Isolation of HSV in tissue culture or demonstration of HSV antigens or DNA in scrapings from lesions is the most accurate diagnostic method. PCR is increasingly being used for detection of HSV DNA and is more sensitive than culture at mucosal sites. Staining of scrapings from the base of the lesion with Wright's, Giemsa's (Tzanck preparation), or Papanicolaou's stain to detect giant cells or intranuclear inclusions is well described, but most clinicians are not skilled in these techniques, which furthermore do not differentiate between HSV and VZV.
Treatment: HSV Genital Infections - First episodes: Oral acyclovir (400 mg tid), valacyclovir (1 g bid), or famciclovir (250 mg bid) for 7-14 days is effective.
- Symptomaticrecurrent episodes: Oral acyclovir (800 mg tid for 2 days), valacyclovir (500 mg bid for 3 days), or famciclovir (750 or 1000 mg bid for 1 day, 1500 mg once, or 500 mg stat followed by 250 mg q12h for 3 days) effectively shortens lesion duration.
- Suppression of recurrent episodes: Oral acyclovir (400-800 mg bid) or valacyclovir (500 mg qd) is given. Pts with >9 episodes per year should take valacyclovir (1 g qd or 500 mg bid) or famciclovir (250-500 mg bid). Daily valacyclovir appears to be more effective at reducing subclinical shedding than daily famciclovir.
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