Treatment with antiviral medications is more effective when started early, but there are still benefits with initiating treatment after the onset of symptoms. The following options are equally effective:

• Aciclovir 400 mg tds for 7-10 days

      or

• Valaciclovir 500 mg bd for 7-10 days

Together with:

• Lignocaine 2% jelly topically if needed. Exercise caution with topical anaesthesia as may cause sensitization with prolonged use.
• Paracetamol/codeine for pain relief
• Antifungal medication (preferably oral) for thrush if present, antibiotics if secondarily infected
• Topical antivirals and antibiotics are ineffective
• Education and counseling for psychosocial effects of reactivation and reoccurrences

Note: Genital Herpes simplex virus (HSV) infection may be acquired from either symptomatic or asymptomatic partners, and from either genital or oral sexual contact.

About 70 % of genital herpes is caused by HSV type 2 but an increasing number of genital infections are due to HSV type 1. Most HSV infections are asymptomatic. Clinical manifestations depend on site of viral entry and immunity from previous exposure. Manifestations of newly acquired infection may be severe in non-immune persons who have had no previous exposure. Sexually acquired manifestations include genital ulceration, gingivostomatitis, urethritis, cervicitis and proctitis.