CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Herpes simplex - genital - Management
How do I know my patient has it?
- Ideally, the diagnosis of genital herpes should be carried out by a specialist in genito-urinary medicine (GUM). Confirmation of genital herpes requires identification of the herpes simplex virus (usually through viral culture), as a diagnosis based on clinical findings alone is not conclusive. GUM will carry out diagnosis, treatment, screening for other sexually transmitted infections (STIs), counselling, and follow up.
- A history and examination is necessary in primary care (even if the person is being referred) to determine the likelihood of genital herpes and exclude other causes of genital ulceration (see Differential diagnosis for more information).
- Ask about symptoms including painful ulcers, dysuria, vaginal or urethral discharge, malaise, and fever; their onset and duration, and whether similar symptoms have been experienced previously. Ask about previous STIs, recent sexual contact and relationship status, number of partners, and whether the person has a history of cold sores.
- Examine the person's external genitalia and surrounding skin (lesions are usually bilateral with signs of redness, blistering, and ulceration). Lesions can also affect the vagina and cervix in women, and men who have sex with men may present with herpes proctitis. There may also be tender bilateral inguinal lymphadenitis. Atypical herpes lesions can look different from typical genital blisters and ulceration, with an appearance of fissures, patchy erythema, linear lesions or excoriations.
- In people unable to attend GUM, take a swab from the base of a lesion for viral culture or polymerase chain reaction (PCR); seek advice if there is doubt about diagnostic sampling and transport.
© NHS Institute for Innovation and Improvement