Prevention strategies 
Routine surveillance, daily skin checks, prompt 
recognition and exclusion of affected athletes, and 
consideration of prophylactic antivirals for those with 
a history of recurrent HG or during outbreaks. 
Emphasis on hygiene, avoidance of shared personal 
items, and facility cleanliness further reduces trans-
mission risk. Sports medicine providers must be 
familiar with governing body guidelines and imple-
ment standardized screening and management proto-
cols to minimize the spread and impact of HG in 
athletic populations.
high-risk periods (e.g., wrestling camps) has demon-
strated an 85–90% reduction in outbreak incidence.
Condition
Primary HSV
Reactivation of 
HSV
NCAA
NFHS
All vesicles crusted
No systemic symptoms
No new lesion for 72 hours
Oral antivirals for 120 hours
No active lesions
Oral antivirals for 10-14 days
No new lesions during 48-hour antiviral 
treatment
All lesions have scabs
No active lesions
Oral antivirals for 120 hours
Oral antivirals for 120 hours
No new lesions during 48-hour 
antiviral treatment
All lesions have scabs
Return to Play requirements (All requirements must be met)
6

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