Specific guidance and supportive materials

See West of Scotland guideline Pregnancy - STIs and Group B (GBS) streptococcal colonisation 

The following are key points only for the management of genital herpes in people with HIV. Refer to BASHH guidelines.

• Genital herpes is the most common STI in HIV positive heterosexuals in the UK.
• Herpes simplex infections activate HIV replication and may facilitate onward HIV transmission to sexual partners.
• The natural history of genital herpes in untreated people with HIV is significantly different from that in HIV-negative individuals. The most important risk factor for herpes reactivation is the degree of HIV associated immunosuppression.
• In the absence of HIV therapy, primary genital herpes may be severe and prolonged with risk of progressive, multifocal and coalescing mucocutaneous anogenital lesions. Moreover, serious and potentially life-threatening systemic complications, such as fulminant hepatitis, pneumonia, neurological disease and disseminated infection have been reported. Prompt initiation of therapy is recommended if herpes is suspected clinically. In severe cases, initiation of IV therapy may be necessary.
• Suppressive treatment of HSV-2 infection with valaciclovir has been shown to reduce HIV shedding in women not on antiretroviral treatment.
• Genital herpes, including chronic erosive lesions, may occur as a manifestation of the immune reconstitution inflammatory syndrome following combination antiretroviral therapy.
• Refer to BASHH guidelines for recommended treatment schedules for episodic and suppressive therapy.

Refer to BASHH guidelines. Resistance to antiherpes drugs is more common in those with HIV coinfection and is associated with treatment failure of genital herpes. Resistance testing is available in Birmingham and Colindale.

The British Association of Sexual health and HIV produces a patient leaflet which is available on line in printer friendly and screen friendly versions.

The Family Planning Association (FPA) produces on line information and a leaflet on genital herpes infection which provides comprehensive patient information.

An NHS Health Scotland leaflet is also available.

Herpes Virus Association:

• Helpline 0845 123 2305 – weekdays
• Email: infor@herpes.org.uk

1. Patel R, Green J, Clarke E, Seneviratne K, Abbt N, Evans C, et al. 2014 UK national guideline for the management of anogenital herpes. Int J STD AIDS. 2015 Oct 1;26(11):763–76. Available from: https://www.bashhguidelines.org/media/1019/hsv_2014-ijstda.pdf DOI: 10.1177/0956462415580512
2. Genital herpes – the basics (printer-friendly) [Internet]. British Association for Sexual Health and HIV; 2015 [cited 2022 Nov 02]. Available from: http://www.bashh.org/documents/HSV%20PIL%202015%20Printer-friendly.pdf
3. Genital herpes – the basics (screen-friendly) [Internet]. British Association for Sexual Health and HIV; 2015 [cited 2022 Nov 02]. Available from: https://www.bashhguidelines.org/media/1039/hsv-pil-2015-screen-friendly.pdf
4. Genital herpes Looking after your sexual health [Internet]. FPA; 2017 Oct [cited 2022 Nov 02]. Available from: https://www.fpa.org.uk/download/genital-herpes/
5. What do you know about... Genital herpes [Internet]. NHS Health Scotland; 2009 [cited 2022 Nov 02]. Available from: www.healthscotland.com/uploads/documents/9880-WhatdoYouKnowAboutGenitalHerpes.pdf
6. Herpes Viruses Association [Internet].Herpes Viruses Association; 2022 [cited 2022 Nov 02]. Available from: https://herpes.org.uk/