Adult Outpatients: Urogenital Infections: Genital Herpes

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

First Clinical Episode or Anogenital Herpes

HSV 2 = 70-90%

HSV 1 = 10-30% 

Acyclovir 400 mg PO TID x 7-10 days

Valacyclovir 1 g PO BID x 7-10 days 

 

In HIV patients with documented acyclovir resistance, use foscarnet.

Episodic Therapy for Recurrent Episodes

 

 

Acyclovir 400 mg PO  TID x 5 days

OR

Acyclovir 800 mg PO BID x 5 days

OR

Acyclovir 800 mg PO TID x 2 days

Valacyclovir 1 g PO daily x 5 days 

HIV patients:

Acyclovir 400 mg PO TID x 5-10 days

OR

Valacyclovir 1 g PO BID x 5-10 days

Suppression for Frequent Recurrence

HSV 2 = 70-90%
HSV 1 = 10-30%
Acyclovir 400 mg PO BID

 

HIV patients:

Acyclovir 400-800 mg BID or TID

OR

Valacyclovir 500 mg PO BID

Valacyclovir 500-1000 mg PO daily Consider suppressive therapy for patients experiencing greater than 3-4 episodes in 12 months.