Treatment of herpes simplex virus type 1 infection in immunocompetent patients
- Robyn S Klein, MD, PhD
Robyn S Klein, MD, PhD
- Associate Professor of Medicine
- Washington University School of Medicine
Herpes simplex virus type 1 (HSV-1) may cause vesicular lesions of the lips and oral mucosa. HSV-1 can also lead to clinical disease in a wide variety of other anatomic locations, including the genitalia, liver, lung, eye, and central nervous system.
The treatment of primary and recurrent HSV-1 infections in the immunocompetent host will be reviewed here. The epidemiology, clinical manifestations, diagnosis and prevention of this infection are discussed elsewhere. (See "Epidemiology of herpes simplex virus type 1 infection" and "Clinical manifestations and diagnosis of herpes simplex virus type 1 infection" and "Prevention of herpes simplex virus type 1 infection in immunocompetent patients".)
The treatment and prophylaxis of HSV-1 infections in the immunocompromised patient are discussed elsewhere. (See "Prevention of infections in hematopoietic cell transplant recipients".)
The principal clinical manifestation of primary HSV-1 infection is gingivostomatitis, sometimes associated with pharyngitis.
Reactivation of prior HSV-1 infection occurs in the trigeminal sensory ganglion. Reactivation may lead to cutaneous, and more commonly, mucocutaneous disease, known as herpes labialis, which occurs along the vermillion border of the lip. In general, symptomatic primary HSV infections (ie, initial HSV infection in a seronegative host) are associated with an increased risk of constitutional symptoms, a longer duration of lesions, and prolonged viral shedding compared with recurrent disease. (See "Clinical manifestations and diagnosis of herpes simplex virus type 1 infection".)
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- AVAILABLE AGENTS
- PRIMARY INFECTION
- Age of onset
- Antiviral treatment
- Timing of therapy
- Adjuvant therapy
- Suggestions for clinical management
- RECURRENT INFECTIONS
- Management strategies
- - No treatment
- - Episodic treatment
- - Topical antiviral therapy
- - Oral antiviral therapy
- - Chronic suppressive therapy
- Prophylaxis for recurrent HSV with specific trigger
- OTHER HSV-1 INFECTIONS
- - Atopic eczema, burns, and other skin disorders
- Ocular infections
- Central nervous system
- Genital ulcers
- FUTURE DRUG DEVELOPMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS