(30 Jan 2002)

New European guidelines for the management of genital herpes say doctors should start oral antiviral treatment for people they suspect may be having a first episode of genital herpes without waiting for laboratory test results to confirm a diagnosis.

‘Confirmation of infection is essential,’ says Dr Raj Patel of the special interest group that drew up the guidelines. However, he added that first episodes may be severe and starting treatment before test results are available may help to avoid the development of complications.

It can be some time from initial infection until herpesvirus can be detected. Blood tests to detect HSV-1 or 2 may not be of use in the early stages of infection because antibodies may take up to 8-12 weeks to develop. This means that even if people have a negative test result at first, they may not be able to rule out the possibility of infection.

The guidelines say that people seeing their doctor within 5 days of the start of an episode, or while they are developing new sores, should be given oral antiviral drugs because they are more effective than topical preparations.

The guidelines also make recommendations about the following:
· Counselling for people with genital herpes
· The treatment of people with recurring outbreaks of genital herpes
· The treatment of pregnant women with genital herpes
· The treatment of HSV in people with HIV

Source: Herpes Simplex Virus Special Interest Group of the Medical Society for the Study of Venereal Diseases, UK. European Guideline for the management of genital herpes. Int J STD AIDS 2001; 12 (Suppl 3): 34-39