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Herpes simplex - genital - Management
How should I treat someone with recurrent genital herpes?

  • Self-care measures may be helpful for some people. If not already tried, 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) and use 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).
    • Try to avoid identified trigger factors (e.g. ultraviolet light, excess alcohol).
  • If self-care measures are not controlling symptoms, prescribe oral aciclovir 200 mg five times a day for 5 days (it is unusual for lesions to still form after 5 days). For future attacks use either:
    • Episodic antiviral treatment if attacks are infrequent (e.g. less than six attacks per year). Consider self-initiated treatment, so antiviral medication can be started early in the next attack.
    • Suppressive antiviral treatment (e.g. oral aciclovir 400 mg twice daily for 6–12 months) if attacks are frequent (e.g. six or more attacks per year), causing psychological distress, or affecting the person's social life:
      • After 1 year, stop treatment for a minimum period of two recurrences.
      • If attacks are still considered problematic, restart suppressive treatment. If attacks are not considered problematic (off treatment), future attacks can be controlled with episodic antiviral treatment (if needed).
      • If the person has breakthrough attacks on suppressive treatment, seek specialist advice.

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