Clinical case review

A concerned young woman with a recurrence of genital herpes

Basil Donovan



A 25-year-old woman experienced herpes simplex virus encephalitis during her first episode of genital herpes. Six months later, genital herpes recurs. Is she at risk of recurrent encephalitis?

Article Extract

Case scenario 

Eight months ago, 25-year-old Josie had her first episode of genital herpes simplex virus type 2 (HSV-2) infection (Figure). She was treated within 48 hours of symptom onset with an immediate dose of 1500 mg oral famciclovir, followed by 500 mg twice daily. Despite this treatment, Josie developed HSV encephalitis within five days of the rash appearing and was hospitalised. After discharge, Josie continued famciclovir for a further six months then ceased the medication; within a week she developed genital herpes again and resumed famciclovir. 

Josie is concerned that if she ceases the famciclovir again she could have a reactivation of encephalitis. Is this correct and if so, is this only if she has an outbreak of genital herpes? 

Picture credit: © Micro/
Model used for illustrative purposes only