Herpes is a family of several viruses, although most people think of genital and oral herpes when they think of a herpes outbreak. Chickenpox and shingles are a type of herpes virus called herpes zoster. (Learn More) These can all become chronic conditions that require medical treatment.
While there are several antiviral drugs that may work, acyclovir, famciclovir, and valacyclovir are the most effective prescription medications available. (Learn More) You may take these when you develop the first symptoms of an outbreak, or you can take them to suppress the herpes virus, especially if symptoms are painful or outbreaks occur often. (Learn More)
There is no cure for herpes, but treatments work well to ease pain and promote healing during outbreaks. (Learn More)
What Is a Herpes Outbreak? How Is It Treated?
Although there are several forms of the herpes virus that can cause symptoms in either children or adults, most people think of genital herpes and oral herpes when they think of this skin condition.
Both genital and oral herpes are caused by herpes simplex virus 1 or 2 (HSV-1 or HSV-2). However, children may also contract varicella-zoster virus (chickenpox), and adults who have had chickenpox as children may develop herpes zoster (shingles) later in life. Other forms of herpesvirus are common, but asymptomatic unless the individual has a suppressed or damaged immune system.
Genital and oral herpes both appear as small, red sores, blisters, or bumps, usually in clusters that may burst open, especially during the first outbreak. It can take a few days to a month for the sores to heal, particularly if this is the first time sores have appeared on the skin. They will crust over and then heal without leaving scars. These may be painful or itchy.
You may also experience the following symptoms:
- Nausea
- Fatigue
- Aches and pains
- Fever
- Chills
These are especially likely during the first HSV-1 or HSV-2 outbreak and less likely to occur during subsequent outbreaks. Sores may or may not appear during subsequent outbreaks. Many people are asymptomatic, or experience mild symptoms that they do not associate with herpes.
Herpes simplex viruses are contracted through contact with an open sore, typically during unprotected oral, vaginal, or anal penetration. If you think you have herpes, your doctor will either take a swab or scraping of the sores, perform a blood test to see if you have antibodies for one of the herpes viruses, or both.
Medications to Treat Herpes Outbreaks
Antiviral medications are the most common approach to treating symptoms of genital HSV-1 and HSV-2, and they may be used to treat severe symptoms of chickenpox or shingles.
While there is a chickenpox vaccine, not everyone received it, so some adults still develop shingles as they age if they had chickenpox as a child. In very rare cases, those who received the chickenpox vaccine as a child may experience shingles as an adult.
In atypical cases, people who have severe, frequent outbreaks of oral herpes may also receive prescription medications to manage symptoms.
The most common and effective prescription antiviral herpes treatments are:
- Acyclovir (Zovirax). This is the oldest antiviral herpes treatment available in the United States. Topical applications have been accessible since 1982, and a pill form has been available since 1985. It is one of the safest medications, with low risk of side effects and interactions in people who need to take it daily for as long as 10 years.
The medication is prescribed for people with chickenpox or shingles, to suppress symptoms, relieve pain, and promote healing. It is also frequently prescribed for a first genital herpes outbreak and sometimes to manage recurring outbreaks, although newer prescription antivirals are more likely to be used for this purpose. The medication stops the spread of the virus in the body, which reduces the severity of the outbreak and allows your immune system time to work effectively.
Side effects may include the following:- Upset stomach or nausea
- Diarrhea
- Dizziness
- Fatigue or sleepiness
- Agitation and restlessness
- Pain, especially in the joints
- Changes in vision
- Hair loss
- Famciclovir (Famvir). This newer antiviral medication uses penciclovir as the base, active ingredient, giving people who do not respond well to acyclovir a better option. For people who need to suppress frequent outbreaks, Famvir is absorbed well, lasts longer in the body, and can be taken less often than acyclovir.
This medication is prescribed mainly for shingles outbreaks, but it has been useful for genital and oral herpes outbreaks too. To treat symptoms of a shingles outbreak, take Famvir within 48 hours of the initial symptoms. For best results with genital herpes, take the medication within six hours of the initial symptoms. It is taken orally in tablet form, and it can be taken with or without food. - Valacyclovir (Valtrex). Acyclovir is the main active ingredient in Valtrex, but acyclovir is delivered more effectively in this option than the generic, older version. The medication is absorbed by the body more readily, so Valtrex will not need to be taken as often.
This drug is prescribed to suppress outbreaks of genital herpes, both HSV-1 and HSV-2, as well as shingles. Valacyclovir may also be taken to suppress chickenpox symptoms. It is only available in pill form.
For people who take this medication episodically, it works best to begin taking it 48 hours after the first symptoms of genital herpes or shingles appear. Side effects are similar to Zovirax.
Treating Acute vs. Chronic Herpes Outbreaks
There are two basic approaches to treatment, depending on the severity of herpes symptoms and how often outbreaks occur.
- Episodic treatment: This is the approach most doctors will recommend for herpes and shingles outbreaks because symptoms occur infrequently. Your doctor will prescribe specific doses of an antiviral medication, which you will start taking when symptoms like pain or itching begin.
This will help sores heal and shorten how long it takes for the outbreak to go away. This also means you are less likely to experience medication side effects as intensely because you do not need to take a pill or use an ointment as often. All three medications above are useful for herpes outbreaks. - Suppressive therapy: People who want to eliminate or greatly reduce herpes outbreaks, or who suffer frequent outbreaks with painful symptoms, can take suppressive therapy. Studies have shown that this approach reduces outbreaks by at least 75 percent, as long as the medication is taken consistently.
Depending on the medication you receive, your doctor may prescribe one or two pills per day. Taking less medication less often is more effective for most people.
Herpes Is a Chronic Condition
The antiviral medications listed above work very well to suppress the symptoms and viral activity from herpes viruses, including genital and oral herpes. This means you will experience fewer outbreaks, less pain, and fewer sores.
If the antiviral drug works well for you, the outbreak will heal faster. If one medication does not reduce how many outbreaks you experience or shorten your recovery time, speak with your doctor to try a new antiviral drug.
There is no cure for herpes. Once you have the virus, it is in your body for the rest of your life. For genital and oral herpes, this is a chronic condition, but many people can manage their symptoms well.
References
Genital Herpes: Frequently Asked Questions, Gynecological Problems. (September 2016). The American College of Obstetricians and Gynecologists (ACOG).
Genital Herpes: Common but Misunderstood. (April 16, 2019). Harvard Health Publishing.
Herpes Treatment. American Sexual Health Association (ASHA).
Acyclovir. (June 15, 2017). MedlinePlus.
Famciclovir (Oral Route). (February 1, 2019). Mayo Clinic.
Valacyclovir (Oral Route). (February 1, 2019). Mayo Clinic.
