When And How Are Later Outbreaks Treated
Later outbreaks with only mild symptoms dont necessarily need to be treated. The blisters can then simply heal on their own.
But antiviral medication can also shorten the duration of later outbreaks by an average of about two days. If you decide to have treatment, its important to start it within the first 24 hours of the outbreak ideally, as soon as you notice the first symptoms. So its a good idea to always have a few tablets at home or to take them with you when you travel so they are ready to use. You can get a prescription from your doctor.
In later outbreaks you can take them for a shorter time. The WHO recommends the following:
- aciclovir: 400 mg three times per day or 800 mg two times per day for five days, or 800 mg three times per day for two days,
- famciclovir: 250 mg two times per day for five days, or
- valaciclovir: 500 mg two times per day for three days.
A different dose and treatment duration may be a good idea for people who have immune system disorders, such as an HIV infection.
What Questions Should I Ask My Doctor
You may want to ask your healthcare provider:
- What is the best treatment for me?
- What happens if I dont treat a cold sore?
- What are the side effects of antiviral medications?
- How can I reduce the risk of future outbreaks?
- Whats the best way to prevent getting another STI?
- How can I protect my partner from getting genital herpes?
- Should I lookout for signs of complications?
How Is The First Outbreak Different
The first outbreak of genital herpes is the most severe because your body hasnt previously encountered the virus and has no immune response. Youll likely have more sores, pain, itchiness, and burning during your first outbreak than during future outbreaks. The first outbreak is also the longest, with symptoms sticking around for two to four weeks.
Some people experience additional whole-body symptoms during their first outbreak, including:
- Swollen lymph nodes
After the first outbreak, the virus lays dormant in your nerve cells. When it reappears, your body can mount an immune response, fighting the virus. Because of that, subsequent outbreaks of genital herpes are less severe, and most people experience fewer outbreaks over time.
During your first outbreak, youre most likely to spread genital herpes, so its important to abstain from sex for the entire time that you have lesions.
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How Do Herpes Drugs Work
Herpes medications like valacyclovir, acyclovir and famciclovir belong to a class of medications called antiviral drugs.
Antiviral drugs are designed to inhibit the multiplication of viruses in the body. Unlike antibiotics, which eliminate the bacteria that cause infections, antiviral drugs simply control viral proliferation, rather than completely eliminating the target virus from the body.
None of the antiviral drugs on the market today can cure herpes. However, consistent use of an antiviral drug can make living with herpes much easier by speeding up healing after an outbreak and reducing your risk of transmitting the virus to other people.
Herpes drugs are taken for several reasons. People with active HSV-1 or HSV-2 infections can take them during outbreaks to control and treat their symptoms. Antiviral drugs are also used as part of suppressive therapy for herpes to reduce the severity and frequency of outbreaks.
Even people with asymptomatic herpes can benefit from using antiviral drugs to lower their risk of spreading the virus to other people through sexual or oral contact.
Drug Treatment For Genital Herpes
If you are infected with genital herpes, your doctor may prescribe oral antiviral drugs to help ease your symptoms during both a first episode and recurrent episodes. Your doctor may also suggest taking antiviral drugs daily as a suppressive therapy to reduce symptoms and protect partners.
Remember, though, that antiviral drugs do not wipe out the virus completely. It continues to live in your body, so if you stop taking the drugs that suppress it, you may have more frequent or more intense symptom outbreaks, and the risk of your transmitting the virus to others rises.
Three antiviral drugs, all taken by mouth, are used to treat genital herpes:
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How Is Herpes Diagnosed
The herpes virus is almost always spread through sexual intercourse, oral sex, or kissing. Although sometimes HSV-1 can spread via shared lip balm, utensils, or other items that come in contact with saliva.
In most cases, healthcare providers can diagnose herpes with a visual examination and by discussing various symptoms. If theres any doubt, they can take a viral culture to confirm, which involves lab analysis of a swab or scraping.
If the patient has no history of herpes simplex and is a new patient, I always do a viral culture, says , MD, a board-certified dermatologist and founder of 5th Avenue Aesthetics. Also, if I am suspicious of HSV-2 or if it is an immunocompromised patient, I will order a viral culture. I start treatment right away before results come back. These results can take one week and it is best to start treatment early.
But again, symptoms arent always present. Fortunately, its also possible to diagnose HSV with a blood test. Your body produces antibodies to combat viruses, and doctors can use a blood sample to detect the specific antibodies that fight the herpes simplex virus.
A primary care physician can perform the examinations and tests necessary for an accurate diagnosis. However, sexual health clinics offer similar, reliable services.
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How Do Other Antivirals Work
Antivirals are medications used in the treatment and prevention of various types of viral infections. Other antivirals are medications that are not categorized into any specific classes of antivirals. Most of the other antivirals block viral replication by interfering with DNA polymerase, an enzymevital for DNA synthesis and viral replication.
Some of the other antivirals are active drugs that directly take effect, while some are prodrugs, which release the active form of the drug after being metabolized. Other antivirals include the following:
- Acyclovir: Acyclovir is an active drug effective against herpes simplex virus 1 and 2 that cause genital and oral herpes, and varicella-zoster virus which causes chickenpox and shingles. Acyclovir gets incorporated into the viral DNA, inhibits DNA polymerase, and terminates the DNA chain to prevent viral replication.
- Brincidofovir: Brincidofovir is a prodrug approved for treating human smallpox, a disease caused by the variola virus. Although smallpox has been eradicated with vaccination, concerns that the variola virus can be used as a bioweapon remain.
- Brincidofovir penetrates cells and releases cidofovir which is metabolized to produce cidofovir diphosphate, the active drug that selectively inhibits orthopoxvirus DNA polymerase-mediated viral DNA synthesis and reduces the rate of viral DNA synthesis.
- Herpes zoster infection , which is caused by reactivation of VZV
- Herpetic keratitis – Orphan
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Stages Of Herpes Outbreaks
Like any other infection, every case is different. The duration of a herpes outbreak will depend on factors such as:
- Your individual immune system
- How many outbreaks youâve had in the past
- Treatment history
Keep in mind that no matter your history or treatment, thereâs help.
The stages of a herpes outbreak can last between two and 14 days and can be broken down into stages:
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What Helps With Discharge
Discharge can result from blisters and irritation in your genital area, so treating discharge can require different approaches.
To manage discharge from herpes blisters:
- Avoid scratching or rubbing the blisters
- Keep the area clean and dry
- Clean your hands before and after touching affected areas
- Avoid sexual or skin-to-skin contact in areas with open blisters
For vaginal discharge:
- Don’t use douches or genital cleansing protects that contain perfumes or other irritants
- Avoid latex condoms or products with lubricants and spermicides
Your healthcare provider may also be able to prescribe you an antiviral medication to manage and decrease the duration of your outbreak.
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Are Antiviral Medications Safe
Antiviral medications are considered to be very safe. They are nearly always well tolerated because the active ingredients only have an effect in cells that have been infected by the virus.
People who have kidney failure may need to take a lower dose because the medication is removed from the body through the kidneys.
Is There An Over
Yes, but OTC medications are generally less effective in treating herpes than prescription ones. Abreva is an over-the-counter topical drug that many people use to treat cold sores from HSV-1, but not HSV-2. NSAIDs like ibuprofen and Tylenol are OTC drugs that reduce pain and discomfort, but they do not treat herpes directly.
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Side Effects And Follow
Side effects with these herpes drugs are considered mild, and health experts believe these drugs are safe in the long term. Acyclovir is the oldest of the three, and its safety has been documented in people taking suppressive therapy for several years.
People taking suppressive therapy should see their doctor at least once a year to decide if they should continue. You may find taking the pills every day to be inconvenient, the drugs may not work for you, or you may naturally have fewer outbreaks as time goes on. Your doctor can help you make treatment choices to suit your needs.
Avoid The Following While You Are Using Acyclovir Buccal Delayed
- Do not chew gum, touch, or press the buccal tablet after it has been applied.
- Do not wear upper dentures.
- Do not brush your teeth until it dissolves. If your teeth need to be cleaned while the tablet is in place, rinse the mouth gently.
Shake the suspension well before each use to mix the medication evenly.
Your symptoms should improve during your treatment with acyclovir. Call your doctor if your symptoms do not improve or if they get worse.
Take or use acyclovir until you finish the prescription, even if you feel better. If you stop taking acyclovir too soon or skip doses, your infection may not be completely treated or may become more difficult to treat. The delayed-release buccal tablet is applied as a one-time dose.
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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
There Is More Than One Type Of Herpes Infection
There are two types of herpes simplex infection: herpes simplex virus type 1 and herpes simplex virus type 2 . Cold sores around the mouth are generally caused by HSV-1. Most cases of genital herpes are caused by HSV-2. Cold sores on the mouth can cause genital infection during oral sex for people who do not already carry the cold sore virus. There are many other viruses that are also in the herpes virus family, however the infection and symptoms are different. One example is varicella zoster virus which causes chickenpox and shingles.
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When Treatments For Genital Herpes Are Given
- Initial treatment. If you have symptoms such as sores when you’re first diagnosed with genital herpes, your doctor will usually give you a brief course of antiviral therapy to relieve them or prevent them from getting worse. Your doctor may keep you on the drugs longer if the sores don’t heal in that time.
After the first treatment, work with your doctor to come up with the best way to take antiviral therapies. There are two options:
- Intermittent treatment. Your doctor may prescribe an antiviral drug for you to keep on hand in case you have another flare-up this is called intermittent therapy. You can take the pills for two to five days as soon as you notice sores or when you feel an outbreak coming on. Sores will heal and disappear on their own, but taking the drugs can make the symptoms less severe and make them go away faster.
- Suppressive treatment. If you have outbreaks often, you may want to consider taking an antiviral drug every day. Doctors call this suppressive therapy. For someone who has more than six outbreaks a year, suppressive therapy can reduce the number of outbreaks by 70% to 80%. Many people who take the antiviral drugs daily have no outbreaks at all.
There is no set number of outbreaks per year that doctors use to decide when someone should start suppressive therapy. Rather, more important factors are how often the outbreaks happen and if they are severe enough to interfere with your life.
Continued
Talk With Your Doctor About Herpes Medications
Its important to first talk with your doctor before using over-the-counter products like docosanol or other home remedies.
If this is the first time you have symptoms of HSV with blisters or sores, your doctor will first diagnose if you have HSV, the type and discuss options to manage your condition. They will tell you about prescription and nonprescription alternatives to treat your HSV infection.
Tell your doctor if you have any serious health conditions including if you have a weakened immune system.
Your doctor will also tell you what you can expect with an HSV infection, how long it may last, and what do to prevent spreading HSV to others while you have an active infection.
Here are answers to a few commonly asked questions about herpes simplex virus.
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Is There A Cure Or Treatment For Herpes
Theres no cure for the herpes virus yet. A herpes vaccine doesnt currently exist, as the herpes virus has more complicated DNA than most infections, creating challenges for researchers.
However, medication can help with symptoms, like sores, and outbreaks. Medication also lowers the risk of transmission to others. You can take most medications for herpes orally, though you may also apply some as a cream or receive them by injection.
Complementary And Alternative Medicine
Some people use natural therapies to treat herpes, either on their own or to support standard medical care. The research supporting their use is generally weak, with little evidence that they can reduce either the severity or duration of an outbreak. Even so, many people swear by their effectiveness and consider them a vital part of managing herpes outbreaks.
Complementary and alternative therapies sometimes used to treat herpes include:
- Propolis: This is a sticky substance produced by bees that may help speed the healing of genital herpes. A 2017 study found that people who used propolis ointment experienced better healing by the 10th day of treatment compared to those who used a sham ointment.
- Algae extract: Lab studies suggest that algae extract can inhibit the growth of HSV-2 in test tubes. Whether it can do so in humans has yet to be proven.
- Acupuncture: A 2011 study concluded that acupuncture was mildly effective in reducing pain caused by the herpes zoster virus , the type of herpes virus that causes shingles. While this suggests that acupuncture may be useful in easing genital herpes pain, this has yet to be proven.
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How Can I Best Learn To Cope With Herpes Simplex
Some people feel distressed or embarrassed about their herpes simplex infection. Its important to understand that the herpes virus is common. For most people, herpes doesnt significantly interfere with daily life.
To cope with negative feelings, you may consider:
- Connecting with others through support groups or online forums.
- Sharing your feelings with a trusted friend or loved one.
- Speaking with a therapist.
Protecting Your Partner And Preventing Herpes Transmission
Research shows that the single greatest fear is the fear of transmission to partners, says Dr. Handsfield.
The main ways to avoid transmitting herpes are:
- Learn to recognize how you feel when an outbreak is on the way, and stop having sex immediately.
- Dont have sex during active outbreaks.
- Always use condoms but dont rely on them during outbreaks. They dont completely cover infectious areas.
- Only after all sores have scabbed over and healed should you have sex again.
- Avoid touching your herpes sores, because you can spread them to other places on your body that way. Whenever you touch a sore, wash your hands immediately.
- Dont kiss people or have sex if you have a cold sore.
- Tell potential partners about having herpes before having sex with them, even though it may be hard.
- Ask your doctor about taking antiviral drugs regularly.
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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 peoples 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 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 , 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 .