Guidelines

Investigation and Diagnosis

For all 1st episodes:

• 1st line: viral swab  for PCR

Management

Conservative Management – All Patients

General advice:

• Increase fluid intake
• Urinate in a bath or with water flowing over the area (can help reduce dysuria)
• Abstinence from sexual contact during lesion recurrences / prodromes

Self-care measures

• Saline bathing
• Analgesia (paracetamol / ibuprofen)
• Topical petroleum jelly / anaesthetic agent (e.g. 5% lidocaine ointment)

Primary Herpes Infection

Ideally diagnosed and management in a specialist GUM clinic/center

Antiviral therapy is generally indicated for primary infections

Specifically indicated in either of the following scenarios:

• <5 days of onset of first episode
• New lesions are forming
• Persistent systemic symptoms

Recommended 1st line oral antiviral regimens (either):

• Aciclovir 400mg TDS for 5 days
• Valaciclovir 500mg BD for 5 days

Recurrent Herpes Infection

Recurrences can be treated in primary care, however, referral should be considered in pregnancy / immunocompromise / presence of complications

Advise patients that recurrences are self-limiting and generally cause minor symptoms

1st line: conservative management 

2nd line: consider antiviral therapy

• Infrequent episodes (<6/year) → episodic oral antiviral treatment (e.g. aciclovir 800mg TDS for 2 days)
• • Taken at the onset of symptoms or during the prodrome

• Frequent episodes (≥6/year) → suppressive oral antiviral treatment (e.g. aciclovir 400mg BD)
  • Consists of taking daily oral antivirals continuously, regardless of symptoms

References

Original Guideline