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Before choosing a treatment for genital herpes, a health-care provider has several issues to consider. More about genital herpes treatment considerations.

Genital Herpes Medications

Three antiviral medications that have been shown in studies to provide clinical benefit for genital herpes. These medications are acyclovir, valaclovir, and famcyclovir. Acyclovir was one of the first medications to be used for viral infections including herpes. It works by limiting the replication and further spread of the virus to other cells. It cannot prevent the destruction of cells that are already infected with the virus. Valacyclovir is metabolized in the liver and intestines to acyclovir and can be used in lower doses than acyclovir. Famciclovir also works by limiting replication of the herpes virus.

First Genital Herpes Outbreak

Most people with an initial genital herpes outbreak and a normal immune system should receive treatment since the symptoms can be severe and prolonged. The following are possible regimens that may be used and all are taken orally:

• Acyclovir 400 mg three times a day for 7 to 10 days
• Acyclovir 200 mg five times a day for 7 to 10 days
• Famciclovir 250 mg three times a day for 7 to 10 days
• Valacyclovir 1 g twice a day for 7 to 10 days

Recurrent Genital Herpes Outbreaks - Episodic Treatment

A person who has less than 6 genital herpes outbreaks a year and a normal immune system may want to consider taking medication only when an outbreak occurs. If this treatment option is chosen, medication must be started within 1 day of symptoms. For this reason, a person choosing this option should already have the medication on hand. These are the treatment options and they are also taken orally:

• Acyclovir 400 mg three times a day for 5 days
• Acyclovir 800 mg three times a day for 2 days
• Acyclovir 800 mg twice a day for 5 days
• Famciclovir 125 mg twice a day for 5 days
• Famciclovir 1000mg twice a day for 1 day
• Valacyclovir 500 mg twice a day for 3 days
• Valacyclovir 1000 mg once a day for 5 days

Recurrent Genital Herpes Outbreaks - Suppressive Treatment

A person who has more than 6 genital herpes outbreaks a year and a normal immune system should consider taking medication every day. This reduces the frequency of genital herpes recurrences by 70 percent to 80 percent. Suppressive therapy reduces but does not eliminate viral shedding. These are the treatment options and they are also taken orally:

• Acyclovir 400 mg twice a day
• Famciclovir 250 mg twice a day
• Valacyclovir 500 mg once a day
• Valacyclovir 1000 mg once a day

Genital Herpes Suppressive Treatment for Discordant Couples

When one partner has genital herpes and the other partner does not or is not sure (a discordant couple), daily suppressive therapy with valacyclovir 500mg decreases the rate of transmission. Suppressive therapy should be strongly considered in addition to regular condom use and avoidance of sexual activity during recurrences.

Genital Herpes and Alternative Medicine

Several alternative medicines have been investigated as options for treatment or suppression of genital herpes including lysine, zinc, echinacea, eleuthero, and bee products. Unfortunately, rigourous clinical testing is lacking for these options. However, one study did show that Propolis, a sticky substance that bees produce from certain tree saps, improved healing time compared to acyclovir. Since these preliminary findings appeared promising, further studies of bee products may be on the horizon.

_Sources:

CDC. "Sexually Transmitted Diseases Treatment Guidelines, 2006." Morbidity and Mortality Weekly Report. 55(2006): 16-20.

Corey, Lawrence, et al. "Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes". The New England Journal of Medicine. 350 (2004): 11-20.

Habif, Thomas. "Warts, Herpes Simplex, and Other Viral Infections" Clinical Dermatology, 4th Edition. Ed. Thomas Habif, MD. New York: Mosby, 2004. 381-388.

Perfect, Michelle, et al. "Use of Complementary and Alternative Medicine for the Treatment of Genital Herpes". Herpes. 12(2005): 38-41.

Vynograd N, et al. "A comparative multi-centre study of the efficacy of propolis, acyclovir, and placebo in the treatment of genital herpes (HSV)". Phytomedicine. 7 (2000): 1-6.

Yeung-Yue, Kimberly. "Herpes simplex viruses 1 and 2." Dermatologic Clinics 20(2002): 1-21.