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".)
Subscribers log in hereLiterature review current through: May 2017. | This topic last updated: Sep 25, 2015.References
- Whitley RJ, Gnann JW Jr. Acyclovir: a decade later. N Engl J Med 1992; 327:782.
- Tyring SK, Baker D, Snowden W. Valacyclovir for herpes simplex virus infection: long-term safety and sustained efficacy after 20 years' experience with acyclovir. J Infect Dis 2002; 186 Suppl 1:S40.
- Amir J, Harel L, Smetana Z, Varsano I. Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. BMJ 1997; 314:1800.
- Ducoulombier H, Cousin J, Dewilde A, et al. [Herpetic stomatitis-gingivitis in children: controlled trial of acyclovir versus placebo]. Ann Pediatr (Paris) 1988; 35:212.
- O'Brien JJ, Campoli-Richards DM. Acyclovir. An updated review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy. Drugs 1989; 37:233.
- Rodu B, Mattingly G. Oral mucosal ulcers: diagnosis and management. J Am Dent Assoc 1992; 123:83.
- Vestey JP, Norval M. Mucocutaneous infections with herpes simplex virus and their management. Clin Exp Dermatol 1992; 17:221.
- Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
- Chauvin PJ, Ajar AH. Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. J Can Dent Assoc 2002; 68:247.
- Cernik C, Gallina K, Brodell RT. The treatment of herpes simplex infections: an evidence-based review. Arch Intern Med 2008; 168:1137.
- Gilbert SC. Management and prevention of recurrent herpes labialis in immunocompetent patients. Herpes 2007; 14:56.
- Spruance SL, Rea TL, Thoming C, et al. Penciclovir cream for the treatment of herpes simplex labialis. A randomized, multicenter, double-blind, placebo-controlled trial. Topical Penciclovir Collaborative Study Group. JAMA 1997; 277:1374.
- Spruance SL, Nett R, Marbury T, et al. Acyclovir cream for treatment of herpes simplex labialis: results of two randomized, double-blind, vehicle-controlled, multicenter clinical trials. Antimicrob Agents Chemother 2002; 46:2238.
- Sacks SL, Thisted RA, Jones TM, et al. Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: A multicenter, randomized, placebo-controlled trial. J Am Acad Dermatol 2001; 45:222.
- McCarthy JP, Browning WD, Teerlink C, Veit G. Treatment of herpes labialis: comparison of two OTC drugs and untreated controls. J Esthet Restor Dent 2012; 24:103.
- McKeough MB, Spruance SL. Comparison of new topical treatments for herpes labialis: efficacy of penciclovir cream, acyclovir cream, and n-docosanol cream against experimental cutaneous herpes simplex virus type 1 infection. Arch Dermatol 2001; 137:1153.
- Bernstein DI, Spruance SL, Arora SS, et al. Evaluation of imiquimod 5% cream to modify the natural history of herpes labialis: a pilot study. Clin Infect Dis 2005; 41:808.
- Arduino PG, Porter SR. Oral and perioral herpes simplex virus type 1 (HSV-1) infection: review of its management. Oral Dis 2006; 12:254.
- Jensen LA, Hoehns JD, Squires CL. Oral antivirals for the acute treatment of recurrent herpes labialis. Ann Pharmacother 2004; 38:705.
- Spruance SL, Stewart JC, Rowe NH, et al. Treatment of recurrent herpes simplex labialis with oral acyclovir. J Infect Dis 1990; 161:185.
- Spruance SL, Bodsworth N, Resnick H, et al. Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpes labialis. J Am Acad Dermatol 2006; 55:47.
- Spruance SL, Jones TM, Blatter MM, et al. High-dose, short-duration, early valacyclovir therapy for episodic treatment of cold sores: results of two randomized, placebo-controlled, multicenter studies. Antimicrob Agents Chemother 2003; 47:1072.
- Valacyclovir (valtrex) for herpes labialis. Med Lett Drugs Ther 2002; 44:95.
- Worrall G. Acyclovir in recurrent herpes labialis. BMJ 1996; 312:6.
- Rooney JF, Straus SE, Mannix ML, et al. Oral acyclovir to suppress frequently recurrent herpes labialis. A double-blind, placebo-controlled trial. Ann Intern Med 1993; 118:268.
- Baker D, Eisen D. Valacyclovir for prevention of recurrent herpes labialis: 2 double-blind, placebo-controlled studies. Cutis 2003; 71:239.
- Green JA, Spruance SL, Wenerstrom G, Piepkorn MW. Post-herpetic erythema multiforme prevented with prophylactic oral acyclovir. Ann Intern Med 1985; 102:632.
- Nikkels AF, Pièrard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol 2002; 3:475.
- Arduino PG, Porter SR. Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features. J Oral Pathol Med 2008; 37:107.
- Kesson AM. Use of aciclovir in herpes simplex virus infections. J Paediatr Child Health 1998; 34:9.
- Meulener M, Smith BL. Herpes gladiatorum with ocular involvement in a mixed martial arts fighter. Cutis 2011; 87:146.
- Usatine RP, Tinitigan R. Nongenital herpes simplex virus. Am Fam Physician 2010; 82:1075.
- Moedy JL, Lerman SJ, White RJ. Fatal disseminated herpes simplex virus infection in a healthy child. Am J Dis Child 1981; 135:45.
- Foley FD, Greenawald KA, Nash G, Pruitt BA Jr. Herpesvirus infection in burned patients. N Engl J Med 1970; 282:652.
- Fidler PE, Mackool BT, Schoenfeld DA, et al. Incidence, outcome, and long-term consequences of herpes simplex virus type 1 reactivation presenting as a facial rash in intubated adult burn patients treated with acyclovir. J Trauma 2002; 53:86.
- Mantry P, Desai D, Kumar V, Udwadia T. Herpes simplex hepatitis. Indian J Gastroenterol 1997; 16:33.
- Furuta Y, Fukuda S, Chida E, et al. Reactivation of herpes simplex virus type 1 in patients with Bell's palsy. J Med Virol 1998; 54:162.
- Crute JJ, Grygon CA, Hargrave KD, et al. Herpes simplex virus helicase-primase inhibitors are active in animal models of human disease. Nat Med 2002; 8:386.
- Kleymann G, Fischer R, Betz UA, et al. New helicase-primase inhibitors as drug candidates for the treatment of herpes simplex disease. Nat Med 2002; 8:392.
- Chono K, Katsumata K, Kontani T, et al. ASP2151, a novel helicase-primase inhibitor, possesses antiviral activity against varicella-zoster virus and herpes simplex virus types 1 and 2. J Antimicrob Chemother 2010; 65:1733.
- 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