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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].
- Self-care advice is based primarily on expert opinion [New Zealand Herpes Foundation, 2007; Sen and Barton, 2007], and pragmatic advice based on good clinical practice. CKS identified no controlled trials to support self-care measures in the management of recurrent genital herpes. However, as recurrent episodes are usually mild and self-limiting, self-care alone may be an effective treatment.
- Aciclovir, valaciclovir, and famciclovir are licensed for the treatment of recurrent genital herpes [BNF 55, 2008]. The evidence from randomized controlled trials (RCTs) shows that oral antiviral drugs are equally effective at reducing the duration and severity of genital herpes attacks [Jungmann, 2007], and evidence from a meta-analysis shows that, taken prophylactically, they reduce the frequency of attacks compared with placebo [Lebrun-Vignes et al, 2007]. BASHH states that any one of the three antiviral drugs can be used to treat genital herpes. However, CKS believe that oral aciclovir should be prescribed for both episodic and certainly suppressive treatment based on the cost implications. For example, the cost of one year suppressive treatment with aciclovir is £94.90, valaciclovir is £797.89, and famciclovir is £5419.03 [Prescription Pricing Division, 2008].
- Three RCTs provide evidence to suggest that treatment regimens of less than 5 days may be effective, but further research is needed to determine the optimum dose and regimen. The BASHH guideline does provide shorter alternative regimens, using higher doses of antiviral drugs. CKS recommends aciclovir based on cost, and therefore, does not include these regimens in the recommendation.
- Two RCTs provide evidence, supported by meta-analysis [Lebrun-Vignes et al, 2007], on suppressive treatment, suggesting that most benefit of antiviral medication is derived when treatment is started early, ideally within 6 hours of symptom onset.
- Early controlled trials reported that topical preparations were less effective than oral medication [Corey et al, 1982], and that combination treatment was of no additional benefit.
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