Herpes is a common, lifelong viral infection that affects nearly half of American adults under the age of 50.
Most infected individuals do not develop herpes symptoms at all, but for some people, herpes infections can cause painful sores, blisters, or lesions, often on the mouth or genitals.
People who carry the herpes virus can spread it to others through close, direct, and intimate contact.
In this article, I’ll review the medications that doctors use to treat both oral and genital herpes.
I’ll discuss how long it typically takes for these treatments to work, as well as the various dosages available with these treatments.
I’ll examine the different kinds of herpes strains and look at the major side effects of herpes medications.
Finally, I’ll discuss when to see a doctor if you think you may be experiencing a herpes breakout. .
Different Types of Herpes HSV
People with herpes can experience viral symptoms in widely different ways: across this population, there is a large range in both the frequency and severity of people’s herpes outbreaks.
Ultimately, all herpes infections are caused by one of two strains of the herpes simplex virus: HSV-1 and HSV-2.
Herpes simplex virus-1 (HSV-1) is the strain that is primarily responsible for oral herpes outbreaks, which are also known as cold sores.
In some cases, HSV-1 infections can also cause genital herpes outbreaks, for example if the virus is spread through oral sex.
Herpes simplex virus-2 (HSV-2), meanwhile, is the herpes simplex strain that causes most outbreaks of genital herpes.
Typically, most herpes outbreaks will resolve on their own in 1-2 weeks.
At this point, the herpes virus will move from your skin cells and into your nervous system, where it will lay dormant until it is reactivated, if for example, your immune system is under stress.
However, certain medications can make the resolution of a herpes outbreak quicker, and more tolerable.
In some cases, they can even prevent outbreaks from occurring with frequency .
Herpes Medication and Treatments Available
There is currently no cure or vaccine for either HSV-1 or HSV-2.
However, if you are diagnosed with herpes, your doctor may prescribe you certain kinds of treatments and medications during an outbreak or to suppress the virus.
One area where medications can help is pain management.
For genital herpes outbreaks, doctors may recommend prescription-strength pain creams with ingredients like benzocaine or lidocaine.
These can help to reduce discomfort caused by especially inflamed, or acute, herpes lesions.
For oral herpes outbreaks caused by HSV-1 infections, your doctor might similarly prescribe topical creams containing painkilling ingredients like benzocaine (Zilactin).
Over-the-counter pain treatments can also help with milder oral herpes outbreaks.
These include NSAIDS (non steroidal anti inflammatories) like ibuprofen (Advil, Motrin), as well lower-strength gel formulations with numbing ingredients like benzocaine (Anbesol, Orajel).
None of these numbing or painkilling options work to actually speed up or heal the herpes outbreak, however.
They may reduce discomfort, but they do not lessen the time it takes a herpes outbreak to move from emerging, to active, to dormant. For that, doctors turn to antiviral treatments.
Antiviral medications can both speed up the rate of healing, as well as reduce the severity of outbreaks.
For genital herpes, when taken as suppressive therapy, antiviral medications can also reduce the frequency of outbreaks.
To alleviate cold sores, over-the-counter antiviral creams include medications like Docosanol 10% (Abreva). Prescription creams for cold sores include Penciclovir cream (Denavir), and Acyclovir cream (Zovirax).
Acyclovir creams can also be used to treat genital herpes.
More often, though, doctors will opt for orally administered antivirals to treat patients with genital herpes, as well as particularly acute forms of oral herpes.
The three most commonly prescribed antivirals for genital herpes are acyclovir, valacyclovir, and famciclovir.
All three medications have demonstrated similar levels of effectiveness.
Acyclovir (Sitavig, Zovirax) is an antiviral medication that comes in capsule, liquid, and delayed-release tablet form.
During an active herpes outbreak, acyclovir is usually taken two to five times a day, for five to ten days, with or without food.
You should try to start taking acyclovir as soon as possible once the symptoms of an outbreak arise.
As a preventative treatment, acyclovir is usually taken two times a day.
Like all antiviral treatments, acyclovir may prevent recurring outbreaks and speed up the healing of genital herpes lesions, but it does not remove the herpes virus from the body.
Valacyclovir (Valtrex) is an oral antiviral medication that comes in a tablet form and can be taken either with or without food.
To treat an outbreak of genital herpes, valacyclovir is typically taken one to two times a day depending on the dose, for five to 10 days.
As with all oral antivirals, you should continue to take valacyclovir for the amount of time your doctor prescribes it , even if your symptoms clear up more quickly.
As a preventative treatment for genital herpes, valaciclovir is typically taken once per day.
Famciclovir (Famvir) is an oral antiviral medication that is prescribed in a tablet form, to be taken with or without food.
To treat an outbreak of genital herpes, famciclovir is typically taken up to three times a day and most effective if taken within 48 hours of symptoms.
As a preventative treatment for genital herpes, famciclovir is typically taken twice a day.
For cold sores, famciclovir can be prescribed as a single dose to be taken as soon as possible after early symptoms occur (for example, tingling, itching, or burning).
Organizations like the World Health Organization (WHO) recommend different dosages for herpes management depending on whether the patient is experiencing an initial outbreak, or a later, subsequent outbreak.
A patient’s first outbreak of herpes is usually the most severe and may last longer than subsequent outbreaks.
In order to speed up healing and lessen the duration of this initial outbreak, doctors will often administer higher or more frequent doses of antiviral medications for a longer duration of time (often up to 10 days).
For later outbreaks, medications may be prescribed in more moderate doses, or fewer times a day.
These treatment courses often last for a shorter period of time.
For preventative treatment, doctors will prescribe a moderate dose of an antiviral medication to be taken once or twice a day, often for a period of one year.
After a year, doctors will often assess if the severity and frequency of a patient’s herpes outbreaks have begun to lessen even when a patient is unmedicated.
That’s because for many patients, herpes outbreak symptoms begin to diminish naturally over time.
How Long Does it Take for the Medication to Work?
All antiviral herpes medications begin to work quickly, which is why they should be taken as close as possible to the first emergence of symptoms.
This will give the medications the best chance to reduce the severity of the outbreak, and to speed up the resolution of an outbreak .
When taken within the first three days of an initial genital herpes outbreak, antiviral medications can shorten the lifespan of the outbreak by two to four days.
During later occurrences, these medications can shorten the lifespan of these (typically shorter) outbreaks by 1-2 days.
Many people with HSV-2 do not experience regular genital herpes outbreaks.
But for people who do experience several episodes per year, preventative treatment can make a big difference.
In clinical studies, many patients who begin daily preventative treatment, go on to experience zero genital herpes outbreaks over the course of the following year.
Preventative antivirals can even help those patients who experience especially frequent and painful outbreaks of genital herpes.
In one study of this population, for instance, preventative antivirals were shown to reduce the average number of yearly outbreaks from 11 to 2.
It’s important to remember, though, that none of these medications can completely cure herpes or eliminate the HSV virus from the body.
While preventative medicines, especially, can make it less likely that you’ll pass on the infection to sexual partners, it cannot completely eliminate this risk.
Side Effects of Herpes Medication
Other side effects may include:
If any of the above side effects become severe, you should contact your physician.
You should also talk to your doctor immediately if you experience any of these symptoms:
- Hives, rashes, or itching
- Difficulty breathing or swallowing
- Pain, burning, numbness, or tingling in the hands or feet
- Yellowness or paleness of the skin or eyes
- Fever, chills, sore throat, or cough
- Hallucinations or confusion
- Difficulty speaking
- Blood in the urine
- Fainting or seizures
When to See a Medical Provider
Patients should get in contact with their doctors as soon as possible if they suspect they are experiencing an initial outbreak of genital herpes, or are experiencing especially severe and frequent cold sore outbreaks.
In these cases, the sooner your doctor can test you for herpes and prescribe you medication, the better.
Following an initial diagnosis, you should work with your doctor to make sure that you have the right antiviral medications on hand to treat later outbreaks as soon as they happen.
Your doctor can also help set you up with a preventative course of antiviral treatment.
Once on medication, you should talk to your doctor if you are experiencing any serious side effects.
It’s especially important to consult your doctor about initial or recurrent genital herpes outbreaks if you are pregnant, or trying to become pregnant.
In these cases, doctors use special medication and treatment strategies to not only support their pregnant patients, but also to safeguard the health of the babies.
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Frequently Asked Questions
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
What are the treatment options for genital herpes? (2018).
Genital Herpes – CDC Fact Sheet (2022).