What are the treatment options for genital herpes?

Antiviral medications can help to control the symptoms and shorten the duration of initial herpes outbreaks by 2 to 4 days. The treatment of an initial outbreak should be started within the first three days – the earlier, the better.

The medications are taken as tablets. The number of tablets per day depends on the active ingredient and the dose. The World Health Organization (WHO) recommends the following doses and amounts be taken for ten days to treat an initial outbreak:

• Acyclovir: 200 mg five times per day or 400 mg three times per day,
• Famciclovir: 250 mg three times per day, or
• Valaciclovir: 500 mg two times per day.

These three medications are about as effective as each other. Acyclovir is the most commonly used because doctors and patients have the most experience with this medication.

Later outbreaks with only mild symptoms don’t necessarily need to be treated. The blisters can then simply heal on their own.

But antiviral medication can also shorten the duration of later outbreaks by an average of about two days. If you decide to have treatment, it’s important to start it within the first 24 hours of the outbreak – ideally, as soon as you notice the first symptoms. So it’s a good idea to always have a few tablets at home or to take them with you when you travel so they are ready to use. You can get a prescription from your doctor.

In later outbreaks you can take them for a shorter time. Experts recommend the following:

• Acyclovir: 400 mg three times per day or 800 mg two times per day for five days, or 800 mg three times per day for two days,
• Famciclovir: 250 mg two times per day for five days, or
• Valaciclovir: 500 mg two times per day for three days.

A different dose and treatment duration may be a good idea for people who have immune system disorders, such as an HIV infection.

Some people have outbreaks of genital herpes very often or experience especially severe symptoms. Then it may be a good idea to take antiviral medication for a longer time – including during symptom-free phases. The goal is to prevent further outbreaks and to keep the symptoms from becoming so severe. Also, the antiviral medication reduces the likelihood of infecting others. The following is recommended as preventive treatment:

• Acyclovir: 400 mg two times per day,
• Famciclovir: 250 mg two times per day or
• Valaciclovir: 500 mg once per day.

Research shows that preventive treatment can considerably lower the risk of further outbreaks. The people participating had four or more herpes outbreaks per year before the start of the studies, and then took an antiviral medication or a fake treatment (placebo) for up to one year. A comprehensive analysis of the study results shows that

• 96 out of 100 people who took a placebo had at least one further outbreak of genital herpes.
• 46 out of 100 people who were given antiviral medication had at least one further outbreak of genital herpes.

People with very frequent herpes outbreaks also benefited from preventive treatment: In one study involving people with very frequent outbreaks, the medication lowered the number of episodes in one year from 11 to 2.

The decision about whether to have preventive treatment will not only depend on the frequency and severity of the symptoms, but also on your individual needs.

Some experts recommend stopping preventive treatment once a year to check whether it's still necessary. The frequency and severity of genital herpes outbreaks often decrease over time.

Antiviral medications are considered to be very safe. They are nearly always well tolerated because the active ingredients only have an effect in cells that have been infected by the virus.

People who have kidney failure may need to take a lower dose because the medication is removed from the body through the kidneys.

In some women, genital herpes blisters cause pain when urinating (peeing). Many of them find it soothing to pee while sitting in warm, shallow water (a sitz bath). You can do this using special tubs that fit into toilet bowls. They are available at a reasonable price, for instance from pharmacies or on the internet. It's best not to use soaps or bath additives because they can irritate the affected area even more. Other things you can do to avoid irritating it further include wearing loose-fitting clothes and underwear made out of fabrics that have a smooth surface.

Painkillers such as ibuprofen are an option if the blisters become very painful.

Topical (externally applied) antiviral treatments such as creams or ointments don't provide any relief, but they can increase the risk of viral resistance. Experts advise against using topical treatments for genital herpes.