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Herpes simplex - genital - Management
How should I treat someone with HIV when referral is not needed?

  • Ideally, all people with HIV and suspected genital herpes should be referred to a specialist in genito-urinary medicine for diagnosis, treatment, screening for sexually transmitted infections, counselling regarding risks to themselves and others, and follow up (especially if they are known to have a low CD4 count).
  • However, if referral is declined, people with HIV can be treated in primary care provided that the infection is uncomplicated and not severe.
    • Treat with oral aciclovir 400 mg five times a day for 7–10 days — the dose is higher and the duration longer than for people who are not immunocompromised.
    • If new lesions are still forming after 3–5 days, seek specialist advice.
  • If infection is severe, the person is systemically unwell, or complications are suspected, admit for treatment with intravenous aciclovir.
    • In the absence of antiretroviral treatment, primary genital herpes may be severe and prolonged with risk of progressive, multifocal, and coalescing mucocutaneous anogenital lesions.
    • Complications include fulminant hepatitis, pneumonia, neurological disease, and disseminated infection.
  • Self-care measures may be useful for some people. If appropriate, advise the person to:
    • Clean the affected area with plain or salt water to help prevent secondary infection and promote healing of lesions.
    • Apply vaseline or a topical anaesthetic (e.g. lidocaine 5%) to lesions to help with painful micturition, if required.
    • Increase fluid intake to produce dilute urine (which is less painful to void). Urinate in a bath or with water flowing over the area to reduce stinging.
    • Avoid wearing tight clothing, which may irritate lesions.
    • Take adequate pain relief (e.g. oral paracetamol).
    • Avoid sharing towels and flannels with household members (although it is very unlikely that the virus would survive on an object long enough to be passed on, it is sensible to take steps to prevent this).
  • Advise all people to abstain from sex (including non-penetrative and orogenital sex) until follow up, or until lesions have cleared.

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