Effective Treatments for Herpes

Herpes is a viral infection caused by the herpes simplex virus (HSV). Oral herpes, also known as cold sores, are most commonly caused by herpes simplex virus type 1 (HSV-1), while genital herpes is commonly caused by herpes simplex virus type 2 (HSV-1).

Herpes is not curable, but it is treatable with antiviral drugs. The drugs not only help relieve symptoms and shorten outbreaks but can also be used to prevent recurrences. When herpes is treated properly, the risk of infecting others is greatly reduced.

This article explores the treatment options for oral herpes and genital herpes, including home remedies, over-the-counter medications, prescription drugs, and complementary and alternative therapies.

herpes treatment
Illustration by Emily Roberts, Verywell

Home Remedies and Lifestyle

At-home treatments for herpes are used to relieve pain. They do nothing to alter the course of the infection but can make you more comfortable as the herpes sores begin to heal.

There are several things you can do if have an outbreak of oral or genital herpes:

  • Use a cold compress. Place a cloth-covered ice pack on the sores for 15 minutes several times daily to reduce pain. Keep the ice pack moving to prevent frostbite.
  • Do not touch or scratch. Avoid touching and rubbing the sores. Doing so can spread the infection to other areas of the skin.
  • Keep the sores clean. Herpes sores can become infected with bacteria if touched with soiled hands. Wash your hands thoroughly with soap and water after going to the bathroom or before applying medications.
  • Reduce stress. Stress can increase your sensitivity to pain during a herpes outbreak. You can reduce stress by performing gentle exercises or practicing mind-body therapies like meditation, yoga, and guided imagery.

To reduce the risk of spreading herpes, avoid kissing and sharing objects that come into contact with saliva, like drinking straws and eating utensils.

It's important to note that oral herpes can be spread to the genitals, and that genital herpes can be spread to the mouth. To reduce the risk of infection, use condoms and dental dams during oral sex. Better yet, avoid sex altogether if you are having an active herpes outbreak (or feel an outbreak coming on).

Recap

Regular ice application can help ease herpes pain. To prevent the spread of herpes to other parts of the body, avoid touching or scratching the sores. Make every effort to keep the sores clean to prevent bacterial infection.

Over-the-Counter Therapies

Over-the-counter (OTC) medications are available to help reduce pain and speed recovery from a herpes outbreak. There is even one OTC drug called Abreva (docosanol) that has antiviral properties.

OTC medications commonly used to treat herpes include:

  • Topical pain relievers: These are medications applied to the skin that has a numbing effect. These include creams or ointments containing lidocaine (such as Aspercreme and Anbesol), camphor and phenol (Campho-Phenique), and benzocaine (Orajel and Carmex Cold Sore).
  • Oral pain relievers: Tylenol (acetaminophen) is an oral painkiller that can ease the pain of a herpes outbreak. OTC nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) can also relieve pain while reducing redness and swelling.
  • 1% hydrocortisone cream: This is a low-dose topical steroid that can reduce inflammation and ease redness and burning caused by a herpes outbreak. Hydrocortisone cream is often used in combination with a prescription antiviral drug to treat genital herpes.
  • Abreva 10% docosanol cream: This is the only OTC antiviral drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of cold sores. It is a topical cream applied to the skin five times daily at the first signs of an outbreak (such as tingling, itching, or bump). Research has shown that early treatment can reduce the duration of an outbreak by one to two days. Abreva is not approved for the treatment of genital herpes.
  • Lysine ointment: Lysine is an amino acid that some people believe has antiviral effects. There are numerous lysine-based ointments available for the treatment of cold sores, including Quantum Leap Lip Care and Lip Clear Lysine Plus. Evidence supporting their use is weak.
  • FemiClear: This is an OTC ointment used to treat genital herpes. It contains natural ingredients, including lemongrass and willow bark, and claims to kill 99.9% of herpes viruses. There is currently no evidence that FemiClear alters the course of a herpes infection in any way.

Recap

Over-the-counter treatments for herpes include topical numbing agents made with lidocaine or benzocaine, oral pain relievers like Tylenol or Aleve, and 1% hydrocortisone cream. The only FDA-approved OTC medication used to treat cold sores is Abreva (docosanol) cream.

Prescriptions

Herpes may be treated with antiviral drugs that block the virus' ability to make copies of itself, bringing the infection under control faster. These included oral antivirals that are taken by mouth and topical antivirals that are applied to the skin.

Indications for Treatment

Not every herpes outbreak requires antiviral treatment. Mild outbreaks can often clear on their own without consequence, including the occasional cold sore.

The decision to treat is ultimately based on whether this is a first outbreak or a recurrence. The frequency and severity of your recurrences are also considered.

In people with recurrent herpes, antivirals can be given daily to prevent outbreaks (referred to as prophylactic therapy). Keeping herpes under control also reduces the risk of infecting others.

This is especially true for herpes infections in people with weakened immune systems, such as those with advanced HIV. In these individuals, herpes can sometimes spread (disseminate) to multiple organs, including the liver, brain, lungs, and kidneys.

In people who are immunocompromised, herpes can sometimes spread from the mouth or genitals to distant organs, including the liver, brain, lungs, and kidneys. This is called disseminated herpes. In such cases, antiviral drugs are injected directly into the bloodstream, or intravenously.

Types of Antiviral Drugs

There are three oral antivirals recommended for the treatment of oral or genital herpes:

Additionally, three topical antivirals can be used to treat recurrent oral herpes:

  • Denavir (penciclovir) cream
  • Xerese (acyclovir + hydrocortisone) cream
  • Zovirax (acyclovir) cream

Dosage Recommendations

The dosage of antiviral used to treat genital herpes can vary depending on whether this is your first outbreak or a recurrence. The dosage is also adjusted if used to prevent a recurrence.

The Centers for Disease Control (CDC) issued the following dosing schedule—in grams (g) and milligrams (mg)—for adults with primary genital herpes.

CDC Recommendations for First Episode
Drug and Dose Frequency Duration
Zovirax, 400 mg Three times per day 7 to 10 days
Zovirax, 200 mg Five times per day 7 to 10 days
Famvir, 250 mg Three times per day 7 to 10 days
Valtrex, 1g Twice per day 7 to 10 days

The CDC issued the following dosing schedule for adults with recurrent genital herpes.

CDC Recommendations for Recurrent Episodes
 Drug and Dose Frequency Duration
Zovirax, 400 mg Three times per day 7 to 10 days
Zovirax, 800 mg Twice daily 5 days
Zovirax, 800 mg Three times per day 2 days
Valtrex, 500 mg Twice daily 3 days
Valtrex, 1g Once per day 5 days
Famvir, 125 mg Twice daily 5 days
Famvir, 1g Twice daily 1 day
Famvir, 500 mg + 250 mg Once Twice daily 1 day 2 days

The CDC issued the following dosing schedule for daily suppressive therapy.

CDC Recommendations for Daily Suppressive Therapy
Drugs and Dose Frequency 
Zovirax, 400 mg Twice daily
Valtrex, 500 mg-1g Once daily
Famvir, 250 mg Twice daily

Preventing genital herpes recurrence is important as it reduces the risk of HIV. According to the CDC, having an active genital herpes infection increases the risk of HIV by 200% to 300%.

Recap

Herpes can be treated with oral or topical antivirals, including acyclovir, famciclovir, penciclovir, and valacyclovir. Severe herpes infections that have disseminated (spread to other organs) are treated with intravenous acyclovir.

Complementary and Alternative Medicine (CAM)

Some people use natural therapies to treat herpes, either on their own or to support standard medical care. The research supporting their use is generally weak, with little evidence that they can reduce either the severity or duration of an outbreak. Even so, many people swear by their effectiveness and consider them a vital part of managing herpes outbreaks.

Complementary and alternative therapies sometimes used to treat herpes include:

  • Propolis: This is a sticky substance produced by bees that may help speed the healing of genital herpes. A 2017 study found that people who used propolis ointment experienced better healing by the 10th day of treatment compared to those who used a sham ointment.
  • Algae extract: Lab studies suggest that algae extract can inhibit the growth of HSV-2 in test tubes. Whether it can do so in humans has yet to be proven.
  • Acupuncture: A 2011 study concluded that acupuncture was mildly effective in reducing pain caused by the herpes zoster virus (HZV), the type of herpes virus that causes shingles. While this suggests that acupuncture may be useful in easing genital herpes pain, this has yet to be proven.

Recap

There is no evidence that any complementary or alternative therapy can reduce the severity or duration of a herpes outbreak.

Summary

There is no cure for herpes, but you can manage outbreaks with at-home treatments and over-the-counter medications that can help ease pain.

Antiviral drugs directly treat herpes infections and may help reduce the severity or duration of an outbreak. This includes Abreva (docosanol), a topical antiviral available over the counter, and prescriptions antivirals like Zovirax (acyclovir) and Valtrex (valacyclovir). Antivirals can also be taken on a daily basis to prevent outbreaks in people with frequent recurrences.

Complementary and alternative therapies are sometimes used to treat oral or genital herpes, but there is little clinical evidence to support their use.

A Word From Verywell

The key to successfully treating any herpes outbreak is a timely response. The sooner you recognize the signs and start treatment, the shorter and less severe the episode will likely be. For the best results, start treatment within 48 hours of the first appearance of symptoms.

If your primary care provider is unable to see you, do not hesitate to get an antiviral prescription from a telehealth provider. The visit may be partially or fully covered by insurance.

Frequently Asked Questions

  • What over-the-counter drugs are used to treat herpes?

    Abreva (docosanol) 10% cream is the first and only over-the-counter antiviral drug approved to treat the type of herpes that causes cold sores. If applied before a blister develops, it may reduce the duration of an outbreak to as few as two and a half days.

  • What prescription drugs are used to treat herpes?

    Herpes viruses are treated with antivirals. There are four prescription oral antivirals commonly used to treat oral or genital herpes:

    • Zovirax (acyclovir)
    • Valtrex (valacyclovir)
    • Famvir (famciclovir)
  • Do all antivirals work equally well in treating oral or genital herpes?

    All three oral antivirals are equally effective in reducing the severity and duration of a herpes outbreak. However, some experts recommend Valtrex over Zovirax for treating genital herpes.

  • How long does herpes last if treated with antivirals?

    Studies have shown that if started within 48 hours of the first appearance of lesions, antivirals can reduce the duration of oral herpes by one to two days. Antivirals can also shorten the course of a first genital herpes outbreak by up to 50%.

  • Are there natural remedies that can help treat herpes?

    Evidence on the benefits of complementary and alternative medicines for treating herpes is scant. However, several natural compounds have shown promise, including:

    • African rue (Peganum harmala)
    • Green algae (Stypopodium zonale)
    • Red seaweed (Hypnea musciformis)
    • Verbena (Verbenaceae)
    • Yu Xing Cao (a traditional Chinese medicine)
  • Can herpes be cured?

    There is no cure for herpes. Once you are infected, the virus remains in your body forever.

  • Is there a herpes vaccine?

    There have been some promising trials of herpes vaccines. However, no human trials have proven effective enough to bring a vaccine to market.

20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021: genital herpes.

  2. Álvarez DM, Castillo E, Duarte LF, et al. Current antivirals and novel botanical molecules interfering with herpes simplex virus infection. Front Microbiol. 2020;11:139. doi:10.3389/fmicb.2020.00139

  3. National Library of Medicine: MedlinePlus. Genital herpes - self-care.

  4. Meize-Grochowski R, Shuster G, Boursaw B, et al. Mindfulness meditation in older adults with postherpetic neuralgia: a randomized controlled pilot study. Geriatr Nurs. 2015 Mar-Apr;36(2):154–60. doi:10.1016/j.gerinurse.2015.02.012

  5. National Health Service (UK). Cold sores.

  6. Arain N, Paravastu SC, Arain MA. Effectiveness of topical corticosteroids in addition to antiviral therapy in the management of recurrent herpes labialis: a systematic review and meta-analysisBMC Infect Dis. 2015;15:82. doi:10.1186/s12879-015-0824-0

  7. National Library of Medicine: DailyMed. Abreva—docosanol cream [drug label].

  8. Mailoo VJ, Rampes S. Lysine for herpes simplex prophylaxis: a review of the evidence. Integr Med (Encinitas). 2017 Jun;16(3):42–6.

  9. National Library of Medicine: DailyMed. Femiclear for genital herpes—lemongrass and olive extract.

  10. Sauerbrei A. Optimal management of genital herpes: current perspectives. Infect Drug Resist. 2016;9:129-41. doi:10.2147/IDR.S96164

  11. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1

  12. National Library of Medicine: DailyMed. Denavir—penciclovir cream [drug label].

  13. National Library of Medicine: DailyMed. Xerese—acyclovir and hydrocortisone cream [drug label].

  14. National Library of Medicine: DailyMed. Zovirax (acyclovir) cream [drug label].

  15. Sung SH, Choi GH, Lee NW, Shin BC. External use of propolis for oral, skin, and genital diseases: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2017;2017:8025752. doi:10.1155/2017/8025752

  16. Deethae A, Peerapornpisal Y, Pekkoh J, Sangthong P, Tragoolpua Y. Inhibitory effect of Spirogyra spp. algal extracts against herpes simplex virus type 1 and 2 infection. J Appl Microbiol. 2018;124(6):1441-1453. doi:10.1111/jam.13729

  17. Ursini T, Tontodonati M, Manzoli L, et al. Acupuncture for the treatment of severe acute pain in herpes zoster: results of a nested, open-label, randomized trial in the VZV Pain Study. BMC Complement Altern Med. 2011;11:46. doi:10.1186/1472-6882-11-46

  18. Pinder M, Wright A. Valaciclovir versus aciclovir for the treatment of primary genital herpes simplex: a cost analysis. Int J STD AIDS. 2015 Nov;26(13):971-3. doi:10.1177/0956462414563628

  19. Yip ST, Liu R, Warrington T, Webb CW, Hamilton A. Clinical inquiry: How well do antivirals shorten genital herpes pain duration?. J Fam Pract. 2015;64(3):190-1.

  20. Alvarez DM, Castillo E, Duarte LF, et al. Current antivirals and novel botanical molecules interfering with herpes simplex virus infection. Front Microbiol 2020;11:139. doi:10.3389/fmicb.2020.00139

By Elizabeth Boskey, PhD
Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.