Herpes simplex virus (HSV)

Herpes simplex virus infections

Diagnosis and treatment

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 Sexual and Reproductive Health Section
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
Aciclovir resistant HSV infection 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