What's New Since 2015

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 500mg bd for 7/7 or longer if new lesions appear during treatment or healing is incomplete.
  • Immunocompromised patients consider valaciclovir 1g bd for 7–10 days.
  • Alternative: 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.
  • Alternative: oral aciclovir 800mg 3 times daily for 2 days. 

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

Suppressive therapy

Only recommended for people with HSV confirmed on testing. Given daily to prevent recurrences and reduce asymptomatic shedding. Suggest prescribing for 12 months, followed by a break of 3 months 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).
  • Alternative: oral aciclovir 400mg twice daily.