Prophylactic oral antiviral treatment should be considered if the patient is:
- immunocompromised and has troublesome recurrent oral herpes simplex infection
- has frequent (≥ 6 or more episodes in one year), persistent and/or severe episodes of recurrent oral herpes simplex infection
- has herpes simplex associated with recurrent erythema multiforme.
Those with atypical lesions or in whom the diagnosis is uncertain (but thought to be benign) should be referred routinely to Oral Medicine. Patients with unexplained ulceration of the oral mucosa persisting > 3 weeks should be referred to Oral and Maxillofacial Surgery – urgent, suspicious of cancer.
Severe or recurrent genital HSV infection should be referred to Sexual Health services.
C.M & N.B 12-12-23
Who to refer:
Patients with confirmed non-genital HSV infection which is refractory to oral antiviral therapy.
Who not to refer:
Patients with
- atypical lesions or where the diagnosis is uncertain, but thought to be benign – refer to Oral Medicine
- unexplained ulceration of the oral mucosa persisting > 3 weeks – refer to OMFS as urgent, suspicious of cancer.
- severe or recurrent genital HSV infection – refer to Sexual Health services.
How to refer:
Via Sci Gateway to Infectious Diseases at the Western General Hospital
Guidance on the management of uncomplicated oral HSV is available as a NICE CKS summary. Patients should be offered screening for HIV infection. Prophylactic treatment regimens for recurrent HSV infection can be found in the BNF.
