Herpes & Medication: What Do Doctors Recommend?

Although the herpesvirus family is large, only about eight of these viruses infect humans. Of those, most people are concerned about herpes simplex virus (HSV)-1 and HSV-2. These viruses result in oral and genital herpes respectively. ^{(Learn More)} Both types of herpes have similar symptoms. Sores or blisters may be painful or itchy, and they may be accompanied by fever, malaise, or discharge. ^{(Learn More)} They are very common viruses in the United States. Although they are highly infectious, medication can suppress symptoms, viral replication in the body, and reduce the risk of transmission. ^{(Learn More)} Prescription medications are typically given to people who are diagnosed with genital herpes, but severe oral herpes outbreaks may require prescription treatments. These can be either episodic, or used during a herpes outbreak, or suppressive, meaning they are used daily. ^{(Learn More)} If you have either oral or genital herpes, you can manage symptoms at home, but these treatments should not be used in place of medication and doctors’ visits. ^{(Learn More)} While there is no cure for herpes, there are ways to prevent or reduce the risk of spreading the virus. ^{(Learn More)} 

What Is Herpes?

Herpes is the name of a family of about 100 known viruses, eight of which infect humans. Herpesvirus diseases include chicken pox (human herpesvirus type 3, varicella zoster, or herpes zoster), which may cause shingles later in life; Epstein-Barr virus (HHV-4), which can infect the white blood cells; cytomegalovirus (HHV-5), which may cause gastrointestinal complains; roseola or a rash caused by HHV-6 and HHV-7; and Kaposi’s sarcoma (HHV-8). The most famous strains of herpes are oral herpes, herpes simplex I (HSV-1), and genital herpes, herpes simplex II (HSV-2). Most people around the world come into contact with herpesviruses at some point in their lives. These diseases are only problematic if the individual has a compromised immune system. However, they are very easy to transmit, especially HSV-1 and HSV-2. Most people are concerned about transmitting genital herpes, as this can lead to more direct complications than other forms of herpesviruses. There are vaccines against chicken pox, but there are no current vaccines that are effective against HSV-1 and HSV-2. It is important to know the symptoms to reduce the risk of spreading these infections to others.

Herpes Simplex: Transmission and Symptoms

While people who have compromised immune systems may be concerned about other forms of herpes, the two most concerning and infectious forms of herpesvirus in the United States are HSV-1 and HSV-2, also known as oral herpes and genital herpes. The viruses are both chronic conditions, so they are not curable once they are contracted. Although they are related, they involve different treatment approaches.

• Oral herpes: HSV-1 is a very common form of herpes, typically appearing as cold sores on a person’s lips or inside their mouth. HSV-1 blisters may appear on other parts of the face too, like around the eyes or the nose. HSV-1 infection in the eyes is herpes keratitis. Symptoms of oral herpes, or cold sores, typically last 8 to 10 days. For many people, symptoms may not even appear as blisters or sores. They can feel like chapped lips, a cut in the lip, or a pimple.According to the

  World Health Organization, almost 70 percent of the global population who are under 50 years old are believed to have oral herpes. This disease is most frequently transmitted through saliva or blood contact in childhood. However, HSV-1 is increasingly considered a sexually transmitted disease (STD), as it can be transmitted to the genitals through oral sex, and vice versa.

• Genital herpes: HSV-2 can look similar to oral herpes, with blisters that may hurt or itch; however, the blisters or sores appear on the genitals. The disease is less common than HSV-1, with about 20 percent of sexually active adults in the U.S. being diagnosed with this condition. The Centers for Disease Control and Prevention (CDC) reports that about one in every six people in the United States, between the ages of 14 and 49, has

  genital herpes

  from either HSV-1 or HSV-2.You will not contract genital herpes from toilet seats, bed sheets, towels, or swimming pools; however, you will contract the disease if your genitals come in direct contact with an open herpes sore, either on someone else’s genitals or on their mouth.The disease is spread through contact with an HSV-2 sore. This is predominantly through unprotected genital-to-genital contact, but increasingly, HSV-2 is transmitted through genital-oral contact. Like oral herpes, people with genital herpes are typically asymptomatic, so they do not know they have the disease unless they get regular STD testing.

HSV-1 and HSV-2 can both infect the rectal area since it is a mucous membrane. Both of these types of herpes have similar symptoms. The initial outbreak may be associated with flu-like symptoms, especially for adults who contract HSV-2. The first symptoms will appear about 4 days after exposure, although blisters can appear from 2 to 12 days after exposure to the virus. Herpes simplex symptoms include the following:

• Fever

• Headaches

• Tiredness or lethargy

• Lack of appetite

• Swollen lymph nodes

These symptoms are signs that your immune system is fighting a new pathogen. After the initial outbreak, you are unlikely to experience flu-like symptoms. During active phases of either herpes virus, you will experience the following symptoms:

• Sores or blisters that may hurt, itch, feel hot, or swell

• Burning or itching around the genital area before sores appear

• Pain during urination (genital herpes) or eating (oral herpes)

• Itching in the blister area as the sores appear, burst, and heal

• Discharge, especially from the vagina

• Blisters or ulcers on the cervix

Diagnosis of either herpes virus requires a medical professional to evaluate your symptoms and perform additional tests. This will likely involve a blood test, which can detect antibodies from your immune system, so your doctor can see if you have the virus even if it is not active. Your doctor may perform a herpes culture if you have active blisters or sores, which will involve a swab of the sores. Over time, outbreaks will occur less and less often, and symptoms will be less and less painful regardless of whether you receive prescription medication or not. Medical treatment, especially for HSV-2, greatly reduces how infectious you are to others. Treatment can reduce your outbreaks and symptoms associated with outbreaks much faster than your immune system can on its own. There is no cure for any herpesvirus, although some types of the virus have vaccinations. HSV-1 and HSV-2 do not have effective vaccines, however. Medical treatment for the disease, particularly HSV-2, involves antiviral medications that may be taken when the virus becomes active or taken regularly to consistently reduce the viral load in your blood.

Prescription Drug Treatments for Herpes Simplex 1 and 2

Antiviral medications are the primary treatment for herpes, especially genital herpes. If you have frequent outbreaks of oral herpes, you may benefit from prescription medical treatment for cold sores or fever blisters. Medical treatments for both oral and genital herpes include:

• Acyclovir: This is one of the oldest herpes treatments, approved by the U.S. Food and Drug Administration (FDA) in 1982 as a topical treatment and in 1985 as an oral medication. Acyclovir is one of the most successful forms of herpes treatment. It is safe for continuous or daily use for over 10 years.

• Famciclovir: This medication uses a base ingredient, penciclovir, to stop the herpes virus from replicating. This prescription drug is readily absorbed by the body, and it persists for a longer period of time in the body’s tissues, so it can be taken less frequently than acyclovir.

• Valacyclovir: This is a newer antiviral medication. It uses acyclovir as an active ingredient as well as other ingredients to help the body absorb this antiviral drug more readily and efficiently, so it can be taken less often than the original versions of acyclovir.

If you are diagnosed with genital herpes, your doctor is likely to prescribe one of these medications to manage outbreaks and reduce the risk of transmitting the virus to sexual partners. It is much rarer for a doctor to prescribe antiviral medications to treat oral herpes, as a significant portion of the population has HSV-1 and does not experience severe outbreaks. However, if you experience frequent, long-lasting, or painful outbreaks of HSV-1, you can ask your doctor about prescription management. Oral herpes treatments may include acyclovir ointment, under the brand name Zovirax, or a penciclovir cream, often under the brand name Denavir. These speed the healing process after the first cold sore appears and reduce viral activity. Since they are topical medications, they are applied directly to lesions or blisters. Some people benefit from applying them before sores appear if they are familiar with initial symptoms leading up to blisters, which is a period called prodrome. This period may involve itching, swelling, or hot skin in the area. One newer FDA-approved medication for oral herpes, Abreva, has been shown in clinical trials to speed up the healing process.

Episodic vs. Suppressive Herpes Treatment

People who experience fewer than six recurrences of HSV-2 or HSV-1 in a year can benefit from episodic treatment, or treatment that manages symptoms specifically during viral outbreaks. During an outbreak, your doctor will prescribe an antiviral medication to be taken for about five days until symptoms clear up. This reduces your risk of infecting others and lessens symptoms during the outbreak. If you have more than six occurrences of herpes outbreaks in a year, you will benefit more from daily antiviral medications. This reduces or prevents further outbreaks and reduces the viral load in your body. Taking oral antiviral medication every day can reduce your risk of transmitting herpes to a sexual partner, but there is still risk even when condoms or other barrier protections are used. Your doctor will continue to assess the best course of medical treatment for you. If you want to move from suppressive to episodic treatment, this will involve a change in your prescription, so it is important to speak with your doctor. Do not make any changes to your prescription medications without first consulting a medical professional.

Home Management of Herpes Symptoms

Once you receive prescription medical treatment, you can take some steps on your own to manage symptoms associated with herpes outbreaks when they occur.

• Take nonsteroidal anti-inflammatory drugs (NSAIDS) like acetaminophen to reduce pain and swelling.

• Bathe in slightly salty, warm water to reduce pain, inflammation, and itching.

• Apply petroleum jelly to the area to soothe itching.

• Avoid wearing tight clothing to reduce pain in the area.

• Thoroughly wash your hands after touching the infected area, whether your genitals, lips, or eyes.

• If urinating is painful during outbreaks, your doctor may prescribe a topical numbing agent like lidocaine.

• Refrain from sexual activity that involves genital contact until symptoms of HSV-2 outbreaks have cleared.

There are over-the-counter topical ointments that can manage symptoms of oral herpes, including lip balms like Blistex. These medications only ease symptoms for a few hours, and they do not reduce viral activity or improve healing time. Many of these ointments feature numbing agents that reduce itching or pain in the area. Unfortunately, they can delay healing times for some people, as they can irritate the area with repeated application. These topical ointments must not be applied to the genitals or genital area, as they can irritate those mucous membranes and make HSV-2 outbreaks worse. During an outbreak of genital herpes, the best approach to managing symptoms, alongside taking your medications as prescribed, is to keep the area clean and dry. Allowing free flow of air around the outbreak helps, so tight clothing is not recommended. Rinse the area with clean water and pat dry with a towel, as you would normally. Bathing too frequently, scrubbing, or using perfumed soaps can irritate the area and make the outbreak feel worse. Both HSV-1 and HSV-2 can be managed with individual monitoring of symptoms. You may find that stress management techniques like meditation or mindfulness help to reduce your symptoms or the frequency of your outbreaks. Eating healthier foods or getting regular exercise may improve your healing time. In some cases, exposure to too much ultraviolet (UV) light can irritate skin and lead to an outbreak, which is especially common for oral herpes. Other medications or illnesses that suppress your immune system can make herpes outbreaks more frequent. Smoking can increase the frequency of herpes outbreaks, and other substance abuse can damage your overall health, so your symptoms feel worse or healing time is slowed.

Is There a Cure for Herpes? What Does Long-Term Management Involve?

There is no cure for either oral or genital herpes, so they are considered chronic conditions. If you contract herpes simplex, you will have it for the rest of your life. Although symptoms are rare and typically not painful, especially if you take prescription medications as your doctor orders, the disease may impact various parts of your life, including:

• Mental health and levels of stress, especially if you meet a new romantic or sexual partner.

• Menstrual periods, which may become irregular with HSV-2.

• Physical health, as HSV infections can increase your risk of contracting “opportunistic infections” like colds or the flu.

• Skin, as you may have a greater risk of sunburns from sun exposure.

With both oral and genital herpes, prevention is the best approach to managing your health. To avoid contracting HSV-1:

• Do not share lip products, like lipstick, with anyone else.

• Do not share toothbrushes or utensils with others.

• Do not kiss anyone who has cold sores or fever blisters.

• Do not engage in unprotected oral sex, especially during an outbreak.

• Keep makeup applicators of all kinds clean.

• Wash your hands routinely.

People who have been diagnosed with HSV-2 can safely have sexual contact with others as long as they are not currently experiencing an outbreak or have any open sores on their genitals; they take antiviral medications as prescribed by their doctor; and they use barrier protection methods like condoms.

Frequently Asked Questions

What is herpes?

The term herpes covers about 100 types of viruses, eight of which can infect humans. This larger group of viral diseases, which are all related, are typically called herpesviruses. Among the eight that infect humans, chicken pox (which can cause shingles later in life) can be prevented with a vaccine. Human herpesvirus (HHV) 4 through 8 are not considered dangerous unless you have a compromised immune system. When most people think of herpes, they think of herpes simplex virus (HSV)-1 or HSV-2. These are oral and genital herpes, respectively; however, the term genital herpes increasingly includes HSV-1, as oral-to-genital transmission is becoming more common.

Is there a difference between herpes simplex 1 and 2?

HSV-1 and HSV-2 are different viruses, although they are related and have very similar symptoms. HSV-1 is usually oral herpes, which involve cold sores or fever blisters. The sores appear around the mouth. After the initial outbreak, they typically do not occur often, and blisters are rarely in clusters. Over half the U.S. adult population has HSV-1, and most people are asymptomatic. HSV-2 is usually genital herpes, which is very similar in appearance and frequency to oral herpes, but blisters, sores, or lesions appear in the genital area. Outbreaks may be more frequent or painful, and medical professionals are more likely to prescribe antiviral medications to suppress this virus. In rare instances, HSV-2 can be transmitted from the genitals to the mouth; however, it is more likely that HSV-1 is transmitted from the mouth to the genitals.

How is herpes simplex diagnosed?

Since most people are asymptomatic, diagnosing herpes involves blood tests to detect antibodies produced by your immune system. Sometimes, your doctor will take a culture swab of an open sore or blister if you have an active outbreak. This is true for both HSV-1 and HSV-2.

How is herpes simplex 1 or 2 treated?

If you are diagnosed with genital herpes, your doctor will likely prescribe one of three antiviral drugs to reduce how frequently your outbreaks occur, any symptoms you experience during outbreaks, and reduce the risk of transmitting the virus to others. If you have fewer than six outbreaks in a year, your doctor will offer episodic treatment, meaning you only need to take medication when an outbreak starts. If you experience more than six outbreaks a year, your doctor will prescribe suppressive treatment, which is a daily pill to reduce how often you experience herpes symptoms. It is rare for people with oral herpes to need prescription medication. Many simply use over-the-counter ointments to manage symptoms. For those who experience frequent outbreaks that are painful or disruptive, prescription antivirals can help. Your doctor may prescribe topical antivirals rather than oral medication.

Can you prevent herpes simplex infection?

Avoiding open sores greatly reduces the risk of herpes transmission for both HSV-1 and HSV-2. This means avoiding kissing, oral sex, and unprotected penetrative sex during outbreaks. Using barriers like condoms during every sexual encounter reduces the risk of genital herpes. Avoid sharing lipstick, lip ointment, utensils, or other items that go in your mouth or around your face to reduce the risk of oral herpes or herpes keratitis.

References

Overview of Herpesvirus Infections. (May 2018). Merck Manual: Consumer Version.

Herpes Simplex. (February 27, 2019). Healthline.

Oral Herpes. American Sexual Health Association (ASHA).

Genital Herpes – CDC Fact Sheet. (August 28, 2017). Centers for Disease Control and Prevention (CDC).

Symptoms, Causes, and Treatment for Herpes. (November 13, 2017). Medical News Today.

Herpes Treatment. American Sexual Health Association (ASHA).