CKS identified no national referral guidelines for genital herpes. In the absence of established policy, these recommendations are pragmatic advice based on good clinical practice.

• As genital herpes is difficult to diagnose clinically and is associated with psychosocial comorbidity, the initial management and subsequent follow up (counselling) should be carried out by a specialist.
• Specialist advice is needed for pregnant women who acquire a primary infection.
• In late pregnancy the risk of neonatal transmission is greatest, occurring in about 40% of cases. Such women will require a Caesarean section for delivery.
• Primary infections acquired in the first or second trimester can be treated with either oral or intravenous antiviral medication. Women will usually be offered continuous antiviral medication in the last 4 weeks of pregnancy to reduce the risk of clinical recurrence at term and the need for delivery by Caesarean section.
• In women with recurrent genital herpes a Caesarean section is not required for attacks in the third trimester, unless lesions are present at the time of delivery [BASHH, 2007; Sen and Barton, 2007].
• Specialist advice is needed in people who are immunocompromised as episodes may be longer and more severe, and there is a higher risk of complications. Treatment regimens may be complicated by refractory lesions and the emergence of resistant strains of herpes simplex virus [Patrick, 2004; BASHH, 2007].
• The recommendation that people with HIV can be treated in primary care is based on a guide for GPs, practice nurses, and other members of the primary care team published by the Medical Foundation for AIDS & Sexual Health (MedFASH) [Madge et al, 2005].