Best treatments for herpes simplex virus

Introduction

Herpes simplex virus (HSV) is a common infection that affects billions of people worldwide. There are two main types of HSV

• HSV-1, which typically causes oral herpes or cold sores around the mouth
• HSV-2, which usually leads to genital herpes.

While HSV is a lifelong condition with no cure, there are many ways to manage symptoms, reduce outbreaks, and prevent spreading the virus to others. In this article, we'll discuss the symptoms and causes of HSV, explore treatment options, share tips for living with HSV, and cover ways to prevent transmission.

Symptoms and Causes of Herpes Simplex Virus

Symptoms of HSV vary depending on the type.

HSV-1 mainly causes cold sores or fever blisters around the mouth.

HSV-2 is the main cause of genital herpes, characterized by painful blisters or sores on or around the genitals, anus, or thighs.

However, both types can infect either area through oral-genital contact.

HSV spreads through direct contact with herpes lesions, mucosal surfaces, or oral secretions of an infected person. The virus enters the body through small breaks in the skin or mucous membranes. It then travels to nerve cells, where it can lay dormant for extended periods before reactivating and causing symptoms.

The first outbreak is often the most severe. Symptoms may include painful blisters or ulcers at the site of infection, fever, body aches, and swollen lymph nodes.4,5 Following outbreaks are usually milder and shorter but can still be uncomfortable and distressing.

One of the most challenging aspects of HSV is that it remains dormant in nerve cells after the primary infection. The virus can get reactivated, traveling back down the nerve fibers to the skin or mucosa and causing recurrent outbreaks. Various triggers, such as stress, illness, sun exposure, or hormonal changes, may provoke these recurrences.12,13

Many people with HSV have mild or no symptoms, so they may be unaware of their infection. However, they may be able to transmit the virus to others through viral shedding, which is the release of infectious virus particles in the absence of noticeable symptoms.15 This makes preventing the spread of HSV challenging.

Prescription Medications for Herpes Simplex Virus

Recurrent or severe herpes outbreaks can be treated with prescription antiviral medications.. These drugs work by blocking viral replication, which helps shorten the length of outbreaks, reduce the severity of symptoms, and decrease the risk of transmission to partners.

The most commonly prescribed antivirals for HSV are acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir).

These medications are available in oral tablet form and are typically well-tolerated with few side effects. They can be used for episodic treatment, taken at the first sign of an outbreak to speed healing, or as daily suppressive therapy to reduce outbreak frequency and risk of transmission.

Episodic treatment involves taking antiviral medication for a short course, usually 2-5 days, starting at the first sign of symptoms like tingling, itching, or burning before sores appear. This can significantly shorten the duration of an outbreak and provide faster symptom relief compared to no treatment.6,7

For people with frequent outbreaks, typically 6 or more per year, daily suppressive therapy may be recommended. This involves taking an antiviral medication every day to prevent outbreaks from occurring. Studies have shown that daily suppressive therapy with valacyclovir can reduce outbreak frequency by up to 80%.6,7 Suppressive therapy also reduces the risk of transmitting HSV to sexual partners.

While antivirals are highly effective in managing HSV, they do not completely eliminate the virus from the body or prevent all outbreaks. The medication only works while it is being taken; once stopped, outbreaks can recur. Some people may develop resistance to antiviral drugs over time, particularly those with weakened immune systems.

Over-the-Counter Treatments for Herpes Simplex Virus

Several over-the-counter (OTC) treatments can help manage symptoms and promote healing during outbreaks. These remedies can provide temporary relief from pain, itching, and discomfort associated with herpes sores.

• Pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help with pain, achiness, and fever.
• Topical treatments can be applied directly to herpes sores. Creams or ointments containing benzocaine, lidocaine, or dibucaine can numb the affected area, providing temporary relief. Examples include Anbesol or Orajel. Some also contain protective ingredients like allantoin or petrolatum to help soothe and moisturize the skin.
• Keeping the affected area clean and dry can help prevent bacterial infections and promote healing. Gently washing with mild soap and water, then patting dry can help keep sores clean.
• Some people find that applying a cold compress or ice pack wrapped in a towel can numb the area and reduce swelling.
• Petroleum jelly (Vaseline) or other fragrance-free, hypoallergenic ointments can be applied to herpes sores to soothe and protect the skin. These help prevent drying and cracking.
• Certain OTC oral supplements may help boost the immune system and reduce outbreak frequency or severity. The amino acid lysine has shown some promise in managing herpes outbreaks. However, more research is needed to confirm lysine's effectiveness and optimal dosing.
• Stress is a common trigger for herpes outbreaks, so finding ways to manage stress through self-care practices may help.
• Getting enough sleep, eating a balanced diet, staying hydrated, and engaging in relaxation techniques like deep breathing or meditation can help support overall health and potentially reduce outbreak frequency.

Living with Herpes Simplex Virus

Receiving a herpes diagnosis can be emotionally challenging, and living with a chronic, sexually transmitted infection can impact various aspects of life. However, with the right mindset, medical treatment, and coping strategies, people with HSV can still lead fulfilling lives and maintain healthy relationships.

• Educate yourself. One of the most important steps after diagnosis is to educate yourself about the virus. Learning about transmission risks, treatment options, and self-care practices can help you feel more in control. Connecting with healthcare providers who are knowledgeable about HSV and provide compassionate, non-judgmental care is crucial.
• Get emotional support. Many people experience feelings of shame, anxiety, or depression following an HSV diagnosis. Seeking support from a mental health professional, friends, family, or support groups can help you process these emotions and develop a positive self-image. Online forums and communities can provide a safe space to connect with others navigating similar experiences.
• Discuss your HSV status with romantic partners. This can be daunting, but open and honest communication is key to fostering trust and intimacy. Choosing the right time and place for the conversation, providing accurate information about transmission risks, and being open to questions can help partners feel more comfortable and informed.
• Use protection to prevent transmission. Using condoms and dental dams consistently during sexual activity can significantly reduce the risk of transmitting HSV to partners, though they do not provide complete protection. Suppressive antiviral therapy, which reduces viral shedding and outbreak frequency, can further decrease transmission risk.15,17
• Avoid triggers. People with HSV may need to be mindful of potential triggers that can provoke outbreaks. Common triggers include stress, lack of sleep, poor nutrition, and excessive sun exposure. Developing healthy lifestyle habits and stress-management techniques, such as regular exercise, balanced meals, and relaxation practices, can help minimize triggers and promote overall well-being.

While genital herpes can affect sexual relationships, it does not define a person's worth or attractiveness. Many people with HSV have fulfilling sexual and romantic lives. Focusing on open communication, trust, and shared responsibility for sexual health can strengthen bonds with partners.

It's important to remember that HSV is extremely common, affecting millions of people worldwide. While stigma surrounding herpes persists, increasing public awareness and education is helping to break down stereotypes. Connecting with others who have HSV and sharing personal stories can be empowering and help combat feelings of isolation.

Preventing the Spread of Herpes Simplex Virus

Preventing the transmission of herpes simplex virus is a key concern of people with HSV. While no single method provides complete protection, combining several strategies can significantly reduce the risk of spreading the virus.

• Wait until sores go away. One of the most effective ways to prevent transmitting HSV during an active outbreak is to abstain from sexual activity until the sores have completely healed. This includes avoiding oral sex if cold sores are present, as HSV-1 can spread to the genitals through oral-genital contact. Waiting until scabs have fallen off and new skin has formed can help minimize the risk of transmission.
• Use barrier methods like condoms and dental dams consistently and correctly during sexual activity can provide substantial protection against HSV transmission. These barriers can reduce contact with infectious fluids and lesions, though they do not cover all potentially affected areas. Condoms should be put on before any genital contact and removed and disposed of properly after use.

It’s important to recognize that HSV can spread even in the absence of visible symptoms through asymptomatic viral shedding. This means that condoms and avoiding sex during outbreaks, while important, are not foolproof prevention methods. Studies have shown that up to 70% of genital HSV-2 infections are transmitted during asymptomatic shedding.15,16

• Take daily suppressive therapy with antiviral medications like valacyclovir to significantly reduce the risk of transmitting HSV to partners. By decreasing viral shedding and outbreak frequency, these drugs lower the chances of spreading the virus during both symptomatic and asymptomatic periods. Studies have found that daily valacyclovir can reduce HSV-2 transmission risk by up to 48% in heterosexual couples.1

However, even with suppressive therapy, HSV transmission can still occur, though the risk is low. A study found that transmission occurred in 1.9% of partners using condoms and antiviral suppression over a one-year period.17

Conclusion

Herpes simplex virus is a highly prevalent and lifelong infection that affects millions of people worldwide. While HSV-1 is more commonly associated with oral herpes and HSV-2 with genital herpes, both virus types can infect either area. Many people with HSV have no symptoms, while others have painful blisters or sores at the infection site.

Although there is no cure for HSV, antiviral medications like acyclovir, valacyclovir, and famciclovir are highly effective at managing symptoms, reducing outbreak frequency, and decreasing the risk of transmission to partners. Over-the-counter treatments can provide temporary relief for milder symptoms. Suppressive therapy with daily antivirals can significantly improve quality of life for people with frequent outbreaks.

Living with HSV can be challenging, but with the right support, treatment, and coping strategies, people with herpes can still lead fulfilling lives.

Citations:

<1>Sauerbrei, A. (2016). Optimal management of genital herpes: current perspectives. Infection and Drug Resistance, 9, 129-141. https://doi.org/10.2147/IDR.S96164</1>

<2>Álvarez, D. M., Castillo, E., Duarte, L. F., Arriagada, J., Corrales, N., Farías, M. A., ... & Valenzuela, B. (2020). Current antivirals and novel botanical molecules interfering with herpes simplex virus infection. Frontiers in Microbiology, 11, 139. https://doi.org/10.3389/fmicb.2020.00139</2>

<3>Cuddy, S. R., Beltran, W. F., Blanchard, J. L., Barker, C. J., Patel, A. H., & Nicoll, M. P. (2020). Neuronal hyperexcitability is a DLK-dependent trigger of herpes simplex virus reactivation that can be induced by IL-1. eLife, 9, e58037. https://doi.org/10.7554/eLife.58037</3>

<4>Deethae A, Peerapornpisal Y, Pekkoh J, Sangthong P, Tragoolpua Y. Inhibitory effect of Spirogyra spp. algal extracts against herpes simplex virus type 1 and 2 infection. J Appl Microbiol. 2018;124(6):1441-1453. doi:10.1111/jam.13729</4>

<5>Qi T, Lan H, Zhong C, et al. Systematic review and meta-analysis: the effectiveness and safety of acupuncture in the treatment of herpes zoster. Ann Palliat Med. 2022;11(2):756-765. doi:10.21037/apm-22-109</5>

<6>Pinder M, Wright A. Valaciclovir versus aciclovir for the treatment of primary genital herpes simplex: a cost analysis. Int J STD AIDS. 2015 Nov;26(13):971-3. doi:10.1177/0956462414563628</6>

<7>Alvarez DM, Castillo E, Duarte LF, et al. Current antivirals and novel botanical molecules interfering with herpes simplex virus infection. Viruses. 2020;12(6):604. doi:10.3390/v12060604</7>

<8>Aubert, M., Haick, A. K., Strongin, D. E., Klouser, L. M., Loprieno, M. A., Stensland, L., ... & Jerome, K. R. (2016). Gene editing for latent herpes simplex virus infection reduces viral load and shedding in vivo. Nature medicine, 22(7), 756-761.</8>

<9>Horváth, G., Molnár, E., Szabó, Z., Kecskeméti, G., Juhász, L., Tallósy, S. P., ... & Virok, D. P. (2016). Carnosic acid inhibits herpes simplex virus replication by suppressing cellular ATP synthesis. Antiviral research, 130, 104-111.</9>

<10>Oh, P. S., Han, Y. H., Lim, S., Vetha, B. S. W., & Jeong, H. J. (2022). Antiviral and synergistic effects of photo-energy with acyclovir on herpes simplex virus type 1 infection. Photodiagnosis and Photodynamic Therapy, 37, 102654.</10>

<11>Aubert, M., Strongin, D. E., Loprieno, M. A., Stensland, L., Huang, M. L., Makhsous, N., ... & Jerome, K. R. (2020). Gene editing and elimination of latent herpes simplex virus in vivo. Nature Communications, 11(1), 1-13.</11>

<12>Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People · Sexually Transmitted Infections Treatment Guidelines, 2021 ... Genital herpes is a chronic, lifelong viral infection. Two types of HSV can cause genital herpes: HSV-1 and HSV-2. Most cases of recurrent genital herpes are caused by HSV-2, and 11.9% of persons aged 14–49 years are estimated to be infected in the United States (436).</12>

<13>Fatahzadeh, M., & Schwartz, R. A. (2007). Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. Journal of the American Academy of Dermatology, 57(5), 737-763.</13>

<14>Ngan, T. T. D., Tuyet, N. T., Hung, D. T., Cap, N. T., Nguyen, D. M., & Dat, V. Q. (2022). Clinical characteristics and outcomes of patients with Herpes Simplex Encephalitis in Vietnam: a retrospective study. PLoS ONE, 17(11), e0277546.</14>

<15>Mertz, G. J. (2008). Asymptomatic shedding of herpes simplex virus 1 and 2: implications for prevention of transmission. The Journal of Infectious Diseases, 198(8), 1098-1100.</15>

<16>Wald, A., Zeh, J., Selke, S., Ashley, R. L., & Corey, L. (2002). Genital shedding of herpes simplex virus among men. The Journal of Infectious Diseases, 186(Supplement_1), S34-S39.</16>

<17>Wald, A., Zeh, J., Barnum, G., Davis, L. G., & Corey, L. (1996). Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir. Annals of Internal Medicine, 124(1_Part_1), 8-15.</17>