Long-term clinical and psychological management of genital herpes

Many patients with genital herpes will have recurrences, and for some the recurrences may be frequent and severe and accompanied by profound psychosexual morbidity. Some patients can successfully be managed with intermittent courses of oral or topical acyclovir to be used with each recurrence. However this treatment is of limited efficacy, and longterm acyclovir suppression may be useful. This form of treatment is highly successful for patients with frequent recurrences most of whom will have no episodes during treatment. The optimum dosage for commencing acyclovir suppression is 200 mg four times daily, and the dose may subsequently be reduced. Some patients can successfully be managed on 400 mg twice daily. Treatment should be stopped after 1-2 years as there is some evidence of a decrease in the frequency of recurrences. Selecting patients for suppression should be based on the frequency, severity, and duration of recurrences as well as any associated emotional problems. Some patients may recur on suppression, usually due to inadequate dosage. Many patients with first episode genital herpes experience emotional and psychological problems. However these problems only continue if patients have recurrences and continued psychological support is essential. Long-term acyclovir suppression improves psychological well-being but is not a substitute for information, counselling, and expert psychosexual support.