Treatment with antiviral drugs can help people who are bothered by genital herpes outbreaks stay symptom-free longer. These drugs can also reduce the severity and duration of symptoms when they do flare up. Drug therapy is not a cure, but it can make living with the condition easier.
There are three major drugs commonly used to treat genital herpes symptoms: acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). These are all taken in pill form. Severe cases may be treated with the intravenous (IV) drug acyclovir.
Formulas applied to the surface of the skin provide little benefit, and doctors don't usually recommend them.
When Treatments for Genital Herpes Are Given
Initial treatment. If you have symptoms such as sores when you're first diagnosed with genital herpes, your doctor will usually give you a brief course (seven to 10 days) of antiviral therapy to relieve them or prevent them from getting worse. Your doctor may keep you on the drugs longer if the sores don't heal in that time.
After the first treatment, work with your doctor to come up with the best way to take antiviral therapies. There are two options:
Intermittent treatment. Your doctor may prescribe an antiviral drug for you to keep on hand in case you have another flare-up; this is called intermittent therapy. You can take the pills for two to five days as soon as you notice sores or when you feel an outbreak coming on. Sores will heal and disappear on their own, but taking the drugs can make the symptoms less severe and make them go away faster.
Suppressive treatment. If you have outbreaks often, you may want to consider taking an antiviral drug every day. Doctors call this suppressive therapy. For someone who has more than six outbreaks a year, suppressive therapy can reduce the number of outbreaks by 70% to 80%. Many people who take the antiviral drugs daily have no outbreaks at all.
There is no set number of outbreaks per year that doctors use to decide when someone should start suppressive therapy. Rather, more important factors are how often the outbreaks happen and if they are severe enough to interfere with your life.
Taking daily suppressive therapy may also reduce the risk of transmitting the virus to a sex partner. Antiviral drugs reduce viral shedding, when the virus makes new copies of itself on the skin's surface.
A recent study of people taking daily doses of valacyclovir shows the drug may help protect sex partners from being infected, although you should still use a condom. Half the partners of people taking daily valacyclovir became infected with the virus, and half did not. Moreover, 75% of the partners did not show any symptoms of genital herpes, even if they had acquired the virus.
Side Effects and Follow-up Care for Genital Herpes
Side effects with these herpes drugs are considered mild, and health experts believe these drugs are safe in the long term. Acyclovir is the oldest of the three, and its safety has been documented in people taking suppressive therapy for several years.
People taking suppressive therapy should see their doctor at least once a year to decide if they should continue. You may find taking the pills every day to be inconvenient, the drugs may not work for you, or you may naturally have fewer outbreaks as time goes on. Your doctor can help you make treatment choices to suit your needs.