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Let's face it, herpes is a sensitive subject. It causes seventh graders in health classes everywhere to stifle their nervous giggles. You might be shifting in your seat right now just reading this. While our minds often jump to genital herpes as a consequence of sexual activity, herpes simplex virus (HSV) is a bit more diverse than that. And just because herpes is usually kept private doesn't mean it's rare. Millions of Americans seek treatment for it each year. Fortunately, we're here to answer sensitive questions about herpes. Read on for all the important information about herpes and its various treatments.
What is herpes?
Herpes is a common and contagious infection caused by the herpes simplex virus (HSV). Spread by skin-to-skin contact with infected areas, it commonly manifests as sores or blisters around the mouth and/or external genitalia. Other herpes symptoms can include itching, fever, chills, body aches, and painful or difficult urination.
There are two types of herpes. HSV-1 is far more common and often less severe. The World Health Organization estimates that 3.7 billion people worldwide have HSV-1, nearly half the global population. It's often called oral herpes because it occurs around the mouth, appearing as cold sores, although many cases are asymptomatic. This herpes simplex virus type can be transmitted by oral-to-oral or oral-to-genital contact, even when there are no active sores. Sometimes, sharing toothbrushes or utensils with an infected person can also lead to transmission.
HSV-2, genital herpes, is a sexually transmitted disease and (as the name suggests) primarily affects the genital area. Like HSV-1, HSV-2 can show very mild symptoms or no symptoms at all. But it can also cause blisters and ulcers on the genitalia and rectum. Further, people with HSV-2 might also experience flu-like symptoms, specifically fever, chills, and body aches.
Both forms of HSV infection are lifelong and incurable. This doesn't mean constant recurrent outbreaks, though. People can go long stretches, even years, without outbreaks or symptoms. This is one of the reasons why herpes is so prevalent. According to a CDC fact sheet, 1 out of every 6 Americans ages 14 to 49 has genital herpes, and that an estimated 87.4% of them never receive a clinical diagnosis.
How is herpes diagnosed?
The herpes virus is almost always spread through sexual intercourse, oral sex, or kissing. Although sometimes HSV-1 can spread via shared lip balm, utensils, or other items that come in contact with saliva.
In most cases, healthcare providers can diagnose herpes with a visual examination and by discussing various symptoms. If there's any doubt, they can take a viral culture to confirm, which involves lab analysis of a swab or scraping.
"If the patient has no history of herpes simplex and is a new patient, I always do a viral culture," says Marie Hayag, MD, a board-certified dermatologist and founder of 5th Avenue Aesthetics. "Also, if I am suspicious of HSV-2 or if it is an immunocompromised patient, I will order a viral culture. I start treatment right away before results come back. These results can take one week and it is best to start treatment early."
But again, symptoms aren't always present. Fortunately, it's also possible to diagnose HSV with a blood test. Your body produces antibodies to combat viruses, and doctors can use a blood sample to detect the specific antibodies that fight the herpes simplex virus.
A primary care physician can perform the examinations and tests necessary for an accurate diagnosis. However, sexual health clinics offer similar, reliable services.
Herpes treatment options
Unfortunately, herpes is a persistent disease and there's no cure, so anyone who has it, has it for life. The silver lining is that many people report experiencing less frequent and severe symptoms over time, sometimes going years between outbreaks.
But that doesn't mean people with herpes simplex virus infections have to simply grin and bear it. There are ways to manage its symptoms. The most common (and effective) is prescription antivirals. These are typically employed in one of two ways: episodic therapy or suppressive therapy.
Episodic therapy treats each outbreak as it arises. The patient begins antiviral therapy at the first sign of an outbreak and continues taking it for several days, shortening the episode’s timeframe. This makes it ideal for people who experience less frequent outbreaks. Suppressive therapy, on the other hand, is more conducive to patients who experience recurrent outbreaks. It involves taking daily doses of antiviral medication to keep HSV symptoms at bay and reduce the likelihood of episodes. Neither of these treatment types will prevent transmission to sexual partners, though.
Whether it's a patient's first episode or their 10th, it's best to start medication at the first sign of an outbreak. "You do not need to wait for a rash or bumps to appear to start treatment," Dr. Mayag says. "The sooner you start, the better. Medications will not stop it immediately, but they will decrease the length of the infection and the viral load."
Anyone with an HSV infection should avoid over-the-counter creams and lotions. Keeping the infected area clean and dry is essential, and creams can interfere with the healing process.
Herpes medications
Even though there's no cure for the herpes simplex virus, antivirals can hinder its spread, and pain relievers can help manage its symptoms.
Antivirals
Antiviral treatment is really the only kind of prescription medication that acts directly on the herpes virus. It won't cure the disease, but it can help to prevent viral reproduction, potentially suppressing outbreaks and calming herpes symptoms. By interfering with the virus' reproductive mechanism, antivirals stop it from spreading to healthy cells. These medications work for either type of HSV and doctors most often prescribe them to patients experiencing their first outbreak. "The three most often prescribed oral medications are Valacyclovir, Acyclovir, and Famciclovir," says Kenneth Mark, MD, a cosmetic dermatologist and clinical assistant professor at NYU Department of Dermatology. Another popular choice is Abreva, a topical ointment primarily for HSV-1 treatment.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Over-the-counter pain relievers like ibuprofen and acetaminophen won't treat the disease itself, nor will they prevent its spread. However, they can reduce any pain or discomfort associated with the symptoms of herpes. NSAIDs can potentially interact with antiviral drugs like Valtrex and Zovirax, so the two types of medication should not be taken together.
What is the best medication for herpes?
The effectiveness of a particular medication varies depending on the person, so there's no single "best" herpes treatment. Doctors prescribe the most suitable drug for each patient's condition, medical history, and current medications. That said, here are a few of the drugs most commonly used to treat HSV:
| Best medication for herpes | ||||
|---|---|---|---|---|
| Drug name | Drug class | Administration route | Standard dosage | Common side effects |
| Valtrex (valacyclovir) | Antivirals | Oral | 1,000 mg taken twice a day for 3-10 days | Headache, nausea, abdominal pain |
| Famvir (famciclovir) | Antivirals | Oral | 500 mg 3x a day | Headache, nausea, diarrhea |
| Zovirax (acyclovir) | Antivirals | Oral | 200-400 mg 3-5 times a day for 5 days or up to 12 months (depending on outbreak frequency) | Nausea, vomiting, diarrhea |
| Abreva (docosanol) | Antivirals | Topical | Applied as a thin layer to the affected area | Itching, rash, redness |
Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist.
What are the common side effects of herpes medications?
While taking Valtrex, Famvir, or Zovirax by mouth, patients may experience:
- Nausea
- Vomiting
- Dizziness
- Headache
- Abdominal pain
For the topical version of Zovirax or Abreva, common side effects include:
- Dry skin
- Flakiness
- Stinging
- Redness
- Swelling
This doesn't encompass the full scope of potential side effects, just the most common ones. Anyone considering treatment with one of these medications should speak with a healthcare professional for a more comprehensive list.
What are the best natural remedies for herpes?
When experiencing a herpes outbreak, one of the most important things someone can do is keep the area clean, cool, and dry, since heat and dampness can irritate the sores. Maintaining a healthy immune system can go a long way too, according to Dr. Hayag. "A strong, healthy immune system can keep herpes under control, prevent outbreaks, and reduce the duration of symptoms," she says. "Supplements like zinc, vitamin C, and echinacea are vital to increasing your immune function and easy to incorporate into your daily routine." And when it comes to natural remedies, there are several that can provide much-needed relief.
Supplements
- Lysine When taken in large doses (500 mg to 3000 mg a day), this amino acid has shown some efficacy in reducing the severity and frequency of outbreaks, but there isn't any extensive data available.
- Vitamin C By supporting your immune system, vitamin C can potentially promote healing and less frequent outbreaks.
- Zinc has shown some promise in protecting against HSV-2 outbreaks.
- Probiotics This study indicates that probiotics can be effective in fighting HSV-1 outbreaks.
Topical Remedies
- Licorice root extract. When combined with Aquaphor or vaseline and applied to the affected areas, this licorice's antiviral properties may help contain an outbreak.
- Lemon balm oil. Applying this oil at the first sign of an outbreak has shown efficacy in reducing outbreak severity, particularly in cold sores.
- Manuka honey. Applied directly to herpes lesions, this honey can inhibit their spread and severity.
- Garlic. Because it has antimicrobial and antiviral properties, topically-applied garlic can potentially help fight herpes outbreaks.
- Cold compresses. These primarily help by reducing discomfort and swelling during an outbreak.
Frequently asked questions about herpes
Can herpes be cured?
Unfortunately, no. Once someone contracts oral or genital herpes, they have it for life. Drugs and natural remedies, however, can help manage symptoms, and many cases are completely asymptomatic.
What does a herpes sore look like?
A herpes outbreak often manifests as clusters of small blisters filled with clear fluid. When these blisters break, they form small open sores that eventually scab over.
How do people get herpes?
Herpes is contracted primarily through unprotected sexual contact with an infected person, whether genital-to-genital, oral-to-oral, or oral-to-genital.
How can I treat herpes at home?
Certain dietary supplements—like lysine, vitamin C, zinc, and probiotics—can help support your immune system and prevent or shorten outbreaks. Once an outbreak has begun, applying cold compresses, licorice root extract, lemon balm oil, manuka honey, or garlic can reduce its severity and provide symptom relief.
What helps herpes sores heal faster?
Keeping the sores clean, cool, and dry is beneficial to the healing process. Bandaging, heating, or picking at sores will irritate them and can extend their duration. The most effective method for shortening herpes outbreaks is a prescription antiviral medication like valacyclovir, famciclovir, or acyclovir.
How effective is herpes medication?
Antiviral herpes medication will not cure oral or genital herpes infections. However, suppressive therapy significantly ameliorates its symptoms. The Centers for Disease Control and Prevention determined that this treatment can reduce genital herpes outbreaks by 70%-80% in patients that frequently experience them.
Is there an over-the-counter medicine for herpes?
Yes, but OTC medications are generally less effective in treating herpes than prescription ones. Abreva is an over-the-counter topical drug that many people use to treat cold sores from HSV-1, but not HSV-2. NSAIDs like ibuprofen and Tylenol are OTC drugs that reduce pain and discomfort, but they do not treat herpes directly.