Cleveland Clinic Journal of MedicineIs There a Role for Chronic Suppressive Therapy in Herpes Simplex Virus Infection?

Navigating the Complexities of Chronic Suppressive Therapy in Herpes Simplex Virus Management

Herpes Simplex Virus (HSV) infection, with its two distinct types, HSV-1 and HSV-2, presents a challenging landscape for medical practitioners, particularly in managing recurrent outbreaks and reducing transmission risks. This article provides a “1-Minute Consult” into the intricacies of chronic suppressive therapy, its indications, effectiveness, and the nuanced approach required in treating HSV, providing physicians with critical insights for informed decision-making in clinical practice.

Key Points:

• Chronic suppressive therapy is crucial for reducing the frequency, severity, and duration of herpes simplex virus (HSV) outbreaks, and for lowering the transmission risk.
• HSV-1 primarily causes oral herpes but is increasingly responsible for genital herpes, while HSV-2 predominantly causes genital herpes.
• The initial HSV infection treatment does not impact the recurrence rate of the virus, which remains dormant and can reactivate.
• Antiviral medications like acyclovir, valacyclovir, and famciclovir are the mainstays of both initial treatment and chronic suppressive therapy.
• Chronic suppressive therapy is particularly recommended for patients with recurrent genital HSV-2 infection, significantly decreasing outbreak frequency and transmission risk.
• There is no consensus on the benefit of chronic suppressive therapy for recurrent genital HSV-1 infection due to its lower recurrence rate.
• The choice between episodic and chronic suppressive therapy should be tailored to the individual’s outbreak frequency, severity, and potential transmission risk.
• Serologic and virologic testing play key roles in differentiating between HSV-1 and HSV-2, guiding appropriate management strategies.
• Patients on chronic suppressive therapy should undergo annual evaluations to assess the necessity of continuing treatment.

The prevalence of herpes simplex virus (HSV) type 2 infections in the general population ranges from 10% to 60%, and the risk of HIV acquisition is three times higher in people with HSV-2.

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