Genital Herpes

Comments

  1. Genital Herpes can be caused by either herpes simplex virus (HSV) 1 or 2
  2. Following direct inoculation to the genital area individuals can experience a prodromal viral illness, genital itch, vesicles, painful ulceration with painful regional lymphadenopathy within seven days of infection. The genital ulceration will spontaneously clear and thereafter the virus remains dormant in local sensory ganglia and can reactivate periodically resulting in symptomatic lesions or asymptomatic, but infectious, viral shedding. The likelihood of recurrence is greater with HSV-2 than HSV-1 and the likelihood of recurrences and asymptomatic viral shedding reduces over time
  3. The diagnosis can be made clinically but should be confirmed with a HSV NAAT swab to determine if HSV-1 or HSV-2. HSV NAAT swabs are available to order from the NVRL
  4. Treatment should be started on the basis of clinical impression.
    • Topical antiviral medication is not as effective as oral antiviral medication.
    • Simple oral analgesia and local anaesthetic cream (eg EMLA cream)
    • Advise micturition into bath water to relieve dysuria
    • Hospitalisation may be required for urinary retention, meningism or severe constitutional symptoms.
  5. Patients diagnosed with HSV-2 should be advised to avoid sexual contact when they have symptoms of genital herpes unless it is known that their partner has already been exposed to HSV-2
  6. Individuals diagnosed with genital herpes should be offered testing for other STIs including HIV, Hepatitis B, syphilis, chlamydia and gonorrhoea. Hepatitis C testing should be offered those with a history of injecting drug use and MSM, further information on this is available in the ICGP STI e-learning module.
  7. Pregnant patients with a history of genital herpes should inform their obstetrician of this history and referral to an STI clinic should be considered, particularly if the patient is experiencing frequent recurrences
  8. Patients presenting with genital herpes for the first time in pregnancy should have the diagnosis confirmed, treatment started and be referred to an STI clinic.
  9. Patients presenting with frequent recurrences (>/= one per month) should be offered suppressive therapy and may be best managed at an STI clinic
  10. Genital Herpes Simplex is a notifiable disease. The complete list of notifiable diseases and information on the notification process is available at HPSC

Treatment

Antiviral medication

Comments

First episode

Valaciclovir 500mg twice daily x 5 days

Aciclovir 400mg three times daily x 5/7

Aciclovir 200mg five times per day x 5/7

These medications can be used in pregnancy where there is a clear clinical need.

Aciclovir is less expensive than valaciclovir and famciclovir

Famciclovir 250mg three times daily x 5/7

Recurrent episode

Valaciclovir 500mgs twice daily x 3 days

Aciclovir 400mg three times daily x 3 days

famciclovir 1gram twice daily x 1 day


Useful resources


Patient information

We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

Reviewed June 2017