Treatment Overview

The goal of treatment for genital herpes is to provide relief from the discomfort of herpes sores and to reduce the time it takes for an outbreak to heal.

Treatment works best if it is started as soon as possible after an outbreak begins. This is especially true for outbreaks that come back again and again (recurrent outbreaks).

Initial treatment

Most people find some relief and recover more quickly from the first (primary) outbreak of genital herpes by taking antiviral medicines.

• Use medicines to relieve symptoms and speed healing of blisters and sores.
  • Antiviral medicines, such as acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex) are recommended for treating primary genital herpes outbreaks.
  • Nonprescription medicines, such as ibuprofen (Advil) or acetaminophen (Tylenol), may reduce the pain and fever from genital herpes.
• Use home treatment, such as taking warm sitz baths and wearing cotton underwear, to promote healing of herpes sores. For more information, see the Home Treatment section of this topic.
• Take steps to prevent the spread of genital herpes. These include avoiding any sexual contact if you or your partner have symptoms or are being treated for genital herpes. For more information, see the Prevention section of this topic.

Antiviral medicine may reduce the time it takes a first outbreak to heal. The medicine also decreases the number of days you can spread the virus (are contagious).

Taking antiviral medicine for the primary genital herpes outbreak does not prevent genital herpes outbreaks from recurring.

Ongoing treatment

The decision to take antiviral medicines for recurrent outbreaks of genital herpes depends on how long the outbreaks last, how severe they are, and how often they return. People who do not have frequent or severe outbreaks may not want to take medicine on a regular basis.

Antiviral medicines reduce the time it takes for genital herpes sores to heal and helps prevent some outbreaks. Antiviral medicines have the added benefit of reducing the possibility that people can transmit HSV to their sex partner(s).

People can take antiviral medicine for recurrent outbreaks of genital herpes in one of these ways:

• Every day. Some people take antiviral medicine every day to help reduce the risk of recurrent outbreaks and reduce how long a recurrent outbreak lasts. Antiviral medicine may reduce the number of outbreaks by about one or two episodes a year.
• As needed. Some people take antiviral medicine when they first notice the prodromal symptoms (tingling and pain) of a recurrent outbreak. To be effective, a medicine taken only for 2 or 3 days must be used at higher doses than when the medicine is taken every day.

A study has shown that an HSV-infected person in a heterosexual, single-partner (monogamous) relationship who takes valacyclovir daily to prevent recurrent outbreaks reduces by about half the risk of infecting his or her partner.² Other antiviral medicines may also reduce transmission, but further study is needed.

Home treatment, such as taking warm sitz baths and wearing cotton underwear, can promote healing of herpes sores. For more information, see the Home Treatment section of this topic.

You can reduce the risk of transmitting HSV to your sex partner(s) by taking steps to prevent the spread of genital herpes. These include avoiding any sexual contact if you or your partner have symptoms or are being treated for genital herpes. Using condoms during outbreaks also reduces the risk of giving HSV to your partner. For more information, see the Prevention section of this topic.

Treatment during pregnancy

The Centers for Disease Control and Prevention (CDC) has published guidelines about the use of antiviral medicines for genital herpes during pregnancy.¹

• Oral acyclovir (Zovirax) may be given to pregnant women for a primary HSV infection or for severe recurrent outbreaks.
• Oral acyclovir may be given to pregnant women at any time during the pregnancy, including the first trimester.
• Acyclovir may be given intravenously (IV) to pregnant women with severe HSV infection.
• Acyclovir (Zovirax) is used in the last 4 weeks of pregnancy to reduce the risk of a recurrent outbreak at the time of delivery. This lower risk, in turn, makes it less likely that delivery by cesarean section will be needed.

If a genital herpes blister or sore is present at the time of labor and delivery, a cesarean section is usually done. A cesarean section may be recommended if a woman has tingling or pain (prodromal symptoms), suggesting an impending outbreak.