen. In immunosuppressed patients, any erosive mucocutaneous lesion should be regarded as herpes simplex until proven otherwise.

Patients need to be counselled about the following:

The recurrent nature of the lesions, as well as their likely persistence,
The infectiousness of mucocutaneous or genital herpes.
Care of local lesions: keep them clean with frequent (2 to 3 times a day) washing with soap and water and keeping them as dry as possible.
In very severe cases or immunocompromised patients, acyclovir should be given
Bacterial superinfection may complicate lesions and will require antibiotics
Suppressive therapy may be required for frequent (more than 4 to 6 episodes per year) recurrent HSV infections. After 1 year, the situation may be reviewed to either continue or change to episodic treatment or discontinue and assess the clinical situation.

Episodic and Suppressive treatment for herpes simplex

	Medicine	Adult Dose	Frequency	Duration
	acyclovir po	400mg	3 times a day	5 days
or	valaciclovir po	500mg	twice a day	5 days
	acyclovir po	400mg	twice a day	daily for 12 months then review
or	valaciclovir po	500mg	twice a day	daily for 12 months then review