Herpes treatments

Genital herpes is a common sexually transmitted infection (STI) in Australia. In fact, more than 1 in 10 Australians has the herpes simplex virus, which is the cause of genital herpes. Once you have been infected with the herpes simplex virus, the virus stays in your body indefinitely. However, there are medicines available from your doctor for treating and managing genital herpes.

In addition to prescribing treatments, your doctor can give you advice about how to manage your sex life safely when you have genital herpes. Be reassured that genital herpes is a common condition — don’t be embarrassed to see your doctor and get treatment.

Even with no treatment, outbreaks of genital herpes tend to be less severe and frequent over time. (Episodes or outbreaks are when you experience genital herpes symptoms of sores, blisters or ulcers around the genital or anal area. The sores can be painful, but usually heal on their own after a couple of weeks.)

What are the treatments for genital herpes?

Although there is currently no cure for herpes, treatments are available that can reduce the severity, frequency and duration of episodes.

Antiviral medicines

One type of effective and specific treatment for genital herpes is antiviral medication, which is usually given in tablet form. Antiviral medicines help to stop the herpes virus from multiplying.

Antiviral medicines can be taken just during an outbreak, starting as soon as the first signs are noticed (episodic treatment), or they can be taken continuously (even when there are no symptoms) to reduce the chance of having repeat outbreaks (suppressive treatment).

Herpes antiviral medicines available in Australia include:

  • acyclovir (brand names include Zovirax, Acyclo-V);
  • famciclovir (brand names Famvir, Ezovir); and
  • Valaciclovir (Valtrex, Vaclovir).

Side effects of antiviral medicines may include nausea, headaches, tiredness and dizziness. Side effects are usually mild.

What is episodic treatment of genital herpes?

Episodic treatment of genital herpes involves starting a course of antiviral tablets as soon as you notice symptoms of an outbreak, such as tingling or redness on an area of genital skin.

Taking medication at the first signs of an episode will help to reduce the length and severity of symptoms. It may also ward off an outbreak if you start taking the medicine as soon as you notice warning signs of a recurrence.

This type of treatment is often the preferred treatment for people who don’t have genital herpes outbreaks very often.

What is suppressive treatment for genital herpes?

Suppressive (preventative) treatment involves taking medication on a daily basis to reduce the chance of a genital herpes outbreak.

Taking antiviral medicines on a daily basis also reduces the amount of virus that is shed, both when sores are present and in between outbreaks, when the skin looks normal.

Suppressive treatment does not guarantee that you will not get a herpes outbreak, but should reduce the severity and frequency of herpes outbreaks.

Over time, your immune system tends to exert better control over the herpes virus, so your doctor may suggest stopping treatment every 6 months to see whether you have any further outbreaks. Treatment can be re-started if you do have a recurrence.

Who should consider taking suppressive therapy?

Continuous suppressive treatment is particularly useful for people who are experiencing frequent or troublesome episodes of genital herpes.

If you are constantly worried about having another bout of herpes, you may find that suppressive treatment allows you to be less focused on the herpes virus. This emotional break can provide you with time to adjust to living with this infection. You may also find professional support helpful.

If you know that stress triggers a recurrence and you are experiencing significant stress, or your outbreaks tend to occur during specific situations such as holidays, then a course of suppressive therapy may be appropriate on such occasions.

The use of antiviral medicines on a daily basis as suppressive therapy (along with condom use during sex) can help reduce the risk of transmitting the virus to a non-infected partner.

Herpes antiviral treatment and HIV

Episodes of herpes can be more severe and frequent in people with HIV infection. Many doctors suggest people with HIV use suppressive treatment for their genital herpes. The same is true for other situations where the immune system is suppressed, for example, following transplant surgery.

Herpes treatment during pregnancy

Talk to your doctor if you are pregnant and have genital herpes, or your partner has genital herpes, as it is possible for the baby to be infected with the herpes virus during pregnancy or birth.

Your doctor may recommend you take antiviral treatment before the baby is due, or may recommend delivering the baby via Caesarean section.

Lifestyle changes

Some people with genital herpes find that reducing stress can help minimise the number of herpes episodes.

Relieving episodes of genital herpes

The symptoms of herpes – sores, blisters or ulcers around the genital or anal area – may cause some people significant discomfort. The following self-care measures may prove helpful in relieving the symptoms associated with an episode of genital herpes.

  • Try lying in a bath of water with 2 to 3 tablespoons of salt dissolved in it.
  • If urination is painful, pour lukewarm water over the painful area when you are trying to urinate. You could also try passing urine while taking a shower or bath.
  • Wear cotton underwear with loose clothing on top.
  • Try mild pain killers such as aspirin or paracetamol.
  • Lidocaine (lignocaine) ointment or gel – a local anaesthetic – can be applied to the sores to relieve pain and discomfort. Ask your pharmacist or doctor about lidocaine (lignocaine).

How to avoid passing on genital herpes

There are several steps you can take to reduce the chances of passing genital herpes on to your sexual partner(s), including:

  • always using condoms when you have sex;
  • taking suppressive antiviral medicines; and
  • avoiding sex whenever you have symptoms.

However, while these steps will help reduce the chance of spreading the infection, there is still a chance that you could pass on the genital herpes virus through sexual contact.

Find a doctor you feel comfortable with

While some doctors have a special interest in sexual health, others may not be familiar with, or comfortable discussing, these issues. Finding a doctor with whom you can openly and comfortably discuss these issues is important. There are doctors who specialise in this area: some are in private clinics, while others belong to sexual health services. There are also sexual health services in country areas. All sexual health services are strictly confidential.

Talk to your doctor if you are feeling worried about the impact of genital herpes on your sex life, relationship or future relationships. Your doctor can give you advice on how to discuss sexually transmitted infections with your partner, and can recommend support groups.

Last Reviewed: 30 November 2016
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References

1. Genital ulcer disease (revised November 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2016 Jul.http://online.tg.org.au/complete/ (accessed Nov 2016).
2. BMJ Group. Patient information from the BMJ Group: Genital herpes (published 27 Oct 2016). http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/532420.pdf (accessed Nov 2016)
3. Centers for Disease Control and Prevention (CDC). Genital herpes – CDC fact sheet (reviewed 23 Jan 2014). http://www.cdc.gov/std/herpes/stdfact-herpes.htm (accessed Nov 2016).
4. Australian STI Management Guidelines for use in primary care. Herpes (updated 20 May 2016). http://www.sti.guidelines.org.au/sexually-transmissible-infections/herpes (accessed Nov 2016).
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