Page 155 - HPP ANTIMICROBIAL GUIDELINE 2018

Suggested Treatment
Infection/ Condition Comments
Preferred Alternative

Herpes Genitalis First and second trimester
First episode and in pregnancy Acyclovir 400mg q8h PO for 5 days acquisition:
Acyclovir is not licensed for use in
pregnancy; however, there is
substantial clinical experience
Suppressive therapy: Acyclovir 400mg PO q12h for up to 1 supporting its safety i.e. the benefits
(may be indicated if > 6 year, then reassess of antiviral therapy outweigh the risk
recurrences per year) of withholding treatment (pregnancy
category.

Vaginal delivery should be
anticipated

Third trimester acquisition:
If a true first episode is confirmed,
caesarean section should be
considered for all women, particularly
those developing symptoms after 34
weeks of gestation, as the risk of
viral shedding is very high. If vaginal
delivery is unavoidable, acyclovir
treatment of mother and baby may
be indicated

References:
1. Malaysian Guideline in the Management of Sexually Transmitted Infections 2008.
2. Syphilis: A Provider’s Guide to Treatment and Prevention 2017. CDC United States.
3. UK National Guidelines on the Management of Syphilis 2008
4. British Association of Sexual Health and HIV Clinical Effectiveness Guidelines 2016

HPP AMG Sexually Transmitted Infections 72