Management

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