Herpes Simplex - Orolabial (1) and Genital Warts (2)

HSV-1: Patients often report blisters or sores around the mouth, accompanied by tingling, itching, or burning sensations prior to lesion development. They may have a history of oral contact or past oral lesions.

HSV-2: Patients usually present with genital or anal sores and may mention discomfort or pain during urination. Sexual contact history with an affected partner may be reported, as well as recurring outbreaks.

HSV  1:

For the treatment of orolabial herpes, the current recommendation is oral valacyclovir (2 grams twice daily for one day). If the patient has frequent outbreaks, chronic suppression is warranted. For chronic suppression of immunocompetent patients, oral valacyclovir 500 mg daily (for patients with less than ten outbreaks per year) or oral valacyclovir 1 gram by mouth daily (for patients with greater than 10 outbreaks a year) is recommended.

HSV  2:
Acyclovir:

• Primary herpes genitalis: 3 x 400 mg tablets PO daily for 7 to 10 days

• Severe primary herpes genitalis: 3 x 5 mg/kg IV daily for 5 to 7 days

• Recurrent herpes genitalis (less than 5 to 6 episodes/year): 400 mg PO twice a day for 3 days 

• Prophylaxis: 2 x 400 mg PO daily for 6 months

• Recurrent herpes genitalis (less than 5 to 6 episodes/year): 2 x 500 mg PO twice daily for 3 days, or

• 1 x 1000 mg tablet daily for 5 days 

For the treatment of eczema herpeticum, it is recommended to use 10 to 14 days of either acyclovir (15 mg/kg with a 400 mg maximum) 3 to 5 times daily or Valacyclovir 1 gram by mouth twice a day.

For immunocompromised patients with severe and chronic HSV, treatment is aimed at chronic suppression. For chronic suppression of immunocompromised patients, oral acyclovir 400 to 800 2 to 3 times daily, or oral valacyclovir 500 mg twice daily is recommended.

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• Primary infections are very painful: analgesia is indicated.

• Lips: zinc oxide ointment or zinc oxide and castor oil; soothes and protects from sunlight.

• Antiseptic mouthwash e.g. chlorhexidine mouthwash 3-4 times daily and topical antiseptic or antibiotic e.g. betadine ointment or oxytetracycline ointment 3 times daily for bacterial superinfection.

• Use a lip cream / stick with a sunblocker daily to prevent recurrences.

• Genital herpes: Betadine or potassium permanganate solution sit baths 3 times daily. Zinc oxide and castor oil to soothe, or sulphur 5% in zinc oxide. Alternatively betadine ointment or oxytetracycline ointment 3 times daily.