Recurrent Herpes?

• Usually supportive management adequate – reassure attacks become less frequent over time
• If clear ‘prodrome’ (tingling / paraesthesia hours /days prior to skin changes) can use episodic treatment to “abort” an attack – standard course aciclovir – give 2-3 packs to keep at home
• If more than 6 attacks / year consider suppressive aciclovir 400mgs bd for 6-12 months
• On stopping to re-assess natural history, minimum period should include 2 recurrences
• Patients who continue to have unacceptably high rates of recurrence may continue treatment in long-term

Notes:

• Counselling is an important part of management - significant associated psychological distress - refer Liaison HA (telephone: 07789 995086) or GUM (01273 694726) if ongoing issues
• 80% HSV infections are sub-clinical - asymptomatic shedding is a significant source of new infection
• Shedding more likely in first 12 months following primary attack, as well as just before/after an episode
• If diagnosis in doubt, or discordant couples with high level anxiety, type specific serology can be useful - but need clear documentation previous cold-sores
• Reassure women with prior HSV planning future pregnancy risk transmission extremely low (<1:10,000)
• Primary attack 1st / 2nd trimester - consider suppressive aciclovir for last 4 weeks - discuss with GUM
• Primary attack in 3rd trimester - refer GUM/O&G for LSCS

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