Genital Herpes

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

If you have previously been diagnosed with genital herpes, and you are confident that you recognise the symptoms of repeat outbreaks, you can request treatment from Dr Fox pharmacy.

If you are aged under 18 please contact your GP or a local sexual health clinic for testing and treatment:

• England
• Wales
• Scotland
• Northern Ireland

Diagnosis and check-up before treatment

Not every sore in the genital area is caused by herpes. It is important to see a doctor or visit a Sexual Health Clinic to have a diagnosis and to be tested for other sexually transmitted infections. Do NOT self-treat with antiviral medication without getting a medical diagnosis first. New sores in different places are unlikely to be caused by herpes. Aciclovir 400mg and 800mg tablets are for the treatment of herpes sores in the vaginal area, on or around the penis, and in the region of the anus (back passage) - see photos of herpes. More photos of herpes on genitalia available from DermNet NZ.

Treatment with aciclovir

A course of aciclovir tablets will typically reduce the duration of genital herpes sores by one or two days. It also reduces severity of symptoms and infectiousness. If taken early enough, aciclovir may prevent sores from breaking open. A treatment course of aciclovir will not prevent future outbreaks. Aciclovir cream is not recommended for treatment of genital herpes.

Suppression with aciclovir

If genital herpes outbreaks are frequent (6 or more per year), guidelines recommend considering twice daily aciclovir 400mg tablets as a suppressive antiviral treatment.

If breakthrough genital herpes outbreaks occur during suppressive treatment please consult your GP or visit a sexual health clinic.

Genital herpes and partners

Genital herpes is considered to be very infectious. When herpes sores are open and active, the virus is more infectious, however if you have the virus it can be spread to others even when you don't have sores. Using condoms provides good protection from transmission, but this protection is not 100% effective. Spread can still take place.

There is currently no genital herpes vaccine.

The following steps will help to reduce infection:

• Using male condoms for all sexual contact, including oral and anal sex.
• Avoid all sexual contact if you or your partner have blisters or sores, or other signs that a herpes sore is developing.
• Avoid contact with blisters and sores - wash thoroughly if this occurs.
• Avoid sharing sex toys and use them with a condom.
• Managing stress - a common trigger for an outbreak.
• Be open about discussing the risk with your partner.
• Suppressive aciclovir treatment reduces frequency of outbreaks and also reduces viral shedding between outbreaks. It is often recommended by sexual health clinics if you have genital herpes and your regular partner does not.

Dose of aciclovir

Treatment of a repeat genital herpes outbreak

Start treatment early, preferably at the tingling stage, before the sores develop. There are two options for treatment courses:

1. Take one 400mg tablet 3 times daily 8 hours apart for 5 days (15 tablets is one course of treatment).
2. Take one 800mg tablet 3 times daily 8 hours apart for 2 days (6 tablets is one course of treatment).

Suppression of genital herpes

Take one 400mg tablet twice a day 12 hours apart for a minimum of 6 months. Can be taken for up to 12 months, then a trial of stopping suppressive treatment is advised to reassess the overall frequency of outbreaks. There may be an outbreak 4-5 days after stopping long-term treatment. This is not a sign that there will be regular repeated outbreaks. However if you have 2 or more outbreaks, and outbreaks continue again frequently, the suppression can be re-started for another few months. Research has shown that aciclovir can be safely continued for many years if necessary.

Keep hydrated

Swallow tablets whole with plenty of fluids, or dissolve in water. Can be taken with or without food. Seek medical advice if treatment is not effective or there are new symptoms or side effects. It is important to drink plenty of water whilst taking aciclovir.

Can anyone take aciclovir?

There are a few conditions where someone may not be advised to take aciclovir. Checks are carried out during the online consultation. Dr Fox pharmacy only supplies medicine to adults (over 18 years old) so if you are aged under 18 please contact your GP or a local sexual health clinic for testing and treatment.

You are recommended to check with your regular doctor before taking aciclovir if any of the following apply:

• Over 65.
• Reduced immunity e.g after a bone marrow transplant, low white blood cell count, HIV.
• Neurological illness.
• Long-standing low oxygen levels from any cause.
• Abnormal liver function tests.
• Blood chemistry abnormalities.
• Kidney disease.
• Pregnancy.
• Breastfeeding.

If you experience an outbreak of genital herpes during pregnancy or while breastfeeding, consult your doctor to discuss treatment options.

Aciclovir does not affect contraception.

Aciclovir tablets and other medication

People taking the following medications should consult a doctor or pharmacist before taking aciclovir:

• Mycophenolate mofetil (used to stop your body rejecting transplanted organs).
• Theophylline (used in asthma and other breathing problems).
• Any medication which mentions urine or kidney problems as side effects in the patient information leaflet.

Side effects of aciclovir

Like all medicines, aciclovir can cause side effects, although not everybody gets them.

If you have an allergic reaction (may affect up to 1 in 1,000 people) stop taking aciclovir tablets and see a doctor straight away.

Common side effects include headache, feeling dizzy or sick, diarrhoea, stomach pains, rash, skin reaction after exposure to light (photosensitivity), fatigue, and fever.

See the patient information leaflet for further details.

Dr Fox supplies genital herpes medication on prescription - you are required to answer a short medical questionnaire before your order can be completed.

Authored 26 February 2020 by Dr Tony Steele
MB ChB Sheffield University 1983. Former hospital doctor and GP. GMC no. 2825328

Reviewed by Dr A. Wood, Dr C. Pugh, Dr B. Babor
Last reviewed 06 September 2023
Last updated 30 November 2023
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