Preferred Management of HSV-2 Meningitis Varies Among Infectious Disease Specialists

Preferences for the type and duration of antiviral treatment for HSV-2 meningitis varied among infectious disease specialists, suggesting the need for further studies on HSV-2 management.

Treatment measures for herpes simplex virus 2 (HSV-2) meningitis, including indication, type, and duration, were found to significantly vary among infectious disease specialists. These study results were published in Open Forum Infectious Disease.

Researchers emailed a self-administered online survey about the treatment of HSV-2 meningitis to infectious disease specialists in Denmark France, Sweden, and Australia between November 2020 and May 2022. Questions in the survey focused on specialists’ preferred antiviral treatment methodology, including dosages, duration of treatment, and route of administration. The primary objective was to describe variations in the management of HSV-2 meningitis and to determine future research topics.

Among a total of 223 ID specialists who responded to the survey, 45% were women, and 82% fully completed the survey.

Among all survey participants, 39% indicated always using antiviral treatment for patients with HSV-2 meningitis and 10% indicated never using antiviral treatment. Intravenous acyclovir followed by valacyclovir was reported by 61% of participants as the most preferred antiviral treatment regimen, followed by monotherapy with either IV acyclovir (20%) or valacyclovir (19%). Of note, only 1% of participants reported using adjunctive dexamethasone for the treatment of HSV-2 meningitis.

For immunocompromised patients with HSV-2 meningitis, 33% of participants recommended increasing the total treatment duration, 28% recommended increasing the duration of IV treatment, and 23% recommended mandatory antiviral treatment. Long-term prophylactic treatment for recurrent HSV-2 meningitis was recommended by 50% of the participants.

RCTs on antiviral treatment vs. placebo or IV acyclovir vs. valacyclovir are of high priority.

Similar findings were noted in sensitivity analyses.

Limitations of this study include the relatively low response rate to the survey. Additionally, the researchers noted HSV-2 meningitis may be managed by clinicians other than those who specialize in infectious disease.

According to researchers “RCTs [randomized controlled trials] on antiviral treatment vs. placebo or IV acyclovir vs. valacyclovir are of high priority.


Bodilsen J, Tattevin P, Tong SYC, Naucler P, Nielsen H. Treatment of HSV-2 meningitis: a survey among infectious diseases specialists in France, Sweden, Australia, and Denmark. Open For Infect Dis. Published online November 30, 2022. doi:10.1093/ofid/ofac644