Guidance adapted from Sexually Transmitted Infections in Primary Care (RCGP 2013)

If the diagnosis is unclear then take a viral swab for HSV/VZV. Risk factors for additional STI screening:

• under 25 years
• no condom use
• recent (less than 12 month)/ frequent change of partner
• symptomatic partner.

Oral antivirals are indicated within 5 days of start of episode or while new lesions are still forming, or if symptoms persist.

Aciclovir tablets

• 400mg every 8 hours or 200mg five times a day for 5 days
• Review after 5 days and continue if new lesions still appearing, complex disease, or immunosuppressed
• Severe cases require urgent referral
• Refer to GUM if patient suffers more than 6 occurrences a year

Supportive treatment:

• Saline bathing, topical petroleum jelly, lidocaine ointment for a few days when required

Recurrent episodes

Prodromal symptoms occur up to 48 hours before appearance of lesions, often milder than the initial episode with faster resolution. Symptoms = milder/self-limiting, therefore manage in partnership with patient.

Options are:

Supportive treatment

• Saline bathing, topical petroleum jelly, lidocaine ointment, for a few days when required

Episodic prescription:

• Standby prescription for next episode to start at prodrome

Aciclovir tablets

• 200mg five times a day for 5 days or
• 400mg eight hourly for 3-5 days or
• 800mg eight hourly for 2 days