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  • Dec. 19, 2008

    Herpes treatment options

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

34 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.

34 comments posted

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  • November 6, 2009 10:13 a.m.

    Wow! I feel very lucky. I do have the disease, from a liar. But, I went on to have a great sex life with my partner and neither of us has ever had any outbreaks. I am on Valtrex everyday and it really must be doing it's job. My insurance pays for most of it. If anyone is considering daily suppression therapy I say, do it. You have nothing to loose and everything to gain.

    - Rose

  • November 4, 2009 2:03 a.m.

    My husband and I found out we are both positive for genital herpes, we found out a few weeks before our wedding which was in September. I've only been with 2 people, my husband and an ex-boyfriend. My husband has only ever been with me, therefore it was me that had it (however I should mention that I have never had a outbreak). My ex got tested for a lot of things before we got together since he knew I was a virgin, however this didn't help as he must have cheated on me. Since we both have it the P.A. that we see said unless we have a lot of breakouts it doesn't pay for us to be on the medication. I was wondering if anyone on here has tried the Red Marine Algae??? I have heard in some cases it helps with all the symptoms, there is supposedly no known side effects, and is a lot cheaper than the medication the doctors prescribe. Has anyone tried this??? What is your opinion of it???

    - Sydney

  • October 21, 2009 11:00 p.m.

    I'm curious as to how there is a chicken pox vaccine, but no herpes vaccine? Aren't they in the same family of viruses? I caught herpes off my unfaithful partner over ten years ago. I was devastated at first, but have learned to accept this non-deadly, but yes-highly annoying disease. I'm fortunate that I rarely experience outbreaks ( maybe one or two a year) and when I do, they're very mild. I feel that there is no one typical herpes case. I know people who have to remain on suppressive therapy because of frequent outbreaks, and others, like myself, who forget they even have it because it's so mild. As for sex lives, I don't get why people feel it's so horrible. It doesn't kill you, and with safe sex, it isn't nearly as contagious as it's made out to be. And hey, one in five people have it, so your next partner might be struggling with it too! So don't beat yourself up over having it. It's not deadly, and it is treatable. My ex lover was very understanding when he discovered I had it. I think most good people won't judge if you are honest, upbeat and realistic about herpes. There are much worse diseases to have.

    - Janice

  • October 14, 2009 3:04 p.m.

    Sam, I have the same outbreaks. My D.O. told me this is because herpes effects the nerve endings & this is one area where nerves end. Some time ago I was tested (by a blood test) to see which type I have (1 or 2). This helps the Dr to detemine how to treat it. I take a supplement called L-lysine (recommended by my D.O. - the M.D. I saw previously never even suggested it as an option! He just wanted to treat it with prescription meds & had an "oh well" attitude. couldn't even explain why I got it in this area only). If taken consistently, it keeps me from having any outbreaks at all. If I skip doses, sure enough, I will have an outbreak. I take Acyclovir to treat these episodes. It works very quickly, usually in the first dose & only have to take it for 2-3 days.

    - Lory

  • October 2, 2009 5:58 p.m.

    Sam, I have the same symptoms. Sores on my back, at the top of my buttocks. But only on the left side. My first outbreak was 10 years ago - at age 50! My husband has never had a sore and we've been married 35 years! I have NEVER had a relationship with anyone since well before we married. When I feel a sore coming on we avoid body contact. I'm as confused as you.

    - Linda

  • October 2, 2009 4:20 a.m.

    Perhaps someone can enlighten me.... I have had herpes for 20 years. I take the meds on a twice weekly basis to be consistant, otherwise, I feel as though I'm just waiting for "it" to happen. My doctor says that the virus weakens as time passes. My outbreaks occur ONLY on the top of my buttocks at the base of my back. Never on my genitals. Obviously I wouldn't have sex during any outbreak, but since my outbreaks are distant from my genital area, could I possibly infect someone genitally? Clearly, if my partner came in contact with a sore on my backside, they might get the virus, but I have never had a sore on my genitals. Would someone kindly fill me in on my vulnerability of infecting someone. Further, my doc refers to my outbreaks as cold sores, only on my back. Yet, he prescribes Valtrex. Anyone??

    - Sam

  • September 5, 2009 5:06 a.m.

    WHAT TO DO IN BREAST FEEDING MOTHERS , WILL MEDICATION AFFECT THE BABY?

    - MARIA

  • September 3, 2009 7:50 a.m.

    Herpes has been around for a long, long time. Seems as if we would be winning this battle. To date we have no cure or resolve.....hmmmm. Do the drug companies really want one. First, they would have us take a regimen of the drugs during the period of an outbreak. But NOW, they would have us take it on an addivctive continuos basis (suppressive therapy)...hmmmm. THERE IS NO BENEFIT FOR A CURE or resolve for the drug companies, now that we have to take this med for life - the addict. And for those of you who claim you can pinpoint who and where you contracted herpes, guess again. The herpes virus can remain dormant in your body for years and you not know it. So yes, look back at all your relationships and take a guess!!

    - Maryland

  • August 26, 2009 11:43 a.m.

    I am on Valtrex since diagnosis (jan 2009) because breakouts are so frequent, looking forward to a generic. Someone asked about shaving, which is indeed how mine first showed up. Long Story, I'll spare you. Breaks in skin, even tiny ones, are going to enable the viruses that are camping out on the nerves just beneath the skin to come out and ulcerate. I am told that over time breakouts reduce in number and intensity. Someone asked why test if no effective cure? Ethically sound question. Knowledge can help you make choices: condom or not? Tell partner or not? What kind of relationship? Medicine or beer? How can this experience make you a better person? For me, I have readjusted some priorities and am not able to/going to have the meaningless sex i've had in the past. I get to focus on helping others out, on learning how to care better for my patients. I've had cancer before, and privileged to have healed. Herpes is harder for me than cancer was.

    - Herpes Nurse

  • June 20, 2009 3:25 p.m.

    I have a friend who is 84 years old. She has had a sore tongue for a year now. One doctor she went to said it is oral herpes (OTOL) whatever that means. That doctor has not prescribed anything for her. She has suffered for a year now. One of my daughters and my husband get the cold sores that are herpes so I am familiar with it in that context. But this lady has little red nodules on her tongue and I just don't know anything about it and have checked web sites to no avail. I wish she could take somethilng to make her feel better. Please respond. Thank you, Karen

    - KaKaren

  • June 1, 2009 12:28 a.m.

    Ok, I need to get something off of my chest. Not sure if I have it, but I do have symptoms (no outbreak) so I've been doing research. Firstly, I wish people would be upfront about how much it sucks to have herpes. Statements like "educate yourself, don't let it control you" are such an oxymoron. If you truly educate yourself (unlike the girl who I think gave it to me) you would realize that it DOES control your life. How great would this world be if you could only transmit during an outbreak...that way I'd buy into all the Valtrex crap. Spend more days between outbreaks, have more sex...hooray!! Instead, were told don't have sex during an outbreak (duh), BUT you might want to tap the break during non outbreak days because you can shed. Oh and guess what, we (the medical community) STILL can't even tell you when you're shedding. Oh and btw, condoms won't really help because you could (and probably) be shedding somewhere other than the penis. So what has all this education done fore me?? Made me so paranoid that,honestly, there is no safe sex with herpes. Yeah, yeah you can find a lifelong, committed partner who wants to play Russian Roulette every time you sleep together...but if a single, casual lifestyle is your choice...forget about it! Imagine if herpes was life threatening like AIDS. Do you think the advice would be 'educate yourself, don't let this control you?' Hell no, they would say wrap it up and pack it away...you can transmit ANY time you h

    - Herpes, the (casual) sexual death penalty...

  • May 8, 2009 2:13 a.m.

    If you are a guy you can get herpes with a rubber, my little brother got infected in the groin area. AND yea, Why DO you not make any mention of it??? emw? Oh Joe...you're so wise!

    - cathy

  • April 27, 2009 10:34 a.m.

    Dear RI, No medication is 100% protective to prevent herpetic sores. During stressful times, it is common to develop a sore, even if you are taking suppressive medications. It is important to remember to take the medication twice a day with Acyclovir. The advantage of Valtrex is that it is a once a day dosing regimen. If you have difficulty remembering to take the medication twice a day, it may be in your best interest to use the once a day medication. A generic of the once a day medication should be available soon.

    - Lois McGuire

  • April 22, 2009 4:39 a.m.

    I have had genital herpes (Im a woman) about 14 yrs - after a 1 nite stand. My outbreaks thankfully, arent that bad compared to what Ive heard it can be like. I usually only have 1-2 a year, without any meds, & you can barely see any sores. I can just feel that tingly burning feeling, especially when I pee. It usually takes about 4-5 days a least, on Acyclovir, to get it cleared up. I am now in a current sexual relationship that is new, & began taking the Acyclovir daily. Dont you know, I just had 2 very stressful life events, AND its the week before my period, & I have an outbreak. The meds dont seem to be helping at all. Is Acyclovir AS effective as the other options? I only take that as opposed to the other meds, for cost reasons. But if it helps cut down on the risk of my partner contracting it, I will MOST certainly pay for the more expensive Valtrex. Also, what can I take or put on the area, if anything, to speed healing? Thanks

    - RI

  • April 21, 2009 10:13 a.m.

    I have herpes of the mouth but nothing in my genital region, yet the break outs I get are not your typical cold sore, in fact they are quite severe and have caused severe scarring. I treat it suppressively and in fact have noticed when I grow a mustache me outbreaks are slim to none. Any connection with shaving and breakouts?

    - confused

  • April 19, 2009 1:43 p.m.

    When will the generic Valtrex be available? the cost of this medicene is outragous considering that 1 in 5 Americans have this...SmithKline has had the funds to develope this a very long time ago!

    - Sandy

  • April 8, 2009 1:05 a.m.

    I had gentile herpes for under a year now.. I been taking Valtrex and its been about 2 months and it remains very sensitive and the affected area is darker. Why wont this pass?

    - Mark

  • April 2, 2009 8:35 p.m.

    I have had herpes for years with only 2 outbreaks. Now I guess it has been 10 years plus, and randomly I get pain in my legs, vaginal area, like I just fell on the cross bar of a bycycle that was to big. and pain in my butt, and upper legs. what is this? I assume it is the virus. Is there anything for this?

    - just sore

  • March 27, 2009 11:03 p.m.

    Ft. Lauderdale, Sounds like you should try suppressive therapy if you've had 4 outbreaks in that period of time. ALWAYS tell any potential sex partner about your herpes before you start a sexual relationship. The woman who possibly gave you herpes may not even know she has it. Don't be ashamed, become informed about herpes and take control of it--don't let it control you. Maybe one night stands aren't the way to conduct your love life--just be glad that it's herpes and not HIV. Good luck.

    - Deb

  • March 27, 2009 12:40 a.m.

    First of all thanks to everyone who has posted comments - it is good to know that I am not alone... I discovered that I had genital herpes back in December of 2008 and have had 4 outbreaks of sores since - the most recent being the worst but I used a topical treatment and it shortened the healing time of the sores. I feel devastated - I had a one night stand with a married woman who showed no symptoms of having the virus and I had an outbreak about two weeks after this encounter. I feel like my life is over as sex is and always has been a big part of my life. How do I go about getting over the shame I am feeling for having this virus and what is the best way to bring it up with a potential partner if I can ever get myself out of the house and back on the dating scene? Any advice will be gratefully received. Thanks!

    - ashamed in ft lauderdale

  • March 2, 2009 9:05 p.m.

    i have terrible pain i my left butt cheek Were i have had the outbreak but it is now inside my body. Do u think it has been festering for the 7 years which i have not had an outbreak?

    - ellen

  • February 22, 2009 10:20 p.m.

    Unknown, Yes you can still have sex, but must use suppressive therapy and condoms to protect your partner. Also, you must tell your partner that you have herpes before having sex with them--truthfulness will help a relationship and if your partner doesn't want to risk getting herpes then you must respect their choice.

    - Deb

  • 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

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