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

  • People with HIV and recurrent genital herpes can be treated in primary care provided that the infection is uncomplicated and not severe.
  • Once the attack has resolved, refer the person to a specialist to optimize antiretroviral treatment.
  • Use episodic antiviral treatment if attacks are infrequent (e.g. less than six attacks per year).
    • Treat with aciclovir, using a higher dose than people who are not immunocompromised. Treatment may also need to be continued for longer.
    • Prescribe oral aciclovir 400 mg three times a day for 5–10 days.
    • If new lesions are still forming after 3–5 days, seek specialist advice.
  • Seek specialist advice about starting suppressive antiviral treatment (off-label use) if attacks are frequent (e.g. six or more attacks per year), causing psychological distress, or affecting the person's social or sex life.
    • Treatment is usually with aciclovir 400 twice a day, but the dose may sometimes need to be titrated up to 800 mg two or three times a day.
    • 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.
  • 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.
    • 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).

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