New Directions In STD Treatment - University of Hawaii

Genital Herpes – Treatment Issues
� Initial Infection
� Treat because may develop severe or prolonged symptoms later
� Established Infection
� Suppressive therapy discussed first as if preferred over episodic therapy
for both HIV negative and positive individuals with recurrent outbreaks
� Benefits of suppressive therapy now include reducing risk of
transmission in addition to clinical benefit of decreasing symptoms and
recurrences
� Indication for suppressive therapy to reduce transmission include:
� Discordant heterosexual couples where the partner has a hx of genital HSV
� Persons with multiple partners including MSM
� Persons who are HSV-2 seropositive without a history of genital HSV
� No studies in discordant pregnant couples
� Options of suppression and episodic therapy should be discussed
� Higher doses of antivirals not recommended for rectal and oral
infections