Treatment

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Although herpes cannot be cured, there are several drugs that can reduce the intensity of symptoms, as well as the number of recurrences. Acyclovir (Zovirax), valacyclovir (Valtrex) and famciclovir (Famvir) are all prescription antiviral drugs that are effective in treating genital herpes. Dosage, frequency and duration of treatment vary depending upon the individual and the type of treatment. They are taken by mouth. Topical creams are ineffective. Intravenous treatment may be used in the hospital specifically for individuals who have a suppressed immune system, that is, those who have HIV/AIDS. Since all three drugs are good, effective antivirals, decisions about which to use usually take into account convenience and cost. Valtrex has been approved by the U.S. Food and Drug Administration for prevention of genital herpes transmission. However, while Valtrex significantly decreases the risk of sexual transmission of herpes, transmission can still occur.

Treatment can be taken in different ways. "Episodic therapy" is taken at the first appearance of symptoms. This therapy involves taking daily dosages of a drug until symptoms subside, usually for a course of one to five days. The antiviral drugs are safe, have few side effects, shorten the length of first episodes and reduce the severity of recurring outbreaks, especially if taken within 24 hours of the onset of prodromal symptoms. For those who have frequent recurrences, "suppressive therapy" can keep the virus in check indefinitely. This treatment involves daily medication, even when you have no symptoms. It can reduce the number of recurrences significantly. Suppressive therapy also reduces the chances that an infected person will transmit the virus to a sexual partner primarily because it reduces asymptomatic shedding of the virus.

As for other treatments, there is some evidence that zinc and vitamins C and A can enhance the immune system's response to herpes. Aloe vera extract and other topical ointments may speed healing time of lesions. However, there is no scientific proof that these natural therapies work, and experts caution that topical treatment of sores appears to have no added benefit when used in conjunction with antiviral drugs.

Treating women who develop genital herpes during pregnancy is critical to protecting newborns from acquiring the virus. Nearly half of the babies infected with herpes either die or suffer neurologic damage. Babies born with herpes can also develop encephalitis (inflammation of the brain), severe rashes and eye problems. Fortunately, only five percent of women with HSV pass the infection onto their babies.

The risk of transmission to an infant varies greatly depending on when a woman is infected. A pregnant woman who develops a first episode of genital herpes during her pregnancy is at highest risk of passing the virus to her fetus and may be at higher risk for premature delivery. If a mother has her first outbreak near or at the time of a vaginal birth, the baby's risk of infection is high. If the outbreak is a recurrence—meaning the mother was infected before she was pregnant—the baby's risk is much lower. Overall, studies show that less than two percent of pregnant women with HSV acquired the virus during pregnancy.

Before much was known about how HSV is transmitted from mother to baby during birth, many pregnant women with the virus were given cesarean sections, regardless of when they became infected. Today, cesarean sections are limited to women who have detected sores in or near the birth canal at the time of labor. Women whose virus is active late in pregnancy may be put on suppressive therapy to help prevent transmission to the infant. If an infant is infected, the antiviral medication acyclovir can greatly improve the outcome, particularly if treatment starts immediately. With early detection and treatment, most of the serious complications of neonatal herpes can be lessened. The drug acyclovir appears to be safe in pregnancy, including the first trimester, even when the drug is used for a prolonged period of time. At this time, there isn't as much information on the safety of valacyclovir and famciclovir, but both are classified as class B agents by the FDA (no evidence of risk in humans), similar to the risk of acyclovir.

Comprehensive treatment should include education and counseling. Referrals to support groups as well as online resources may help people with genital herpes adjust to this recurring condition.