Antiviral medications and doses for genital herpes in pregnancy

Indication	Acyclovir	Valacyclovir
First-episode infection*	400 mg orally three times daily for 7 to 10^¶ days	1 g orally twice daily for 7 to 10^¶ days
Symptomatic recurrent episode	800 mg orally twice daily for 5 days or 800 mg orally three times daily for 2 days	500 mg orally twice daily for 3 days or 1 g orally daily for 5 days
Daily suppressive therapy (from 36 weeks of gestation until onset of labor)^Δ	400 mg orally three times daily	500 mg orally twice daily
Severe or disseminated disease	5 to 10 mg/kg intravenously every 8 hours until clinical improvement, then oral therapy for primary infection to complete 10 days of total therapy. Longer duration (total of 14 to 21 days) is recommended for patients with CNS complications.

Because of lack of human pregnancy data and the availability of alternative drugs, famciclovir is generally not used to treat/suppress HSV in pregnancy.

HSV: herpes simplex virus; CNS: central nervous system.
* This includes first occurrence of a genital HSV lesion in patients with no preexisting HSV antibodies (primary infection) and in patients with preexisting HSV antibodies of a different type than the HSV recovered from the genital lesion (nonprimary first-episode infection).
¶ Treatment may be extended if healing is incomplete after 10 days.
Δ Suppressive therapy is offered to women who have had a genital HSV lesion (whether a first-episode or recurrent infection) any time during the pregnancy.

Data from: Centers for Disease Control and Prevention. 2021 Sexually Transmitted Diseases Treatment Guidelines. Available at: https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf (Accessed on December 20, 2021).

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Antiviral medications and doses for genital herpes in pregnancy