What are the criteria for referring a patient with recurrent genital herpes to a specialist?

Refer a patient with recurrent genital herpes to a specialist if any of the following criteria are met:

• The diagnosis is uncertain.
• There is an inadequate or no response to treatment in primary care.
• The patient is pregnant at any gestation; specialist liaison with midwifery and obstetrics may be needed to provide a care plan.
• The patient is immunocompromised or has untreated HIV infection with severe genital herpes or new lesions developing while on episodic antiviral treatment; seek specialist advice from infectious diseases or sexual health services.
• There are breakthrough recurrent episodes while taking suppressive antiviral treatment; consider specialist advice about increasing the oral antiviral dose.
• The patient is concerned about transmitting herpes simplex virus (HSV) to a new or not knowingly infected sexual partner; partner screening advice may be appropriate.

Emergency hospital admission should be arranged if the patient is severely systemically unwell or has suspected severe or potentially serious complications that cannot be managed in primary care.