Herpes Simplex Virus (HSV)

Diagnosis and treatment

Diagnosis:
Identification of HSV-DNA by nucleic acid amplification techniques (NAT) in skin lesions is useful to confirm clinical diagnosis and enables differentiation of HSV-1 vs. HSV-2 vs. VZV.
Identification of HSV-DNA in CSF, aqueous humor or tissue biopsy is recommended for diagnosis of infection of specific sites. Tissue antigen detection may be used when NAT is not available

Notes on treatment:
for treatment optimization, see Anti-infective/ART interaction table

	Drug / Dose	Comments
Initial and recurrent genital/ mucocutaneous HSV		See Sexually transmitted infections
Severe mucocutaneous lesions	aciclovir 5 mg/kg tid iv	After lesions begin to regress, switch to oral treatment for 21-28 days or longer, until lesions have healed
Encephalitis, retinitis or infection of other sites (e.g., GI)	aciclovir 10 mg/kg tid iv	14-21 days If retinitis, consult ophthalmologist
In case of aciclovir resistance or toxicity	foscarnet 90 mg/kg bid iv	Until clinical response If foscarnet is not available, cidofovir 5 mg/kg once weekly can be used. Topical cidofovir and foscarnet can be used for external lesions

Drug / Dose

Comments

Initial and recurrent genital/
mucocutaneous HSV

See Sexually transmitted infections

Severe mucocutaneous lesions

aciclovir
5 mg/kg tid iv

After lesions begin to regress, switch to oral treatment for 21-28 days or longer, until lesions have healed

Encephalitis, retinitis or infection of other sites (e.g., GI)

aciclovir
10 mg/kg tid iv

14-21 days
If retinitis, consult ophthalmologist

In case of aciclovir resistance or toxicity

foscarnet
90 mg/kg bid iv

Until clinical response
If foscarnet is not available, cidofovir 5 mg/kg once weekly can be used.
Topical cidofovir and foscarnet can be used for external lesions