http://www.cdc.gov/std/treatment/2010/genital-ulcers.htm#a2
| Treatment action | Topical/behavioral | Oral meds | Testing/Notes |
|---|---|---|---|
| Comfort measures, general care | Sitz bath, gentle cleansing, topical petrolatum; Avoid irritants, daily panty liners, tight clothing, douching, or feminine hygiene products. Cool gel packs may help. Counsel to avoid having sex when having prodromal symptoms or an overt outbreak. For severe pain with urination, have pt dilute urine with a peri-bottle or by sitting in water when voiding. |
Herpes cultures can and should be done at the time of a fresh blister or ulcer. They are not always reliable if negative. Herpes titers can give information about whether or not the patient has ever been exposed to the herpes virus. IgM relates to new-onset infection, IgG to long-term infection. Titers positive for Type 1 will not reveal whether the patient has a history of “cold sores” or whether she has had genital herpes Type 1. Type 2 herpes is almost always located in the genital area.
Herpes can appear in “new” locations in the genital area and may not always look classical with blistering and erosions or ulcers. It can also occur without eruption, with redness and tingling alone. Link to Herpes Simplex in Atlas. |
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| Reduction of itching or pain | Topical xylocaine 5%, applied as needed, usually up to 4-6 times a day (no more than 15 grams a day) Warn the patient that xylocaine stings when first applied. |
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| Anti-viral action for an initial outbreak | Acyclovir 400 mg orally three times a day for 7-10 days OR Acyclovir 200 mg orally five times a day for 7-10 days OR Famciclovir 250 mg orally three times a day for 7-10 days OR Valacyclovir 1 g orally twice a day for 7-10 days |
*Treatment can be extended if healing is incomplete after 10 days of therapy. | |
| Anti-viral treatment for episodic outbreaks | Acyclovir 400 mg orally three times a day for 5 days OR Acyclovir 800 mg orally twice a day for 5 days Acyclovir 800 mg orally three times a day for 2 days OR Famciclovir 125 mg orally twice a day for 5 days OR Famciclovir 1,000 mg orally twice a day for 1 day OR Famciclovir 500 mg once followed by 250 mg twice a day for 2 days OR Valacyclovir 500 mg orally twice a day for 3 days OR Valacyclovir 1 gram orally once a day for 5 days |
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| Anti-viral treatment for suppressive therapy | Acyclovir 400 mg orally twice a day
OR Famiciclovir 250 mg orally twice a day OR Valacyclovir 500 mg orally once a day* OR Valacyclovir 1 gram orally once a day |
*Valacyclovir 500 mg once a day might be less effective than other valacyclovir or acyclovir dosing regimens in patients who have very frequent recurrences (i.e. > 10 episodes per year). Herpes does not always suppress easily and increased dosing may be necessary. |
Updated 7/11/14 Link to Herpes Simplex in the Atlas