| First clinical episode of genital HSV infection | |
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For adults and adolescents with a first clinical episode of genital HSV infection, the WHO STI guideline recommends treatment over no treatment.
Remarks: This recommendation also applies to people living with HIV, people who are immunocompromised, people with a severe episode and pregnant women. | Strong recommendation, moderate quality evidence |
For adults and adolescents with a first clinical episode of genital HSV infection, the WHO STI guideline suggests a standard dose of aciclovir over valaciclovir or famciclovir.
Dosages:
aciclovir 400 mg orally thrice daily for 10 days (standard dose) aciclovir 200 mg orally five times daily for 10 days valaciclovir 500 mg orally twice daily for 10 days famciclovir 250 mg orally thrice daily for 10 days
Remarks: Given that follow-up visits may not be possible during the course of treatment and symptoms of the first clinical episode may be prolonged, therapy is provided for 10 days. Although the benefits of the medicines are probably similar, the costs of valaciclovir and famciclovir are higher than aciclovir, and therefore aciclovir is preferred. The choice of medicine may also depend on compliance considerations. This recommendation also applies to people living with HIV, people who are immunocompromised, people with a severe episode and pregnant women. | Conditional recommendation, moderate quality evidence |
| Recurrent clinical episode of genital HSV infection (episodic therapy) | |
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For adults and adolescents with a recurrent clinical episode of genital HSV infection, the WHO STI guideline suggests treatment over no treatment.
Remarks: Treatment should be given within the first 24 hours of the onset of symptoms or during the prodromal phase. That recommendation also applies to people living with HIV, people who are immunocompromised and pregnant women. | Conditional recommendation, moderate quality evidence |
For adults and adolescents with a recurrent clinical episode of genital HSV infection, the WHO STI guideline suggests the use of aciclovir over valaciclovir or famciclovir.
Dosages for adults, adolescents and pregnant women:
aciclovir 400 mg orally thrice daily for 5 days, 800 mg twice daily for 5 days, or 800 mg thrice daily for 2 days valaciclovir 500 mg orally twice daily for 3 days famciclovir 250 mg orally twice daily for 5 days
Dosages for people living with HIV and people who are immunocompromised:
aciclovir 400 mg orally thrice daily for 5 days valaciclovir 500 mg orally twice daily for 5 days famciclovir 500 mg orally twice daily for 5 days
Remarks: Although the benefits of the medicines are probably similar, the costs of valaciclovir and famciclovir are higher than aciclovir, and therefore aciclovir is preferred. The choice of dosage may depend on compliance considerations. Treatment should be given within the first 24 hours of the onset of symptoms or during the prodromal phase. | Conditional recommendation, moderate quality evidence |
| Recurrent clinical episodes of genital HSV infection that are frequent, severe or cause distress (suppressive therapy) | |
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For adults and adolescents with recurrent clinical episodes of genital HSV infection that are frequent, severe or cause distress, the WHO STI guideline suggests suppressive therapy over episodic therapy, and reassessment after one year.
Remarks: Individuals who have frequent recurrences (e.g. 4–6 times a year or more), severe symptoms or episodes which cause distress will likely choose suppressive therapy over episodic therapy. To determine frequency or severity, episodes can be monitored for the first few months. This recommendation also applies to people living with HIV, people who are immunocompromised and pregnant women. | Conditional recommendation, moderate quality evidence |
For adults and adolescents with recurrent clinical episodes of genital HSV infection that are frequent, severe or cause distress, the WHO STI guideline suggests aciclovir over valaciclovir or famciclovir for suppressive therapy.
Dosages for adults, adolescents and pregnant women:
aciclovir 400 mg orally twice daily valaciclovir 500 mg orally once daily famciclovir 250 mg orally twice daily
Dosages for people living with HIV and people who are immunocompromised:
aciclovir 400 mg orally twice daily valaciclovir 500 mg orally twice daily famciclovir 500 mg orally twice daily
Remarks: Individuals who have frequent recurrences (e.g. 4–6 times a year or more), severe symptoms or episodes which cause distress will likely choose suppressive therapy over episodic therapy. To determine frequency or severity, episodes can be monitored for the first few months. Although the benefits of the medicines may be similar, the costs of valaciclovir and famciclovir are higher than aciclovir, and therefore aciclovir is preferred. The choice of medicine may also depend on compliance considerations. | Conditional recommendation, low quality evidence |
