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Herpes simplex - genital - Management
Basis for recommendation

These recommendations are based on the British Association for Sexual Health and HIV (BASHH) 2007 national guideline for the management of genital herpes [BASHH, 2007], expert opinion in narrative reviews [Sen and Barton, 2007], and, when available, trial evidence.

  • Self-care advice is based primarily on expert opinion [New Zealand Herpes Foundation, 2007; Sen and Barton, 2007], pragmatism, and good clinical practice. CKS could not identify any controlled trials to support self-care measures in the management of primary genital herpes.
  • Aciclovir, valaciclovir, and famciclovir are licensed for the treatment of genital herpes [BNF 55, 2008]. The evidence from five randomized controlled trials (RCTs) shows no difference in efficacy, tolerability, or toxicity in the management of primary genital herpes. BASHH states that any one of the three antiviral drugs can be used to treat genital herpes. However, CKS recommends that oral aciclovir should be prescribed based on the cost implications. The cost for a 5-day course of aciclovir is £4.01, valaciclovir is £21.86, and famciclovir is £111.35 [Prescription Pricing Division, 2008].
  • Antiviral drugs are usually not used for longer than 5 days. There is no evidence of benefit when they are used for a longer duration. However, experts [Gupta et al, 2007] believe that a longer course of treatment may be needed for severe attacks or with actively forming lesions.

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