Initial antiviral therapy for genital herpes (first clinical episode)

If genital herpes simplex virus (HSV) infection is suspected, take a swab of the lesion for testing, then immediately start treatment; microbiological confirmation is not required to start antiviral therapy.

For patients with a first clinical episode of genital herpes, antiviral therapy is beneficial if started within 5 days of symptom onset, or while new lesions are still formingPatel, 2017. Advise patients to abstain from sexual contact until symptoms have resolvedOng, 2023.

For initial antiviral therapy for genital herpes, useOng, 2023:

1aciclovir 400 mg orally, 8-hourly for 10 days. If clinical response is rapid, stop therapy after 5 days. For dosage adjustment in adults with kidney impairment, see aciclovir oral dosage adjustment aciclovir aciclovir aciclovir

OR

1famciclovir 250 mg orally, 8-hourly for 10 days. If clinical response is rapid, stop therapy after 5 days. For dosage adjustment in adults with kidney impairment, see famciclovir dosage adjustment famciclovir famciclovir famciclovir

OR

1valaciclovir 500 mg orally, 12-hourly for 10 days. If clinical response is rapid, stop therapy after 5 days. For dosage adjustment in adults with kidney impairment, see valaciclovir dosage adjustment. valaciclovir valaciclovir valaciclovir

For the management of neonates born to a birthing parent (eg mother) with an active or recent first episode of genital herpes, see Neonatal herpes simplex infection.