Genital Herpes Treatment

Genital herpes is an incurable, chronic infection caused by either one of two herpesviruses: herpes simplex 1 and herpes simplex 2 (HSV-1 and HSV-2). Both may be spread through sexual contact.

Treatment for genital herpes must address the lifelong nature of the illness.

“Herpes can be managed, with a person being able to lead a normal life and without the impact that people are often afraid of,” says H. Hunter Handsfield, MD, a professor emeritus at the University of Washington Center for AIDS and STD in Seattle.

Antiviral drugs are the backbone of treatment for genital herpes. Antiviral medications can:

• Soothe genital sores and pain during the initial outbreak
• Provide similar relief during any later outbreaks that may occur
• Help protect your sexual partner or partners from catching the illness

While not everyone who has genital herpes chooses to take medication, antiviral drugs offer benefits to most people who have herpes symptoms.

If you are infected with genital herpes, your doctor may prescribe oral antiviral drugs to help ease your symptoms during both a first episode and recurrent episodes. Your doctor may also suggest taking antiviral drugs daily as a suppressive therapy to reduce symptoms and protect partners.

Remember, though, that antiviral drugs do not wipe out the virus completely. It continues to live in your body, so if you stop taking the drugs that suppress it, you may have more frequent or more intense symptom outbreaks, and the risk of your transmitting the virus to others rises.

Three antiviral drugs, all taken by mouth, are used to treat genital herpes:

• acyclovir (Zovirax)
• famciclovir (Famvir)
• valacyclovir (Valtrex)

Treating a First Outbreak of Herpes

A first outbreak of genital herpes can cause a long illness with severe genital sores and can also affect the nervous system. Even if your first episode of herpes is mild, you may have severe or prolonged symptoms later. For this reason, the Centers for Disease Control and Prevention (CDC) recommends that everyone who has a first episode of genital herpes take antiviral drugs. (1)

Almost everyone who has one episode of genital herpes caused by HSV-2 also has later breakouts of sores. Later episodes are less common if your case of genital herpes is due to an HSV-1 infection.

The frequency of genital herpes outbreaks slows down over time in many people.

Some people with genital herpes choose to take antiviral medication daily to reduce the number of symptom outbreaks they have. In some cases, daily therapy prevents outbreaks completely.

Numerous studies over the years have demonstrated the safety and effectiveness of all three of the approved antivirals used to treat genital herpes.

Studies have also shown that daily antiviral therapy reduces the rate of transmission from an HSV-2 infected person to an uninfected partner of the opposite sex.

Daily therapy also lowers the odds of infecting other people if you have multiple sex partners or if you are a man who has sex with men.

The drugs work both for people who have had herpes symptoms and for those whose blood tests show they have an HSV-2 infection but who have never had symptoms.

Some people choose to take antiviral drugs only as needed, for outbreaks that occur after the first one. For this to work, you need to start taking the medicine within one day of sores cropping up or during the time period (called the prodrome) that comes before some outbreaks.  

During the prodrome, you may feel

• Burning in the area where the virus first entered your body
• Itching or tingling in that area
• Pain in your back, buttocks, thighs, or knees

Your doctor will probably give you a prescription you can fill and keep handy for timely use, and tell you to start taking the drugs just as soon as symptoms begin.

Most people with genital herpes can manage the condition without much disruption to their daily lives. In some fairly rare cases, though, the disease can cause severe pain or illness that demands hospitalization and intravenous acyclovir therapy.

One rare complication of herpes is hepatitis, which can lead to liver failure and even death. Herpes simplex virus hepatitis is more common among people with a compromised immune system and in pregnant women. (2)

Although at times it’s been said that the herpesvirus causes cancer, there is no good evidence to support the idea that the types of herpesviruses that cause genital herpes are associated with cancer.

“Research shows that the single greatest fear [for people with genital herpes] is the fear of transmission to partners,” says Dr. Handsfield.

The main ways to avoid transmitting herpes are:

• Learn to recognize how you feel when an outbreak is on the way, and stop having sex immediately.
• Don’t have sex during active outbreaks.
• Always use condoms but don’t rely on them during outbreaks. They don’t completely cover infectious areas.
• Only after all sores have scabbed over and healed should you have sex again.
• Avoid touching your herpes sores, because you can spread them to other places on your body that way. Whenever you touch a sore, wash your hands immediately.
• Don’t kiss people or have sex if you have a cold sore.
• Tell potential partners about having herpes before having sex with them, even though it may be hard.   
• Ask your doctor about taking antiviral drugs regularly.

If you have genital herpes, it’s important for you to get educated about herpes and have the opportunity to ask questions in a supportive environment.

Becoming informed will help you learn to cope with the illness. It will also help you prevent sexual transmission of the illness, or transmission to an infant during a pregnancy.

“Herpes has a tremendous psychosocial overlay. But knowledge about it and understanding about how well it can be managed can reduce that,” says Handsfield.

Your doctor may be able to provide you with all the information you need, or you may choose to seek counseling from a mental health professional or at a clinic that specializes in sexual health, such as Planned Parenthood.

If you have a regular sexual partner, that person should also have the chance to learn about herpes and ask any questions they may have about it.

Researchers are working on new treatments for genital herpes and strategies to prevent transmission.

Microbiocides, which are antimicrobial chemicals that can be applied to the vagina, offer one possible approach to protecting uninfected women. These substances block infection by destroying bacteria or viruses before they enter the body.

Two microbiocide products may show some promise for preventing the spread of herpes in the future, although more research is needed:

• Tenofovir gel, a topical formulation of tenofovir (Viread) — a drug currently used to treat HIV — reduced new HSV-2 infections in women in a study from South Africa. (3)
  
• Zinc oxide tetrapod nanoparticles, applied to the vagina, reduced infection with HSV-2 in a lab study using mice and human cell lines. (4)

Although there have been several clinical trials that tested vaccines against genital herpes, there is no vaccine currently available to prevent infection. There is ongoing research though, and researchers are exploring using mRNA vaccines. (5)