What criteria should I use to decide when to refer a patient with recurrent infections to a specialist?

When determining whether to refer a patient with recurrent infections to a specialist, consider the following criteria based on the type of infection:

• Recurrent Genital Herpes Simplex Infection:
  • Refer if the diagnosis is uncertain NICE CKS.
  • Refer if there is an inadequate or no response to treatment in primary care NICE CKS.
  • Refer if the patient is pregnant at any gestation, as specialist liaison may be needed for a care plan NICE CKS.
  • Refer if the patient is immunocompromised or has untreated HIV infection, with severe genital herpes or new lesions developing while taking episodic antiviral treatment NICE CKS. Specialist advice from the person's infectious diseases team or sexual health services may be appropriate NICE CKS.
  • Refer if there are breakthrough recurrent episodes while taking suppressive antiviral treatment; consider seeking specialist advice about increasing the oral antiviral dose NICE CKS.
• Recurrent Oral Herpes Simplex Infection:
  • Refer immunocompromised individuals with recurrent HSV infection, as they are at increased risk of severe, prolonged, or frequent recurrent oral disease and serious complications NICE CKS.
  • Refer individuals with frequent (defined as 6 or more recurrences a year) or severe recurrent HSV infections, as suppressive oral antiviral treatment may be necessary NICE CKS.
  • Refer if HSV is complicated by recurrent erythema multiforme NICE CKS.
• Recurrent Cellulitis:
  • Consider routine referral to secondary care for advice on the use of prophylactic antibiotics if a person has had two separate episodes in the previous 12 months NICE CKS.
  • Specialists may consider a trial of antibiotic prophylaxis for adults who have had at least two separate episodes of cellulitis or erysipelas in the previous 12 months, especially if treated in hospital or under specialist advice NICE CKS.
  • Consider antibiotic prophylaxis in people who have two or more attacks of cellulitis per year NICE CKS.
  • For patients with frequent recurrences (3–4 episodes per year) despite managing predisposing conditions, antimicrobial prophylaxis can be considered NICE CKS.
• Recurrent Bacterial Meningitis:
  • For babies and young children, examine their back and scalp for signs of a sinus tract NICE NG240.
  • For people with recurrent bacterial meningitis, get specialist radiological advice on investigations for a cerebrospinal fluid leak NICE NG240.
  • For people with recurrent meningitis with unconfirmed bacterial cause, get advice from an infection specialist NICE NG240.
• Recurrent Infections in Atopic Eczema (Children under 12):
  • Refer children for specialist dermatological advice if their atopic eczema is associated with severe and recurrent infections, especially deep abscesses or pneumonia NICE CG57.