How Herpes Is Treated

Man and woman sitting together
Dona Monroe / Getty Images

 

Oral herpes, normally caused by HSV type 1, and genital herpes, normally caused by HSV type 2, are both treatable infections, but they are not curable. 

Home Remedies and Lifestyle

There are some things that you can do at home to reduce the pain of a cold sore or of genital herpes. Additionally, you can also take a few steps to prevent the lesions from getting worse and from spreading.

 

  • Cold Compress: You can use a cold compress for comfort. Place the cold material on the lesions and leave on for as long as it makes you feel better. This treatment is especially useful for children, who can be upset by the discomfort if a cold sore. The cold will not worsen or improve the lesion, but it can lessen the pain. 
  • Don't scratch: It is important to avoid touching and scratching lesions caused by herpes, because you can spread the infection to other areas of your own skin. 
  • Keep the sores clean: Cold sores and genital herpes infections can become infected with bacteria. Cold sores may be exposed to bacteria on your hands, and genital sores can be exposed to bacteria from urine, or more often, from feces. It is important to keep the area of sores and blisters clean and dry to avoid an additional infection. 
  • Stress Reduction: Stress can interfere with optimal immune system function, increasing the risk of a recurrence of herpes sores. If you can reduce your stress, this may help prevent excessive herpes recurrences. 
  • Avoid infecting others: If you already know that you have HSV 1 or HSV 2, you can take precautions to avoid infecting others because the infections are spread by skin to skin contact. 

Over-the-Counter Therapies

Antiviral therapy is available in an over-the-counter cream form and may help speed recovery from oral herpes or genital herpes infections.

 

You can use pain creams or lotions to help alleviate the pain caused by active herpes. If the lesions are very tender and you do not want to rub cream on them, you can also use over the counter oral (by mouth) pain medications for comfort.

  • Abreva (docosanol): This is the only FDA approved antiviral medication for herpes infection that you can get without a prescription. This medication comes as a cream, and you can apply it directly to the affected area on the skin. You can use it about every three to four hours, and you should apply to the skin only, not inside the mouth, inside the eyes, or inside the vagina. Wash your hands after using to make sure that the cream does not get into your mouth or on food that you are preparing. 
  • Lotions and Creams: If you have pain, you can use a medicated pain cream or lotion on cold sores or on genital herpes sores. There are a number of over-the-counter options available. Be sure to confirm with your doctor or pharmacist that the product you select is safe to use on herpes lesions, and wash your hands after you have applied any cream or lotion. 
  • Pain relievers: Oral medications such as Tylenol (acteaminophen), Advil (ibuprofen), and Aleve, Naprosyn (naproxen) can help relieve pain of herpes lesions for several hours. 

    Prescriptions

    There are several prescription medications that you can use for herpes. In general, these medications are recommended for treatment of genital herpes. Usually, treatment of cold sores is not needed unless the symptoms are severe and persistent, in which case acyclovir, an antiviral treatment, is generally used. 

    Treatment for Genital Herpes

    There are several situations when prescription antiviral medication is recommended for a genital herpes infection. If you have a first episode or a recurrence, you should take a short course of prescription antiviral medication. And, in some situations, you may need to take daily prescription antiviral medication prophylactically to reduce the frequency of episodes.

    This type of treatment is referred to as suppressive therapy. Taking herpes medication when you do not have symptoms has been shown to reduce the risk of sexual transmission to a partner.

    The Centers for Disease Control (CDC) 2015 has herpes treatment guidelines, but your doctor will decide on the best regimen for you. 

    Recommended Herpes Treatment Regimens for Adults Experiencing a First Genital Herpes Outbreak

    Acyclovir 400 mg orally three times a day for 7–10 days
    OR
    Acyclovir 200 mg orally five times a day for 7–10 days
    OR
    Famciclovir 250 mg orally three times a day for 7–10 days
    OR
    Valacyclovir 1 g orally twice a day for 7–10 days

    If symptoms remain after 10 days, your doctor might choose to continue treatment.

    Recommended Prophylactic Herpes Treatment Regimens for Recurrent Genital Herpes

    Acyclovir400 mg orally twice a day
    OR
    Famciclovir 250 mg orally twice a day
    OR
    Valacyclovir 500 mg orally once a day
    OR
    Valacyclovir 1.0 g orally once a day

    Recommended Herpes Treatment Regimens for Recurrent Genital Herpes in Adults

    Acyclovir 400 mg orally three times a day for 5 days
    OR 
    Acyclovir 800 mg orally twice a day for 5 days
    OR 
    Acyclovir> 800 mg orally three times a day for 2 days
    OR 
    Famciclovir 125 mg orally twice daily for 5 days
    OR 
    Famciclovir 1 g orally twice daily for 1 day

    Famcyclovir 500 mg once,  followed by 250 mg twice daily for  2 days
    OR 
    Valacyclovir 500 mg orally twice a day for 3 days
    OR 
    Valacyclovir 1 g orally once a day for 5 days

    Complementary Alternative Medicine (CAM)

    Several alternative treatment options have been investigated for treatment or suppression of genital herpes, including lysine, zinc, echinacea, eleuthero, and bee products. There is no evidence to show that any of these options are beneficial in treating or preventing herpes.

    Important alternative therapies for herpes include: 

    • Propolis: Propolis, a sticky substance that bees produce from tree saps, shows promise in the treatment of herpes. Studies have found that people who are treated with propolis experience faster healing of herpes lesions and a higher likelihood of fully healed lesions by day 10 of treatment when compared to people who receive placebo.
    • Algae extract: In a laboratory setting, algae extract has been shown to inhibit HSV 2 growth, so this may be a considered a useful component in alternative treatments in the future. 
    • Acupuncture: Acupuncture is often used for the treatment of pain, and it has been used for the treatment of pain caused by herpes lesions, with some beneficial results. This treatment method, while mildly helpful, has also rarely been associated with transmission of HSV, so it is best to use with caution. 
    • Resolve Herpes: A recently marketed alternative therapy for herpes, Resolve Herpes is said to contain minerals and is marketed as a detox therapy. So far, there does not appear to be evidence that Resolve Herpes can cure or treat herpes infections.

    Sources:

    Centers for Disease Control and Prevention, 2015 Sexually Transmitted Diseases Guidelines, Genital HSV Infections, accessed May 17. 2018

    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 Jun;124(6):1441-1453. doi: 10.1111/jam.13729. Epub 2018 Mar 13.

    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. Epub 2017 Feb 6.