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    Lois McGuire, R.N., M.S.N., W.H.N.P.

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  • Dec. 19, 2008

    Herpes treatment options

    By Lois McGuire, R.N., M.S.N., W.H.N.P.

37 comments posted

Although there is no cure for herpes, there are medications that significantly reduce the frequency and duration of outbreaks. These medications have few side effects in most people.

There are 3 prescriptive medications approved for the treatment of herpes. They work by interfering with DNA synthesis to prevent the virus from reproducing. The directions for each medication vary, so pay close attention to the frequency of taking the medication. Herpes treatment options include:

  • Acyclovir (Zovirax): This is the oldest and there is a generic of this medication so it is cheaper.
  • Famcyclovir (Famvir)
  • Valacyclovir (Valtrex): There should be a generic of this medication in approximately one year.

All of these medications are effective in suppressing HSV 1 and HSV 2 and can be taken episodically or continuously.

Episodic therapy
This means taking the medication when you have an outbreak or feel a sore coming on. As soon as you feel a sore coming on, begin taking the antiviral medication. If you begin treatment soon enough, the drugs can lessen the severity and shorten the healing time.

You should take the antiviral medication episodically:

  • If you are not sexually active and have infrequent outbreaks
  • If both partners are infected with genital herpes.

If you are both infected with the same virus, HSV 1 or HSV 2, in the genital area, you don't need to worry about giving it to each other. One or both of you may want to suppress if you are having frequent sores, but you don't have the responsibility to protect each other from getting the virus since you both already have the virus.

Suppressive therapy
You can take the medication continuously to prevent an outbreak or a sore. This is called suppressive therapy. We know that up to 70 percent of new cases of herpes are transmitted from someone showing no apparent symptoms at the time they infect their partner. This is called asymptomatic shedding of the virus. When taken suppressively, the drugs don't always prevent outbreaks, but help them to occur less frequently. In patients who have at least 6 outbreaks per year, suppressive therapy reduces the frequency by 70 percent to 80 percent. Many patients report no symptomatic outbreaks when using suppressive therapy.

You should take the antiviral medication:

  • If you have frequent sores
  • If you have HSV 1 or 2 that and are sexually active with a non-infected partner
  • If you have HSV 1 of the mouth and your partner has HSV 2 of the genital area, both of you would suppress to prevent exposing your partner to the another type of herpes

Once again, for optimal protection, it is important to use a condom or dental dam along with antiviral suppressive therapy.

Over-the-counter medications
Currently, there is no over-the-counter medication shown to be effective. The most frequently discussed OTC is L-lysine. Some people report favorable results but studies don't support L-lysine to be effective in preventing or shortening herpes outbreaks. If you do feel it helps, remember, you still have an obligation to protect your partner. L-lysine has not been shown to be protective for your partner. For now, you will need prescription medication to protect your partner.

Symptom relief
If your genital symptoms are bothersome to severe, here are a few tips to help relieve these discomforts:

  • Wear loose clothing.
  • Wear cotton underwear.
  • Urinate in the tub or pour water over the genitals while urinating.
  • Use a drying agent in your tub water. You can sprinkle cornstarch lightly on your genitals while in the tub. Soak twice a day for 15 minutes.
  • Tannic acid found in black tea has been found to reduce itching and pain. Place a moist tea bag over the sore.
  • Ice packs to the lesion may be soothing.

A vaccine is being tested. This vaccine will not help the person who already has herpes but will protect a person from getting the virus.

Next, I will address the emotional aspects of herpes and reliable resources.

37 comments posted

blog index

  • February 22, 2009 1:38 p.m.

    Something feels like its moving over my body i've be to the dr. everything came back negative but i feel a tight pain in the back of my knee that stiffs up while i am playing basketball is this a sign of an std???????

    - wildchild

  • February 22, 2009 1:35 p.m.

    can you still have sex if you contract herpes

    - unknown

  • January 30, 2009 9:41 p.m.

    put vicks medicated rub or the store brand version on cold sores or genital outbreaks. use it after you wash. It will soothe and heal it. Use along with supressives. You can also cleanse with peroxide then dab on providone iodine then put vicks on it or carmex if you dont have vicks.

    - JOYLUCK

  • January 14, 2009 9:26 a.m.

    I was hoping that this would be a commentary on how people spend billions of dollars on antivirals like Valtrex and Famvir and still they are not 100% effective. What's more, these drugs were created in the late 1970's -- where's the progress? What a joke. HSV has reached epidemic proportions - 80% of adult Americans have HSV-1 and 1 in 5 Americans have HSV-2. The problem is that 90% of people have no idea that they're infected so people run around cracking jokes about it. The people who do know that they're infected aren't the ones transmitting -- Nurse Lois, how about you talk about those? Either we start getting everyone tested or stop testing altogether because the 10% who know have to deal with crippling psychological consequences and a tremendous burden. And shouldn't the medical community, including people like the author, be agitating for things like therapeutic vaccine and permanently suppressive antiviral development, instead of preaching about the current antivirals out there? And when you talk about a vaccine being tested, you should call it by its name (Herpevac) and mention that it only works on women who don't have either HSV-1 or HSV-2 and even then it's only 73% effective. So no men, no one who has either virus (and 50% of people have it before the age of 10) and even then with the vaccine there's a 1 in 4 shot that it won't work. The medical community needs to wake up on this one and start making changes. It's been a total failure to date.

    - seriously?

  • January 13, 2009 10:40 p.m.

    Mel B. Maybe your husband should read the Mayo blog on herpes to see what other people have been through and how difficult it can be to know if you have herpes. Herpes is so different for each of us and many people do not even realize that they have it and can infect someone else. If herpes is the only reason he wants the divorce, then I think he should be willing to learn more about it. After all, with the high prevalence of herpes he may well be involved with someone else later who has it. Best of luck to you. Now that you know you have it you can use suppressive therapy in any new relationship but please be sure to tell any future partners you tested positive for herpes before you have a sexual relationship with them.

    - Deb

  • January 13, 2009 4:43 p.m.

    I tested positive as well but has never had an outbreak. How do you explain this to a partner? I am in the process of getting a divoce because my husband felt that I lied to him about having it.

    - Mel B.

  • January 13, 2009 3:02 p.m.

    After 28 yrs in a monogamous marriage, I ended up divorced. From my first and only relationship after the divorce, I contracted herpes about 18 months into the relationship. He had been sexually active with out protection prior to our getting together but says he had never had any symptoms or outbreak...... we were both tested and had the same type of genital virus My 1st outbreak was horrendous. I could barley sit down. I had one breakout each of the next couple years and were much less severe. My Dr has me take Acyclovir as needed. Now I have not had any breakouts for the last 3 years.

    - IzzzyAz

  • January 12, 2009 12:53 p.m.

    Tony, I am not a DR but I know a lot about this. You might be an asymptomatic carrier. If you do not have outbreaks then it can be hard to tell where you were exposed. You may never have an outbreak. Regardless, you have herpes. Did the DR give a blood test to see what type you have? I would keep the same. Use condoms for BC reasons and to prevent other STD infections. If you are worried about prevention take the suppressive meds. Hope I helped y'all.

    - Danielle

  • January 6, 2009 8:28 p.m.

    please answer tony's question (12/24/08). It's my situation, too.

    - sheila

  • December 24, 2008 9:27 a.m.

    my female partner recently learned she has hsv-1 of the genetal area. so i went and got tested. dr. said i was exposed to the virus and have antibodies. i've not had any symptoms of mouth or genetal area. what do my partner and i do now? we've always had sex with condom but do we now need to limit activity in any way? will i get an oral or genetal outbreak by engaging in oral sex? not clear on what it means to be exposed...how do i know if i have oral/genetal and how do i prevent? help. thx.

    - tony

  • December 24, 2008 8:10 a.m.

    Abreva does not work well for everyone. In these cases it is less effective or the same as some of the other OTC medications.

    - emw

  • December 19, 2008 11:30 p.m.

    " no over-the-counter medication shown to be effective. " Abreva is actually quite effective at dealing with cold sores. Abreva has been on the market for years. Why do you not make any mention of it?

    - Joe

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