Herpes Simplex

INTRODUCTION

HERPES LABIALIS (CLASSICAL COLD SORES)

The objective is to limit the size and intensity of the lesions.

Topical treatment At the first sensation of the development of a cold sore (preferably at the prodrome stage):

• apply an ice cube to the site for up to 5 mins every 60 mins (for first 12 h) or

• other topical applications include:

  • – idoxuridine 0.5% preparations (Herplex D liquifilm, Stoxil topical, Virasolve) applied hrly day 1 then 4 hrly or

  • – povidone-iodine 10% cold sore paint: apply on swab sticks 4 times a day until disappearance or

  • – aciclovir 5% cream or penciclovir 1% cream, 4 hrly while awake for 4 d

Oral treatment for severe attack

One of:

• famciclovir 500 mg (o) bd for 7 d

• valaciclovir 1 mg (o) bd for 7 d

• aciclovir 400 mg (o) 5 times/d for 7 d

Aciclovir can be used in children.

Oral treatment for recurrent episodes

One of:

• aciclovir 400 mg (o) 5 times/d for 5 d

• famciclovir 1500 mg (o) as a single dose

• valaciclovir 2g (o) bd for 1 d

Prevention If exposure to the sun precipitates the cold sore, use a 30+ sun protection lip balm, ointment or solastick. Zinc sulphate solution can be applied once a wk for recurrences. Oral aciclovir 400 mg bd or valaciclovir 500 mg/d (6 mths) can be used for severe and frequent recurrences (>6/yr).

GENITAL HERPES

Topical treatment Pain relief can be provided in some patients with topical lignocaine 2% gel. Saline baths and analgesics are advisable.

Oral treatment For the first episode of primary genital herpes (preferably within 24 h of onset) one of the guanine analogues can be used.

• Aciclovir: 400 mg tds for 5–10 d or until resolution of infection or

• Valaciclovir: 500 mg (o) bd for 5–10 d

For recurrent episodes, use:

• valaciclovir 500 mg (o) bd for 3 d

• famciclovir 250 mg (o) 4 tablets stat, rpt 12 hrs

Very frequent recurrences (≥6 in 6 mths) benefit from continuous low-dose therapy for 6 mths (e.g. valaciclovir 500 mg (o) once daily).

ECZEMA HERPETICUM

• Aciclovir 400 mg (o) 5 times/d or

• Famciclovir 500 mg (o) bd or

• Valaciclovir 1 g (o) bd until healed.

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