Herpes Treatment Guidelines

Your health care provider can usually make a diagnosis of genital herpes based on a physical exam and a history of your sexual activity.

To confirm a diagnosis, your provider will likely take a sample from an active sore. One or more tests of these samples are used to see if you have herpes simplex virus (HSV), infection and show whether the infection is HSV-1 or HSV-2.

Less often, a lab test of your blood may be used for confirming a diagnosis or ruling out other infections.

Your care provider will likely recommend that you get tested for other STIs. Your partner should also be tested for genital herpes and other STIs.

First Clinical Episode of Genital Herpes

Newly acquired genital herpes can cause a prolonged clinical illness with severe genital ulcerations and neurologic involvement. Even persons with first-episode herpes who have mild clinical manifestations initially can experience severe or prolonged symptoms during recurrent infection. Therefore, all patients with first episodes of genital herpes should receive antiviral therapy.

While there is no cure for herpes, treatment with prescription antiviral pills may be used for the following:

• Help sores heal during a first outbreak
• Lower the frequency of recurrent outbreaks
• Lessen the severity and duration of symptoms in recurrent outbreaks
• Reduce the chance of passing the herpes virus to a partner

Here are some treatment options:

• Acyclovir
• Valacyclovir
• Famciclovir

Recommended Regimens

• Acyclovir (Zovirax) : 400 mg orally 3 times/day for 7–10 days
• Famciclovir: 250 mg orally 3 times/day for 7–10 days
• Valacyclovir: (Valtrex) 1 gm orally 2 times/day for 7–10 days

Treatment can be extended if healing is incomplete after 10 days of therapy.

Acyclovir 200 mg orally five times/day is also effective but is not recommended because of the frequency of dosing.

If you’re experiencing a lot of pain, you may want to ask your doctor to prescribe a painkiller or take some over-the-counter pain medication. Here are some other ways to manage pain during a herpes outbreak:

• Apply cold compresses to the infected area
• Keep the lesion(s) clean and dry
• Wear loose clothing and underwear that breathes

Recurrent HSV-2 Genital Herpes

Almost all persons with symptomatic first-episode HSV-2 genital herpes subsequently experience recurrent episodes of genital lesions. Intermittent asymptomatic shedding occurs among persons with HSV-2 genital herpes infection, even those with longstanding clinically silent infection.

Antiviral therapy for recurrent genital herpes can be administered either as suppressive therapy to reduce the frequency of recurrences or episodically to ameliorate or shorten the duration of lesions.

Certain persons, including those with mild or infrequent recurrent outbreaks, benefit from antiviral therapy; therefore, options for treatment should be discussed. Many persons prefer suppressive therapy, which has the additional advantage of decreasing the risk for transmitting HSV-2 genital herpes to susceptible partners.

Suppressive Therapy for Recurrent HSV-2 Genital Herpes

Suppressive therapy reduces frequency of genital herpes recurrences by 70%–80% among patients who have frequent recurrences. Persons receiving such therapy often report having experienced no symptomatic outbreaks.

Suppressive therapy also is effective for patients with less frequent recurrences. Long-term safety and efficacy have been documented among patients receiving daily acyclovir, valacyclovir, and famciclovir.

Quality of life is improved for many patients with frequent recurrences who receive suppressive therapy rather than episodic treatment. Providers should discuss with patients on an annual basis whether they want to continue suppressive therapy because frequency of genital HSV-2 recurrence diminishes over time for many persons.

However, neither treatment discontinuation nor laboratory monitoring is necessary because adverse events and development of HSV antiviral resistance related to long-term antiviral use are uncommon.

Treatment with valacyclovir 500 mg daily decreases the rate of HSV-2 transmission for discordant heterosexual couples in which a partner has a history of genital HSV-2 infection.

Such couples should be encouraged to consider suppressive antiviral therapy as part of a strategy for preventing transmission, in addition to consistent condom use and avoidance of sexual activity during recurrences.

Suppressive antiviral therapy for persons with a history of symptomatic genital herpes also is likely to reduce transmission when used by those who have multiple partners.

HSV-2 seropositive persons without a history of symptomatic genital herpes have a 50% decreased risk for genital shedding, compared with those with symptomatic genital herpes .

No data are available regarding efficacy of suppressive therapy for preventing HSV-2 transmission among discordant couples in which a partner has a history of asymptomatic HSV-2 infection identified by a positive HSV-2 serologic test.

Among HSV-2 seropositive persons without HIV infection, oral TDF/FTC and intravaginal tenofovir are ineffective at reducing the risk for HSV-2 shedding or recurrences ).

Recommended Regimens

• Acyclovir† 400 mg orally 2 times/day
• Famciclovir500 mg orally once a day
• Valacyclovir1 gm orally once a day
• Famciclovir250 mg orally 2 times/day

Valacyclovir 500 mg once a day might be less effective than other valacyclovir or acyclovir dosing regimens for persons who have frequent recurrences (i.e., ≥10 episodes/year).

All three drugs work pretty much the same, and one study showed that all of them tend to speed up healing time by about one to two days. But the key is to start treatment as soon as you notice signs of an outbreak.

Treatment is most effective when it’s taken within 48 hours of first symptoms, which is a tingling, itching, or painful sensation on the site of the infection.

Taking antiviral medication, such as Acyclovir or Valtrex, is the most effective way to treat outbreaks. The daily medications work by inhibiting the DNA and stopping the virus from replicating. Taking the medication daily, or for 7 to 10 days after the symptoms first appear, can stop the outbreak from getting worse and may help sores recover faster.

Why do some people get frequent herpes outbreaks?

Some people may have a naturally weaker immune system, making it more challenging for their bodies to keep the virus in check. Factors such as poor nutrition, lack of sleep, and overall health can contribute to a compromised immune system, making individuals more susceptible to frequent outbreaks.

Additionally, lifestyle choices can impact the frequency of herpes outbreaks. High-stress levels, unhealthy diet, and lack of exercise can weaken the immune system, making it easier for the virus to become active and cause outbreaks. Managing stress through relaxation techniques, maintaining a balanced diet, and adopting a healthy lifestyle can contribute to reducing the frequency of outbreaks.

What Triggers A Genital Herpes Outbreak?

Controlling herpes outbreaks requires a multifaceted approach that addresses both physical and emotional well-being.

The frequency of herpes outbreaks can vary from person to person due to a combination of factors, including the individual's immune system, lifestyle, and stress levels. While the herpes simplex virus (HSV) is responsible for causing outbreaks, the immune system plays a crucial role in controlling and suppressing the virus.

There is no cure for genital herpes. However, daily use of antiviral medicines can prevent or shorten outbreaks. The most effective way of reducing the frequency of herpes outbreaks is by taking daily antiviral medication.

To understand how genital herpes outbreaks can be prevented, you must first identify your triggers.

Everyone experiences genital herpes differently, and what triggers outbreaks for you may differ from other people.

Avoiding Sex

Avoid sexual contact until all the genital sores are fully healed, which is when they are much less likely to be shedding a viral load (when your body is producing particles that can pass the virus onto others).

Lubrication

Friction during sexual intercourse or masturbation can sometimes trigger genital sores. Using water-based lubricants during sexual activity can help to reduce friction and minimise irritation.

Leaving Sores Alone

While it may be tempting to pick at the blisters when you have an active outbreak, avoid touching the area completely. Touching the sores or wearing tight-fitting underwear could irritate the area and increase the risk of further infection.

Healthy Lifestyle

A healthy diet and exercise help to maintain a healthy immune system, reduces the number of outbreaks they experience. Excessive amounts of alcohol and smoking should also be avoided to keep your body healthy and able to fight the virus.

Reducing daily stress

Reducing daily stress can also help to minimise herpes outbreaks. Low levels of stress will allow your immune system to function properly, and help control the viral activity within your body.

Taking time out of your day to relax, using techniques such as journaling, yoga, and meditation can help regulate stress levels and keep your body functioning as it should.