management

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Diagnosis is made on the basis of the clinical picture supported by virus culture - results usually available in two days.

Treatment:

  • symptomatic:
    • analgesia
    • saline baths
  • first-episode:
    • oral aciclovir 400mg TDS for 5 days OR
    • valaciclovir 500mg BD for 5 days OR
    • famciclovir 250mg TDS for 5 days

  • recurrent episodes:
    • oral aciclovir 800mg TDS for 2 days OR
    • famciclovir 1000mg BD for 1 day
  • rarely admission to hospital for catheterisation (much more likely in women)
  • primary or first-episode genital herpes is managed via referral to the genitourinary medicine clinic

  • interventions to prevent sexual transmission of herpes simplex virus
    • interventions that are likely to be beneficial include (2):
      • male condom use to prevent sexual transmission from infected men to uninfected sexual partners
      • antiviral treatment of infected sexual partner (reduced transmission to uninfected partner) - seek genitourinary medicine specialist advice

Key points (1):

  • Advise: saline bathing, analgesia, topical lidocaine for pain, and discuss transmission
  • First episode: treat within 5 days if new lesions or systemic symptoms, and refer to GUM
  • Recurrent: self-care if mild, or immediate short course antiviral treatment, or suppressive therapy if more than 6 episodes per year

Reference:

  1. Public Health England (June 2021). Managing common infections: guidance for primary care
  2. Clinical Evidence Update. December 2004

Last edited 07/2021 and last reviewed 07/2021

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