What Medication Can I Take For Herpes

Why Is This Medication Prescribed

Acyclovir is used to decrease pain and speed the healing of sores or blisters in people who have varicella , herpes zoster , and first-time or repeat outbreaks of genital herpes . Acyclovir is also sometimes used to prevent outbreaks of genital herpes in people who are infected with the virus. Acyclovir is in a class of antiviral medications called synthetic nucleoside analogues. It works by stopping the spread of the herpes virus in the body. Acyclovir will not cure genital herpes and may not stop the spread of genital herpes to other people.

Why You Should Go To A Sexual Health Clinic

You can see a GP, but theyll probably refer you to a sexual health clinic if they think you might have genital herpes.

Sexual health clinics treat problems with the genitals and urine system.

Many sexual health clinics offer a walk-in service, where you do not need an appointment.

Theyll often get test results quicker than GP practices and you do not have to pay a prescription fee for treatment.

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Oral Antiviral Medication For Herpes

Most people who get herpes will not experience bothersome symptoms, but for those that do there is effective oral antiviral medication. It stops the herpes from multiplying but does not clear the virus from the body. The most common brand used in New Zealand is valaciclovir. It is safe and works effectively for both Type 1 and Type 2 herpes simplex.

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Topical Otc Treatments For Genital Herpes

Several over-the-counter topical options are available for genital herpes treatment, but evidence suggests they arent all effective.

Start with a few simple DIY topical compresses. Research shows that topical therapy can effectively alleviate symptoms of genital herpes outbreaks and even contribute to the prevention of outbreaks when used promptly.

Here are a few tried-and-true natural compress ideas to get you started:

• -Dry, warm compress using warmed rice in a sock
• -Cold compress using an ice pack or soft washcloth filled with ice
• -Baking soda paste
• -Crushed garlic cloves mixed with olive oil
• -Topical apple cider vinegar using one-part ACV and three-parts warm water

Additional Treatment For Oral Herpes

Antiviral pills are often a better choice for treating oral herpes, especially if you have recurrent outbreaks . Theyre typically less expensive than oral herpes creams and are effective options to consider.

If you have persistent oral herpes infections, taking oral antiviral medications may be a better option than creams. Here are three of the most commonly used oral antivirals with their typical cold sore treatment doses:

• Valacyclovir : 2,000 mg by mouth every 12 hours for 1 day

• Famciclovir: 1,500 mg by mouth one time only

• Acyclovir buccal tablets : 50 mg dissolved in the cheek one time only. Healthcare providers sometimes prescribe different doses of oral acyclovir capsules and tablets. This is considered an off-label use, as theyre not FDA-approved for treating cold sores.

There are currently no studies that directly compare all three antiviral medications. But a review of multiple studies found that valacyclovir healed cold sores faster than acyclovir.

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What Is In This Leaflet

This leaflet answers some common questions about Valtrex tablets. It does not contain all of the available information.

It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking Valtrex tablets against the benefits this medicine is expected to have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What Happens At A Sexual Health Clinic

The doctor or nurse at the sexual health clinic will:

• ask about your symptoms and your sexual partners
• use a small cotton bud to take some fluid from 1 of your blisters or sores for testing

The test cannot:

• be done if you do not have visible blisters or sores
• tell you how long you have had herpes or who you got it from

Symptoms might not appear for weeks or even years after youre infected with the herpes virus.

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Ganciclovir Cidofovir And Foscarnet

In the last decade, alternatives to ACV for herpesvirus treatment have emerged and become commercially available as therapeutic drugs. Ganciclovir is a nucleic acid analog that does not require viral proteins for its activation in the cell . These compounds differ from each other either, in their molecular processing into an active form of an acyclic guanosine analog, or bioavailability which significantly determines the frequency of administration .

Ganciclovir is indicated for the treatment of CMV, particularly for systemic and ocular infections in immunosuppressed patients . However, ganciclovir has also been reported to have antiviral activity against HSV-1 and HSV-2 and may be used for the treatment of herpetic keratitis . At present, there is an ongoing clinical study that is recruiting patients for assessing the effects of oral ganciclovir, together with femtosecond laser-assisted corneal debridement in the treatment of herpes simplex virus epithelial keratitis . Of note, ganciclovir has been reported to produce considerable adverse side effects in a high percentage of individuals , such as nephrotoxicity, neutropenia, myelosuppression, confusion, altered mental status, anxiety, ataxia, tremors, convulsions, fever, abnormal levels of liver enzymes in serum, diarrhea, and nausea, among others .

Table 1. Approved and experimental antiviral drugs against HSV-1 and HSV-2 .

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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 dont have genital herpes outbreaks very often.

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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.

What Are Antiviral Medications For Herpes

There are three antiviral medications that are FDA-approved for the treatment of genital herpes:

• Acyclovir: The oldest antiviral medication for herpes is acyclovir. It has been available since 1982 in a topical form and sold since 1985 in pill form. Acyclovir has been shown to be safe in persons who have used it continuously for as long as 10 years.
• Valacyclovir: A newer drug, valacyclovir, actually uses acyclovir as its active ingredient. This medication delivers acyclovir more efficiently so that the body absorbs much of the drug, which has the advantage of taking the medication fewer times during the day.
• Famciclovir: Famciclovir uses penciclovir as its active ingredient to stop HSV from replicating. Like valacyclovir, it is well absorbed, persists for a longer time in the body, and can be taken less frequently than acyclovir.

Antiviral medication is commonly prescribed for patients having a first episode of genital herpes, but they can be used for recurrent episodes as well. There are two kinds of treatment regimens: episodic therapy and suppressive therapy.

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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.

References

1. Genital ulcer disease . In: eTG complete. Melbourne: Therapeutic Guidelines Limited 2016 Jul.http://online.tg.org.au/complete/ .2. BMJ Group. Patient information from the BMJ Group: Genital herpes . http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/532420.pdf 3. Centers for Disease Control and Prevention . Genital herpes CDC fact sheet . http://www.cdc.gov/std/herpes/stdfact-herpes.htm .4. Australian STI Management Guidelines for use in primary care. Herpes . http://www.sti.guidelines.org.au/sexually-transmissible-infections/herpes .

Types Of Antiviral Drugs

There are three oral antivirals recommended for the treatment of oral or genital herpes:

Preventing genital herpes recurrence is important as it reduces the risk of HIV. According to the CDC, having an active genital herpes infection increases the risk of HIV by 200% to 300%.

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Antiviral Medications To Treat And Prevent Herpes

Carrie DeKorte, PharmD, BCPSPharmacy Times

Not all herpes infections are the same. Herpes zoster is an infection caused by the varicella-zoster virus, which is the virus that causes chickenpox. Genital herpes is an infection caused by the herpes simplex virus . Medications can help decrease the severity of the herpes lesions and prevent recurrences, but they do not cure the infection. The dose of the medication is different, depending on which herpes virus is being treated, and whether the medication is for an initial episode or a recurrent episode or chronic treatment to prevent outbreaks.

Herpes Zoster

After an attack of chickenpox, the virus stays in the nerve cells. It is called a dormant infection. Anyone who has had chickenpox carries the virus. Shingles is more common in people with immune systems that are weakened from HIV infection, chemotherapy or radiation treatment, transplant operations, or stress. A stress on the body may allow the virus to become active and produce an “outbreak,” causing a painful rash or blisters.

Herpes Simplex Virus

There are 2 types of herpes simplex virus. HSV-1 most commonly infects the lips and produces what is often referred to as “cold sores”or “fever blisters,” but it also can cause genital herpes. HSV-2 is the usual cause of genital herpes, but it also can infect the mouth. HSV remains in the infected nerve cell of the body for life and can produce symptoms off and on.

What Medications Are Used toTreat and Prevent Herpes?

How Does Herpes Simplex Spread

Herpes spreads through close contact with a person who has the infection. The virus can be found in skin and saliva. If you have herpes simplex, you are most likely to pass the virus to another person when you have sores. But you can infect someone else even if you have no symptoms. Healthcare providers call this asymptomatic viral shedding.

People may get HSV-1 through

• Touching a persons skin near the mouth.
• Sharing food utensils, lip balm or razors.
• If you receive oral sex from someone who has a cold sore, it may spread a herpes infection to your genitals.

People may get HSV-2 through

• Oral sex with someone whos infected.
• Touching open sores, including while breastfeeding.
• Childbirth by a mother or gestational parent who has an active infection.

You cant get genital herpes from objects like toilet seats. But you could pass genital herpes through shared sex toys.

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Herbal Remedies May Also Offer Relief

Research supports the use of certain botanical remedies. You may want to try one or more of these:

Long dan xie gan tan This Chinese herbal formula has been used to quell symptoms and reduce herpes outbreaks. Its English name is clear liver fire pills. In at least one study, the formulawas shown to inhibit the activity of HSV-1 and HSV-2.

Chinese herbal medicine is always individualized, and there are other formulas that help too, so it is helpful to consult a licensed acupuncturist or herbalist before starting this formula, says Mindich.

Mushrooms Mushrooms boost the immune system, Mindich says, and thus can help prevent recurrent herpes outbreaks. She recommends mushroom products from the Immune & Protection collection of Host Defense and from Myko San. Eating shiitake mushrooms daily has also been found to have a positive effect on the immune system in a study published in April 2015 in the Journal of the American College of Nutrition.

Lemon balm This herb, which is related to mint, has traditionally been used to improve brain function and also has antiviral properties. Records concerning the medicinal use of lemon balm date back more than 2,000 years.

Lemon balm can be prepared and drunk as a tea. It can also be applied to the skin to both prevent herpes to prevent outbreaks and reduce symptoms. Research has shown that lemon balm oil directly counteracts herpes viruses.

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Symptoms Of Oral Herpes

Oral herpes is most often caused by HSV-1, but can also be caused by HSV-2. It usually affects the lips and, in some primary attacks, the mucous membranes in the mouth. A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon.

Primary Oral Herpes Infection

If the primary oral infection causes symptoms, they can be very painful, particularly in children. Symptoms include:

• Tingling, burning, or itching around the mouth are the first signs.
• Red, fluid-filled blisters that may form on the lips, gums, mouth, and throat.
• Blisters that break open and leak. As they heal, they turn yellow and crusty, eventually turning into pink skin. The sores last 10 to 14 days and can be very uncomfortable.
• Blisters that may be preceded or accompanied by sore throat, fever, swollen glands, and painful swallowing.

Recurrent Oral Herpes Infection

A recurrent oral herpes infection is much milder than the primary outbreak. It usually manifests as a single sore, commonly called a cold sore or fever blister . The sore usually shows up on the outer edge of the lips and rarely affects the gums or throat.

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How Do I Take Suppressive Therapy

There are two oral antivirals available for suppressive treatment in New Zealand:

• Aciclovir tablets 400mg taken twice daily, morning and night. If you start suppressive therapy, it is important not to miss any doses and to take it regularly at approximately 12 hourly intervals. If your recurrences are not suppressed by this dose, you should discuss this with your doctor as taking 200mg four times a day may be more effective. Aciclovir is also available in a soluble form if you are unable to swallow tablets.
• Valtrex tablets 500mg taken once a day. People who find aciclovir isnt working in treating problematic recurrent herpes can now access Valtrex by fully subsidised prescription from their doctor through a Special Authority application. This is a new generation antiviral with better absorption.

The Virus And Pathogenesis

HSV is a double-stranded DNA virus that may enter the host through abraded skin or intact mucous membranes.1 Epithelial cells are the initial targets. Once infected, these cells die, releasing clear fluid intradermally to form vesicles and merging with other cells to create multinucleated giant cells.

Retrograde transport through adjacent neural tissue to sensory ganglia leads to lifelong latent infection.1 Reactivation of the virus is triggered by local or systemic stimuli such as immunodeficiency, trauma, fever, menstruation, ultraviolet light and sexual intercourse.13 Although emotional stress is assumed to trigger HSV recurrence, recent research fails to show a definite causative role.4 Once reactivated, the virus is transported by the neuron back to the epithelium, where more replication occurs, and another outbreak ensues.

HSV exists as two separate types, labeled 1 and 2, which have affinities for different body sites.2 Ninety percent of infections caused by HSV-2 are genital, and 90 percent of those caused by HSV-1 are oral the reason for this division is unknown.5 In addition, oral HSV-1 infection recurs more frequently than oral HSV-2, and genital HSV-2 recurs more often than genital HSV-1.

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What Happens If I Dont Receive Treatment

Genital herpes can cause painful genital sores and can be severe in people with suppressed immune systems.

If you touch your sores or fluids from the sores, you may transfer herpes to another body part like your eyes. Do not touch the sores or fluids to avoid spreading herpes to another part of your body. If you do touch the sores or fluids, quickly wash your hands thoroughly to help avoid spreading the infection.

If you are pregnant, there can be problems for you and your unborn fetus, or newborn baby. See Im pregnant. How could genital herpes affect my baby? for information about this.

Coping With The Herpes Diagnosis

Anger, violation, and shame are typically the first on-set of feelings that are felt after being told youre going to have to deal with herpes for the rest of your life. You may also feel like youre the only one your friends and family will know that have it.

Wait, do you even want them to know? Who gave it to you? How do you even approach living your life with herpes now? These are some of the initial thoughts thatll probably race through your mind in the same doctors office where you just found out a few seconds ago.

Although diagnoses are overwhelming and can be traumatic by nature, theres also a positive in it. You can take power and control of your life by knowing whats going on with your body. In fact of the 20 percent of people who have HSV-2, only 10 to 15 percent of them know that they have it. Thats because at least 10 percent of herpes sufferers have mild to no symptoms at all. Herpes can produce quite mild symptoms to where you can mistakenly attribute it to various other problems without even thinking it could be a sexually transmitted disease. This then encourages the unintentional cycle of passing herpes on. With having an official diagnosis, you can

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