Herpes Simplex Recurrence Patterns & Management

Herpes simplex virus (HSV‑1 oral, HSV‑2 genital) establishes lifelong latency in sensory ganglia. Reactivation frequency varies widely.

Typical Recurrence Patterns

• HSV‑1 (oral): 1–2 outbreaks/year after first year; many become asymptomatic.
• HSV‑2 (genital): median 4–5 outbreaks/year initially; declines over time.
• Asymptomatic shedding: 10–20% days (HSV‑2); major transmission driver.

Triggers

• UV light (HSV‑1), stress, fatigue, illness, menses, immunosuppression, trauma.

Management

Strategy	Details
Episodic therapy	Valacyclovir 1 g BID × 1 day (HSV‑1) or 500 mg BID × 3 d (HSV‑2); start at prodrome.
Suppressive therapy	Valacyclovir 500–1000 mg daily (HSV‑2); reduces outbreaks 70–80%, shedding 90%, transmission 50%.
Topical	Less effective; penciclovir, docosanol.
Lifestyle	Sleep, stress reduction, sun protection.

Special Populations

• Pregnancy: suppressive acyclovir/valacyclovir from 36 wks if history; C‑section if active lesions at labor.
• Immunocompromised: higher doses, IV acyclovir for severe disease.

Counseling Points

• Transmission possible without lesions (asymptomatic shedding).
• Condoms reduce but don’t eliminate risk.
• Partner testing & disclosure.