Herpes Simplex Virus (HSV) in Emergency Medicine Treatment & Management

Updated: Jul 16, 2019
  • Author: Melissa Kohn, MD, MS, FACEP, EMT-PHP; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Emergency Department Care

ED care consists of diagnosis and appropriate treatment. The concern for possible infection is the basis of initiating treatment. Most patients may be treated in the outpatient setting. Pregnant patients also need to be educated on the importance of follow-up to reduce transmission to the fetus. [14] Identification of patients who need inpatient treatment (ie, encephalitis) and initiation of antiviral and supportive therapy is imperative. [5]



Ophthalmologist for keratoconjunctivitis

Obstetrician for active genital herpes in a near-term pregnancy

Outpatient dermatologist for differentiation of skin infections

Infectious disease specialist for disseminated disease and encephalitis

The psychological effect of HSV diagnosis may require patients to seek further evaluation. [4]



Patients should be counseled on barrier protection methods to prevent HSV transmission to others. A discussion regarding daily prophylaxis can be conducted outside of the emergency department.

HSV-2 is an STD. Patients and all sexual contacts should be tested and treated for accompanying STDs.

Practice abstinence when lesions are present.

Always use condoms because of the potential for asymptomatic viral shedding.

Health care personnel (especially medical, dental) should use universal precautions (eg, gloves) to prevent herpetic whitlow.

Experimental vaccines are currently in clinical trials.

Use sunscreen to decrease herpes labialis recurrences.


Further Outpatient Care

Pregnant patients need to be closely monitored by their obstetricians to reduce the risk of an outbreak at the time of delivery.

Patients with herpetic keratitis should be monitored by an ophthalmologist to evaluate for permanent damage (eg, blindness).

Any patient with genital herpes may need referral to a psychologist because of the emotional effect of a permanent and socially stigmatizing disease.


Further Inpatient Care

Admission for patients with herpes simplex is necessary in the following instances:

  • Encephalitis, hepatitis, or pneumonitis

  • Severe gingivostomatitis causing decreased ability to tolerate oral fluids

  • Immunocompromised patients with severe or disseminated diseases