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Changes at a glance since 2013

Valaciclovir

The special authority and Hospital Medicines List restriction was removed from 1 March 2016 (Pharmac). This is recommended first line treatment.

Treatment of first episode genital herpes

  • Oral valaciclovir 1g bd for 7/7
  • Oral aciclovir 400mg 3 times daily (8 hourly) for 7 days.

Treatment of recurrent genital herpes

Episodic treatment

  • Oral valaciclovir 500mg bd for 3/7
  • Oral aciclovir 800mg (2 x 400mg) 3 times daily for 2 days.

Prescribe enough tablets for patients to be able to self-initiate treatment at onset of symptoms.

Suppressive therapy

Given daily to prevent recurrences and reduce asymptomatic shedding. Recommended for people with confirmed HSV-2. Suggest prescribing for minimum of 12–18 months, followed by a break of 3 months at their convenience to see if recurrences are still frequent and/or bothersome.

  • Oral valaciclovir 500mg daily (increase to 500mg BD on individual basis of clinical presentation and/or having breakthrough recurrences on 500mg daily.
  • Oral aciclovir 400mg twice daily

Treatment of HSV in people with HIV

HSV episodes in those with HIV can be successfully treated with standard antiviral regimens as for non-HIV infected individuals. However there is a higher rate of resistance to standard anti-herpes drugs.