Westover Heights Clinic - Treatment

    There have been many attempts to find a cure for herpes, but to date, no permanent cure has been found.  However, great progress has been made on treating the disease, and research is constantly being conducted on all aspects of the infection.

Antiviral Therapy
    In 1985, the first of the oral antiviral medications became available for general use. There are now three antivirals available in the US: acyclovir, Valtrex (valacyclovir) and Famvir (famciclovir).  All three drugs work equally well when taken as directed.  There may, however, be compliance advantages for medicines requiring less frequent dosing because if you have to take your pills less often you are probably going to be better at taking them.  They will, therefore, “work better.”  

    The antivirals may be taken in one of three ways: first episode therapy, episodic therapy (the taking of medication during outbreaks only), and suppressive therapy (taking medicine every day).  The first two uses of the drug attempt to shorten the length and severity of a specific outbreak. Taking medication during outbreaks, either first or future ones, has not been shown to impact future recurrence rates of herpes.

    The third use of the drug, for suppression of outbreaks (i.e., to prevent outbreaks from coming), is recommended for anyone who has frequent outbreaks, who is bothered by them, or who has an uninfected partner.  Studies with these drugs have found that 80-90% of the people who take the drug for suppression have greatly reduced frequency of outbreaks or do not have outbreaks while taking the drug. The virus is still present in the body, and, after the drug is stopped, the outbreaks and shedding return to a normal level.  While the risk of asymptomatic shedding may be greatly reduced by the medication, it is not stopped altogether.

     An antiviral medication works something like this: the drug presents itself to the herpes virus as being a chemical element that the virus needs to reproduce itself. But it is really just a phony, and when the virus tries to reproduce after it takes up the medicine, it can't. The virus doesn't die off completely, but it doesn't reproduce effectively either.

    None of the antivirals have been proven safe for use in pregnant women, but data has been gathered about the use of antivirals in pregnancy and most obstetric clinicians use the medicines suppressively in the last month of pregnancy to try to prevent outbreaks and/or shedding near the time of delivery. If a woman should become pregnant while taking antiviral medication, she should discontinue its use and consult her clinician.

acyclovir (generic) also known as Zovirax
    This anti-viral medication was first FDA approved as a topical treatment for first-time outbreaks. The topical cream form of the medicine was shown to shorten the first outbreak very slightly, but it had no effect on subsequent outbreaks.  Topical acyclovir has no useful place in the treatment of recurrent genital herpes.

Oral acyclovir is indicated for use in one of three ways:
First time outbreaks: 400 mg three times a day for 7-10 days.
Recurrences: 400 mg three times a day for 5 days or 800 mg twice a day for two days.
Suppression: 400 mg twice a day every day.

    Acyclovir is also available for intravenous use in babies and adults for whom more aggressive treatment is necessary.  It is available in a liquid form for people who have difficulty swallowing pills.

Valtrex (valacyclovir)
    This FDA-approved medicine may be used for first outbreaks, for recurrent outbreaks, and for suppression.  It is also approved to reduce transmission of genital herpes from an infected person to an uninfected one.

First time outbreaks: 1000 mg twice a day for ten days.
Recurrent outbreaks: 500 mg twice a day for three days.
Suppression: 1000 mg once a day for people who have 10 or more outbreaks per year. 500 mg once a day for people who have 9 or fewer outbreaks per year.  It is taken every day.

Cold sores:  2 gram in a single dose, then 12 hours later, 2 grams again, to be taken at the first sign of a cold sore. 

famciclovir (generic) also known as Famvir
    This antiviral medication has been FDA approved for recurrent disease and for suppression.  The FDA has not approved Famvir for first episode treatment, though the CDC does describe a dosing regimen for this purpose:

First time outbreaks:  250 mg three times a day for ten days.
Recurrent outbreaks: 1000 mg twice a day for one day
Suppression: 250 mg twice a day every day.

Cold sores:  1500 mg once in a single dose at the first symptom of a cold sore 

Treatments That Need Further Testing To Determine Their Effectiveness In Treating Genital Herpes
    L-Lysine is a naturally occurring amino acid, available at health food stores.  Studies have not shown L-Lysine to be effective in preventing or shortening herpes outbreaks.  However, some people report favorable results. Probably an equal or greater number report no improvement while taking L-Lysine. There are no known harmful effects from taking reasonable doses of L-Lysine. A larger study is needed to determine if there is any benefit from taking this nutrient daily.

    Resiquimod is an immune modulator whose sister drug, imiquimod or Aldara, has shown good success in treating genital warts.  One study showed some limited benefit while using resiquimod for treating genital herpes.

Other Treatments
    There are also treatments for herpes that do not involve medicines. Reasonable attempts to reduce tension or stress may be beneficial for some people. Exercise is becoming an increasingly popular way to raise one's spirits. Counseling, relaxation techniques, massage and meditation all fall into this category.  Before paying $100 plus per hour for counseling, however, check the credentials of the therapist. A credible professional will not be offended when you ask about his or her qualifications.  On the other hand, beware of a medical person who says that adding a psychological approach to treating a physical illness is pure rubbish.


Treatments Shown To Be Ineffective In Treating Herpes
There are some treatments for herpes that have been tried and have been found to be of no use.  These treatments include:

Ether
Chloroform
Neutral Red Dye With Light Activation
Lithium Succinate Cream
BHT
Glossypol
Proflavine
Small Pox Vaccine (May Also Be Harmful)
Bacillus Calmette-Guerin (Bcg) Vaccine
Influenza Vaccine
Polio Vaccine