Greek flag English flag


Herpes genitalis, or genital herpes, is a common sexually transmitted disease caused predominantly by herpes simplex virus type 2 (HSV-2), but can also be caused by HSV-1.

Herpes genitalis

Herpes genitalis is a recurrent vesicular eruption of the skin and mucosa in the region between the navel and the buttocks, usually preceded by prodromal symptoms including itching, burning, and tingling.

Primary infection may have associated influenza-like systemic signs, including fever, headache, malaise, and myalgia, which occur 2–20 days post exposure. Tender lymphadenopathy may also develop in the second and third weeks.

In general, recurrences lack systemic symptoms and are less severe than the primary outbreak. Lesions of recurrences occur in the same area but are fewer in number and heal more quickly. Typical lesions of recurrent outbreaks manifest as grouped papules on an erythematous base which progress to thin-walled vesicles, ulcers, and then soft crusts. Dry crusts form in 3–4 days, allowing for healing. Residual hypopigmentation, hyperpigmentation, and scarring may occur with healing.

Management strategy

As no cure exists for herpes genitalis, treatment is aimed at reducing the number of recurrences using suppressive therapy and at promoting rapid healing when a recurrence is present.

Furthermore, treatment aims to reduce infectivity by reducing viral shedding, and to reduce complications such as urinary retention and aseptic meningitis. In the past, aciclovir, both topical and oral, was used as a first-line treatment for recurrences. Given aciclovir’s low bioavailability, it requires frequent dosing.

In the past, the standard dosing of oral aciclovir for a recurrence is 200mg five times daily for 5 days. Alternative regimens have also been shown to be effective, including 400mg three times daily for 5 days, 800mg three times daily for 2 days, and 800mg twice daily for 5 days.

The frequent dosing of aciclovir led to the development of valaciclovir and famciclovir (the prodrugs of aciclovir and penciclovir, respectively) as alternative therapies with improved bioavailability.

The use of topical aciclovir should be discouraged as it is less effective than oral aciclovir.

It has also been demonstrated that valaciclovir is effective when dosed 500mg twice daily for 3 days or 1000mg once daily for 5 days. A dosing regimen of oral valaciclovir, given 2000mg twice daily for 1 day, has been studied and shown to be more convenient; however, further comparative studies are needed. Famciclovir is effective when prescribed as 1000mg twice daily for 1 day. It may also be taken as 125mg twice daily for 5 days. Aciclovir, valaciclovir, and famciclovir may all be used for suppressive therapy.

Immunocompromised individuals have more frequent recurrences and can develop more severe lesions, thus requiring longer treatment periods with higher doses than those used in the immunocompetent. Severe cases may require intravenous therapy. Suppressive dosage regimens have been used in this population. Long-term therapy may lead to the selection of resistant strains of virus. In aciclovir-resistant cases, intravenous therapy with foscarnet may be required.

Another important aspect of genital herpes management is psychosocial. The recurrent nature of genital HSV infection can have severe emotional and psychological impact on patients. Counselling serves to help them cope with the infection and to prevent sexual and perinatal transmission. A physician can empower patients, allowing them to better manage the disease by educating them about the disease process.

About the author:

Christofer Tzermias

Specialised in the UK (Oxford & London) and in North America (New York & San Diego) in the field of LASER Dermatology, Dr Tzermias, has been providing dermatological state-of-the-art treatments using cutting-edge LASER and Energy based Devices for over 20 years. He has been Director of Interventional and LASER Dermatology Department at the Athens Medical Center for over 18 years and for the last 9 years is the Scientific Director of IQ - Intensive Quality Dermatology & Cosmetic Surgery Clinics, which at the 2017 Healthcare Awards won the ‘Innovation Award for Innovative Services’ for their pioneering contributions. Since 2018, IQ Dermatology & Cosmetic Surgery Clinics has also been operating in London, UK and in Muscat, Oman. Dr Tzermias is a Fellow of the world-renowned American Society for LASER Medicine and Surgery (ASLMS), a Founder Member of the European Society LASER Dermatology (ESLD), the Vice President of the ‘Open Health Alliance’ and he is also on the Board of Directors of Elitour - Greek Medical Tourism Council.

Most read articles

Greek Flag


49, Vas. Sofias Avenue, Athens
Metro station “Evangelismos”
Parking: Polis Park (Rizari)

Τ: 210 72 42 600
    210 72 34 230


Greek flag


71, Kifissias Avenue, Maroussi
Attiki Odos Ring Road
(Exit 11 “Kifissias” – Towards Athens)
15 parking spaces
Suburban Railway “Kifissias” station

Τ: 210 61 00 900

English Flag


33 Cavendish Square, Marylebone

Τ: +44 (0) 20 8144 8494


We are open every day,
Monday – Friday, 9:00 – 21:00
Saturday, 10:00 – 16:00


tuv certification

elitour certification