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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] and a guide for GPs, practice nurses, and other members of the primary care team published by the Medical Foundation for AIDS & Sexual Health (MedFASH) [Madge et al, 2005].

  • Advice to refer people for optimization of antiretroviral treatment is derived from BASHH [BASHH, 2007]. Herpes simplex infections activate HIV replication, and may facilitate onward HIV transmission to sexual partners. Suppressive treatment of herpes simplex virus reduces genital HIV shedding in women. In addition, optimizing antiretroviral treatment (and therefore CD4 count) will also reduce the frequency of clinical recurrences of genital herpes.
  • Aciclovir, valaciclovir, and famciclovir are licensed for the treatment of recurrent genital herpes in people with HIV [BNF 55, 2008]. Evidence from two randomized controlled trials (RCTs) shows that oral antiviral drugs are equally effective at reducing the duration and severity of genital herpes attacks in people with HIV. Evidence from other RCTs shows that, taken prophylactically, valaciclovir reduces the frequency of attacks compared with placebo, and that aciclovir and valaciclovir are equally effective. 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 to £130.62, valaciclovir is £1,495.87, and famciclovir is £10,808.98 [Prescription Pricing Division, 2010].
  • 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.
  • The recommendations on when to consider stopping or restarting suppressive treatment are extrapolated from the BASHH recommendations regarding this situation in people without HIV [BASHH, 2007].

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