Treatment for Genital Herpes

Treatment for Genital Herpes

No drug can cure herpes simplex virus. The infection may recur after treatment has been stopped, and, even during therapy, a patient can still transmit the virus to another person. Drugs can, however, reduce symptoms and improve healing times.

Acyclovir and Related Drugs

Antiviral drugs called nucleosides or nucleotide analogues are the main drugs used to treat genital herpes. They are taken by mouth. (Acyclovir is also available as an ointment, but the oral form is much more effective.) These drugs limit herpes viral replication and its spread to other cells. They are not cures, however.

Three drugs are approved to treat genital herpes:

• Acyclovir (Zovirax or generic)
• Valacyclovir (Valtrex)
• Famiciclovir (Famvir)

These drugs are used either episodically or suppressively:

• Episodic treatment is used when a patient has an outbreak or suspects one is going to occur. Outbreaks are usually preceded by prodrome -- a group of symptoms that include itching, pain, or tingling. If the drug is taken when these symptoms first appear, it can help prevent the outbreak from occurring. If the outbreak has already occurred, the drug can lessen the severity of symptoms and speed healing time. For episodic treatment, acyclovir is taken 5 times a day for 5 days, valacyclovir twice a day for 5 days, or famiciclovir twice a day for 1 day. (In 2006, famiclovir was approved as the first one-day treatment for recurrent genital herpes.)
• Suppressive treatment requires taking pills daily on a long-term basis. (Acyclovir and famiciclovir are taken twice a day, valacyclovir once a day.) Suppressive treatment may help prevent outbreaks from occurring. It is generally recommended for patients who have frequent recurrences (6 or more outbreaks per year).

Acyclovir and valacyclovir are also approved to treat an initial attack of herpes. When a patient has herpes for the first time, the drug is taken several times a day for 10 days

Side Effects. Nausea and headache are the most common side effects, but in general these drugs are safe. Although there is some evidence these drugs may reduce shedding, they probably do not prevent it entirely. The use of condoms during asymptomatic periods is still essential, even when patients are taking these medications.