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Herpes simplex - genital - Management
What advice and follow is needed in a person with genital herpes?

  • People should be followed up by a specialist in genito-urinary medicine (GUM): to be given the opportunity to discuss the implication of the diagnosis; to receive counselling; to discuss the transmission risk and prognosis; and to be screened for other sexually transmitted infections (STIs).
  • For people unwilling to attend GUM:
    • Follow up after 5 days to determine the effectiveness of treatment and discuss the virology swab result. Explain that even with a negative swab result, they may still have genital herpes. The diagnosis can only be confirmed by further attacks and herpes simplex virus detection.
    • Explain that a first clinical episode may not necessarily indicate recent infection nor that a partner has been unfaithful (if appropriate). They could have acquired the infection (sub-clinically) years previously, or the herpes virus (type 1) may have spread from elsewhere on their body (such as lips or fingers).
    • Explain that transmission can occur when there are no symptoms (asymptomatic shedding), but the risk is higher when symptomatic. Advise the person to:
      • Avoid sex (including orogenital sex) if lesions are present.
      • Use condoms with new or uninfected partners. Explain that condoms cannot completely prevent transmission, due to close skin contact or contact with infected secretions during foreplay.
    • Advise people who are concerned about transmitting genital herpes to long-term partners that their partner may already be infected even if they do not have symptoms, and that they should seek advice from a specialist in GUM for screening.
    • Explain there is no cure for genital herpes at present. However, symptoms improve (reduce in frequency and severity) with time and can be well controlled. On average, people have 4–5 attacks of genital herpes a year in the first 2 years.
  • Consider screening for other STIs. For more information, see the CKS topic on Chlamydia - uncomplicated genital.
  • Provide written information (patient information leaflets) from the Herpes Viruses Association (HVA) at www.hva.org.uk/pil.html or the Family Planning Association www.fpa.org.uk. Offer people further support from the Herpes Viruses Association's helpline 0845 123 2305 (weekdays) or www.herpes.org.uk.

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