Herpes Simplex Virus Disease
Prevention of Exposure
HIV-infected persons should use latex condoms during every act of sexual
inter-course to reduce the risk of exposure to herpes simplex virus (HSV)
and to other sexually transmitted pathogens. They should specifically
avoid sexual contact when herpetic lesions (genital or orolabial) are evident
(AII).
Prevention of Disease
Prophylaxis of initial episodes of HSV disease is not recommended
(DIII).
Prevention of Recurrence
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 can be administered daily
suppressive therapy with oral acyclovir. 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. Topical preparations
of foscarnet and cidofovir also are available.
Notes:
Pediatric Note
The recommendations for the prevention of initial disease and recurrence
apply to children as well as to adolescents and adults.
Note Regarding Pregnancy
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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