Mucocutaneous
For genital herpes simplex, see Genital section, Genital ulcers/lesions.
Immunocompetent
Primary (gingivostomatitis)
- Therapy should be started within 72 hours of symptom onset, or at any time if new lesions forming.
- Topical therapy not recommended as ineffective.
Usual Pathogens
Herpes simplex
| Therapy | Dose | Duration |
|---|---|---|
| Famciclovir | 500mg PO bid | 7 days |
| or | ||
| Valacyclovir | 500mg - 1g PO bid | 7 days |
| or | ||
| Acyclovir | 400mg PO tid | 7 days |
Recurrent (fever blisters, cold sores)
- No role for topical acyclovir.
Herpes simplex
No therapy indicated unless recurrences are:
-
severe
and ≥ 6 episodes/year
Symptomatic therapy
| Therapy | Dose | Duration |
|---|---|---|
| Famciclovir | 1500mg PO daily | 1 day |
| or | ||
| Valacyclovir | 2g PO bid | 1 day |
| or | ||
| Acyclovir | 400mg PO tid | 5 days |
or
Suppressive therapy
| Therapy | Dose | Duration |
|---|---|---|
| Valacyclovir | 500mg PO daily | |
| or | ||
| Acyclovir | 400mg PO bid |
Immunocompromised
- HIV patients and transplant recipients may benefit from suppressive acyclovir therapy 200-400mg PO bid-tid.
Usual Pathogens
Herpes simplex
| Therapy | Dose | Duration |
|---|---|---|
| Famciclovir | 500mg PO bid | 7-10 days |
| or | ||
| Valacyclovir | 500mg-1g PO bid | 7-10 days |
| or | ||
| Acyclovir | 400mg PO 5x/day | 7-10 days |