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Hsv medicine

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CDC genital herpes treatment acyclovir valacyclovir famciclovir guidelines

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genital herpes AND antiviral treatment

For HSV (herpes simplex virus), the main antiviral medicines are:
  • Acyclovir
  • Valacyclovir (converts to acyclovir, usually fewer daily doses)
  • Famciclovir
They treat outbreaks and reduce recurrence and transmission risk, but do not eliminate HSV from the body.
For genital herpes, CDC guidance includes:
SituationCommon oral options
First genital outbreakAcyclovir 400 mg 3 times/day, valacyclovir 1 g twice/day, or famciclovir 250 mg 3 times/day for 7-10 days
Recurrent outbreakShort courses, started within 24 hours of symptoms or during tingling/burning prodrome
Frequent recurrences / reducing HSV-2 transmissionDaily suppressive treatment, commonly valacyclovir 500 mg or 1 g once daily, or acyclovir 400 mg twice daily
Key points:
  • Tablets are preferred. Topical antiviral creams are generally not recommended for genital HSV because benefit is minimal.
  • Kidney disease, pregnancy, immune suppression, severe pain, inability to pass urine, eye symptoms, or widespread rash need clinician assessment and sometimes different treatment.
  • Avoid sex during sores or warning symptoms. Condoms reduce, but do not fully remove, transmission risk.
  • HSV lesions should ideally be confirmed with a swab PCR test if a new outbreak is present.
Which type do you mean: cold sores (oral HSV), genital herpes, shingles, or a suspected HSV exposure?

According to harrioson

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Harrison's Principles of Internal Medicine genital herpes acyclovir valacyclovir famciclovir treatment

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genital herpes AND antiviral treatment

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According to Harrison’s Principles of Internal Medicine, 22nd ed. (2025), medicines for genital HSV are acyclovir, valacyclovir, and famciclovir.
Clinical settingAdult oral regimen
First episodeAcyclovir 400 mg three times daily, or 200 mg five times daily for 7-10 days
Valacyclovir 1 g twice daily for 7-10 days
Famciclovir 250 mg three times daily for 7 days
Recurrent episodeAcyclovir 800 mg three times daily for 3-4 days, or 800 mg twice daily for 5 days*
Valacyclovir 500 mg twice daily for 2 days, or 1 g once daily for 5 days
Famciclovir 1 g twice in 1 day, or 125 mg twice daily for 5 days*
Suppressive therapyAcyclovir 400 mg twice daily
Valacyclovir 500 mg or 1 g once daily
Famciclovir 250 mg twice daily
*The source table text is partially OCR-distorted in places. For an active prescription, confirm the exact regimen against a current local guideline or clinician. The current CDC HSV guidance is a useful cross-check.
Harrison’s key points
  • These drugs are activated preferentially in HSV-infected cells and inhibit viral DNA polymerase.
  • Valacyclovir has much better oral absorption than acyclovir, resulting in fewer daily doses.
  • Oral treatment is used for outpatient disease. IV acyclovir is for severe illness requiring admission.
  • Valacyclovir can suppress genital-herpes recurrences and reduce genital HSV transmission.
  • Reduce acyclovir or valacyclovir doses in renal impairment. Maintain hydration, especially with IV acyclovir, because crystal-related kidney injury can occur.
  • Acyclovir-resistant HSV is uncommon in immunocompetent people. In resistant disease, foscarnet is generally used.
Harrison’s Principles of Internal Medicine, 22nd ed., Table 96-1, p. 1529; antiviral-drug discussion, pp. 1528-1529.

Whole disease

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For the whole disease of Herpes Simplex Virus (HSV) according to Harrison’s, the main areas are:
  1. Etiology and virology
    HSV-1 and HSV-2, transmission, latency in sensory ganglia, and reactivation.
  2. Epidemiology and risk factors
    Oral versus genital infection, asymptomatic shedding, sexual and perinatal transmission.
  3. Clinical manifestations
    • Gingivostomatitis and herpes labialis
    • Genital herpes
    • Herpetic whitlow
    • Keratitis
    • Eczema herpeticum
    • Encephalitis and meningitis
    • Neonatal HSV
    • Disseminated/severe infection in immunocompromised people
  4. Diagnosis
    Lesion PCR, viral culture, type-specific serology, CSF PCR for encephalitis, and differential diagnosis of genital ulcers.
  5. Treatment
    Acyclovir, valacyclovir, famciclovir; episodic versus suppressive treatment; IV acyclovir for severe disease; resistant HSV.
  6. Complications and special situations
    Pregnancy and neonatal prevention, HIV/immunosuppression, renal dose adjustment, transmission counseling.
Brief overview: HSV establishes lifelong latent infection after primary infection, then may reactivate periodically. Many infections are asymptomatic, but viral shedding can still transmit infection. Mucocutaneous disease is treated with oral antivirals; encephalitis, disseminated disease, neonatal infection, and severe immunocompromised-host disease require urgent IV acyclovir.
Which section should I explain in full first?
  1. Genital herpes
  2. Oral herpes and skin disease
  3. HSV encephalitis
  4. Diagnosis and tests
  5. Treatment and drug regimens
  6. Pregnancy and neonatal HSV
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