2014 UK national guideline for the management of anogenital herpes

Abstract

These guidelines concern the management of anogenital herpes simplex virus infections in adults and give advice on diagnosis, management, and counselling of patients. This guideline replaces the 2007 BASHH herpes guidelines and includes new sections on herpes proctitis, key points to cover with patients regarding transmission and removal of advice on the management of HSV in pregnancy which now has a separate joint BASHH/RCOG guideline.

Genital Herpes

“…Acyclovir resistance is accompanied by cross-resistance against other nucleoside analogs such as valacyclovir, famciclovir, ganciclovir, and penciclovir since they share the same mechanism. While treatment with high doses of acyclovir and analogs is possible in cases of partial resistance, other treatment methods, which do not depend on TK, should be considered in cases of complete resistance [35,67]. An oral agent other than acyclovir and analogs is not available.…”

“…It is possible to distinguish between HSV-1 and HSV-2 using these two methods. It is absolutely necessary to distinguish between HSV-1 and HSV-2 in newly diagnosed genital herpes cases [35]. Because viral shedding is intermitent, the fact that no infected cell is detected does not mean that the HSV infection is not present [36].…”

“…They are not recommended for use in case of genital herpes since they lead to an increase in resistance. Intravenous treatment should be considered only when oral agents cannot be tolerated and in complicated cases [35]. Washing with serum physiologic and using analgesic and topical anesthetic agents are additional approaches which may be beneicial.…”

“…The patient should be followed up closely in terms of systemic symptoms, complications, and new lesion formation. In such cases, it may be necessary to prolong the standard treatment [35,36,46]. Table 2 shows recommended doses in detail.…”

“…Since the patient usually experiences an atack after stopping the treatment, it is recommended to wait at least for the second atack. The treatment may be restarted after reassessment for patients who have unacceptable atack frequency and symptoms [35].…”