Herpes treatment guidelines

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What you should know about herpes. How to get diagnosed? How can I know if I have HSV? Is cold sore treatable?

Herpes treatment guidelines

Overview of Herpes Simplex Virus (HSV)


Herpes is a common STI caused by the herpes simplex virus (HSV). Common symptoms of herpes include blisters or sores around the area of infection. Sores caused by HSV can vary depending on where the virus enters your system. Herpes is known to have recurrent outbreaks, and once you contract the virus, HSV can remain in your body forever.

 

Active cold sores or an episode of a herpes outbreak can increase the risk of HIV infection, especially with genital herpes. If you notice symptoms that could be signs of an HSV infection, it is suggested that you also get tested for HIV. The sooner you get checked, the more likely the preventative treatment will be successful. Contact us at info.bkk@pulse-clinic.com for more information or chat with us at any of the following platforms:

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How is Herpes Transmitted?


Herpes is arguably the most common STD, as it is one of the most easily transmitted viruses. Skin-to-skin contact with someone who has the virus is enough to get infected, especially during an outbreak. There is a high likelihood that you know someone with herpes. Many people with herpes may not realize they have it, but their herpes can still be infectious. The only way to be sure is to get tested.

It is uncommon to transmit genital herpes when someone with HSV performs oral sex. However, while the strain of HSV that causes oral and genital herpes might be less likely to cause infection in the other area, there is still a chance that cold sores can cause genital herpes in a sexual partner through contact.

 

Getting Diagnosed for Herpes


Around 67% of the world's population has oral herpes, according to WHO’s estimation. You might have contracted herpes but show no symptoms most of your life. Most of the time, HSV will show no symptoms or very minor symptoms that are often mistaken for something else.

Getting tested for herpes is the only way to be sure you have HSV in your body, which can be done easily with a simple blood test and/or sore swab test. Symptoms of herpes can sometimes also be confused with syphilis, which requires different treatment. Getting a comprehensive test that can identify various STDs would be a useful tool for you to know more about your status.

PULSE Clinic offers a PCR28 test, a comprehensive test for STDs that can detect 28 viruses, fungi, and bacteria that cause STDs. This test can help you know more about your status so you can have a safer sex life. Contact us for more information about getting tested with PCR28.

 

Why Should I Get Diagnosed for Herpes?


Though there aren’t any treatments that can effectively eliminate HSV from our body, knowing that you have herpes can be useful information for you and your sexual partners, as herpes can lead to other complications such as:

  • Increased Risk of Other STDs: Active cold sores increase the risk of getting other STDs, including HIV. Knowing you have HSV can help you take care of yourself and abstain from sex during recurrent episodes to avoid the risk of getting other STDs or spreading HSV to your partners.
  • Transmission to Newborns: People often unknowingly spread herpes to newborn babies. Many people contract herpes this way when they are very young from kisses and touches from adults. Herpes in small children can be dangerous, with severe symptoms that can even lead to death in some cases.

Knowing you have herpes can help you take better care of your body during an episode. You might get antiviral medication to help recover faster from cold sores or use other remedies to relieve pain, while being sure that your symptoms are just a herpes outbreak, not a sign of syphilis or other diseases.

It is suggested that if you show signs of genital herpes, you should also get tested for HIV as a safety precaution, as herpes can increase the risk of contracting HIV. Knowing your status and observing the symptoms of HSV infection can help you plan a safe sex strategy better.

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Herpes treatment guidelines


Herpes is also known as genital herpes, cold sore, herpes simplex virus, HSV. It is a common STI, caused by the herpes simplex virus (HSV) and can be passed on by skin-to-skin contact during sexual contact. There are two types of herpes, which will show symptoms differently. 

 

Types of Herpes


  • HSV type 1 is mainly transmitted by oral-to-oral contact to cause oral herpes (which can include symptoms known as 'cold sore'), but can also cause genital herpes.
  • HSV type 2 is a sexually transmissible infection that causes genital herpes.

 

Causes of Herpes


  • Genital HSV infection may be acquired from either symptomatic or asymptomatic partners, and from either genital or oral sexual contact.
  • Most infections are caused by HSV type 2 but an increasing number of genital infections are due to HSV type 1.

 

Clinical presentation


  • Most HSV infections are asymptomatic.
  • Clinical manifestations depend on the site of viral entry and immunity from previous exposure.
  • Manifestations of newly acquired infection may be severe in non-immune persons who have had no previous exposure.
  • Sexually acquired manifestations include genital ulceration, gingivostomatitis, urethritis, cervicitis and proctitis.

 

Diagnosis


Test

Site/ Specimen

Comments

PCR

Swab of lesion

HSV is usually a clinical diagnosis accompanied by a swab for HSV PCR.

HSV serology

Blood

Serology should not be used in screening and only ordered when there are clear individual clinical indications.

The practitioner who orders HSV serology should have a clear understanding of the positive and negative predictive values of the test result.

 

Management


Condition

Recommended

Extra comments

Primary HSV or initial presentation

Aciclovir 400 mg PO, 3 times a day for 7-10 days

OR

Valaciclovir 500 mg PO, twice daily for 7-10 days

  • Treatment with antiviral medications is most effective when started early, but there are benefits with initiating treatment well after the onset of symptoms.
  • Offer lignocaine 2% jelly or LMX4 cream topically. Exercise caution with topical anaesthetic agents as they may cause sensitisation with prolonged use.
  • Offer paracetamol/codeine for pain relief.
  • Consider antifungal medication (preferably oral) for thrush if present.
  • Consider oral antibiotics if secondary bacterial infection is suspected.
  • Topical antivirals and antibiotics are ineffective.
  • Education and counselling for psychosocial effects of reactivation and reoccurrences.

Recurrent HSV (episodic therapy)

Famciclovir 1g PO stat and repeated in 12 hours

OR

Valaciclovir 500 mg PO, twice daily for 5 days

OR

Famciclovir 500 mg PO, stat and three further doses of 250 mg at 12-hourly intervals

OR

Aciclovir 800 mg PO, three times a day for 2 days

  • Viral replication during recurrent episodes lasts for only 1-2 days, so episodic therapy should be commenced within 24 hours of symptom onset and the earlier the better.
  • 1 day antiviral courses are as effective as longer courses. Valaciclovir 2g PO stat and repeated in 12 hours has been shown to be effective but is not PBS approved in Australia.

Recurrent HSV (suppressive therapy)

Aciclovir 400 mg PO, twice a day

OR

Famciclovir 250 mg PO, twice a day

OR

Valaciclovir 500 mg PO, daily

  • Patients who have frequent recurrences (10 or more per year) may require valaciclovir 500 mg tablets bd or 1g daily.
  • Patients with proven genital herpes who have > 6 episodes annually are likely to experience substantial reduction in frequency of outbreaks on suppressive therapy.
  • All patients should be given information on advantages and disadvantages of suppressive therapy in the context of their overall clinical care.
  • Treatment may be interrupted at 6 months to evaluate natural history. A single episode after stopping suppressive therapy is not necessarily an indication for recommencement of suppression.

People living with HIV with normal CD4 counts

 

Antiviral doses and duration is the same as for those without HIV.

People living with HIV who have moderate to severe immunosuppression

 

  • Initial or primary infections should be treated with twice the usual dose. If new lesions continue to develop 3-5 days after treatment has started, a further increase in dose may be necessary. Treatment should be continued until re-epithelialisation has occurred, which may exceed 10 days.
  • For episodic treatment of recurrences not responding to standard doses, use twice the usual dose and continue treatment for 5 days or longer, depending on clinical response.
  • Suppressive therapy should be given at least twice daily. The usual doses are usually effective, but may be doubled if recurrences are not satisfactorily controlled.
  • Non-healing lesions may be seen in both severe immunodeficiency and as part of an immune reconstitution inflammatory syndrome following commencement of antiretroviral therapy. Such lesions require referral for further virological assessment and topical and/or intravenous therapy.

 


Related treatment guidelines

 
 

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