Genital herpes treatment: what antivirals do and do not do

Genital herpes cannot currently be cured. No medicine removes the virus from your nerve roots. What does exist: antivirals that can make an outbreak shorter and milder, and that with daily use can bring the number of outbreaks down considerably.

I start with the bad news on purpose, because it makes the rest land more honestly. Most people with herpes are troubled by it less as time passes, and that is not thin comfort but the ordinary course.

Below is what treatment realistically achieves. For the complete picture, read our overview of genital herpes.

Can genital herpes be cured?

No. After a first infection the virus settles into a nerve root, where no medicine can reach it. It stays there for life, usually dormant. What you read online about complete cures is not true, and that goes for herbs and supplements promising the same.

That does not leave you powerless. It means the goal shifts: not eradication, but damping.

For many people, outbreaks become less frequent and milder by themselves in the years after the first infection. The Dutch Farmacotherapeutisch Kompas describes the available medicines, and your GP weighs whether they fit your situation.

What do antivirals actually do?

They slow the virus from multiplying. That can make an outbreak shorter and less severe, especially if you start early. With daily use they can also lower the number of outbreaks and reduce how much virus sits on your skin.

The table separates what is achievable from what is not.

That last line matters in a relationship. A lower risk is not the same as no risk.

How much do medicines lower the risk of transmission?

Measurably, but not completely. In a study of couples where one partner had HSV-2, 1.9 percent of partners caught the virus when the carrier took daily valacyclovir, against 3.6 percent in the placebo group (Corey et al., 2004). That is close to a halving.

In that same study the share of days on which the virus was detectable fell from 10.8 percent to 2.9 percent. So the virus does not disappear. It goes quieter.

Picture 4 outbreaks a year while your partner has no herpes. That is exactly the conversation to have with your GP, because the trade-off depends on your situation and not on an average.

When would a doctor suggest daily treatment?

Usually when outbreaks return often, when they cause a lot of discomfort, or when a partner has no herpes and you want to lower the risk. It is a trade-off between burden, preference and side effects. Your GP makes that trade-off together with you.

What we do not do here is prescribe a dose or a medicine. That belongs with your doctor, and that is not a formality.

We can say that the number of outbreaks with HSV-2 is on average higher than with genital HSV-1. So which type you carry matters. We work that out in cold sore or genital herpes.

What can you do yourself during an outbreak?

Keep the area clean and dry, wear loose underwear, and hold off on sex while blisters or sores are there. Many people feel an outbreak coming as tingling or burning. That is the moment to avoid contact, because the virus is at its most active then.

In people with HSV-2 and symptoms the virus was found on 20.1 percent of days, against 10.2 percent in people without symptoms (Tronstein et al., 2011). Caution around an outbreak is therefore the most useful.

Does it hurt when you urinate? Report that to your GP. Thuisarts.nl describes what to expect in those days, and RIVM holds the same line.

What is your next step?

Not yet sure whether it is herpes? Get a PCR swab while the blister is fresh, because that is the test that detects the virus (LeGoff et al., 2014). Treating without knowing what you are treating is the wrong way round.

Want to know which type you carry without symptoms, for instance ahead of a conversation with your partner? Then you can add HSV-1 IgG and HSV-2 IgG separately to your own test with us. How transmission works and what condoms do is in how you get herpes. Which test answers which question is in herpes test.

Sources

1. Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med. 2004;350(1):11-20. PMID 14702423.
2. Tronstein E, Johnston C, Huang ML, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA. 2011;305(14):1441-1449. PMID 21486977.
3. LeGoff J, Pere H, Belec L. Diagnosis of genital herpes simplex virus infection in the clinical laboratory. Virol J. 2014;11:83. PMID 24885431.
4. Farmacotherapeutisch Kompas. Herpes genitalis. Available via farmacotherapeutischkompas.nl.
5. RIVM. STI guidelines and sexual health surveillance. Available via rivm.nl.
6. Thuisarts.nl (NHG). I have genital herpes. Available via thuisarts.nl.

This information is general and does not replace personal medical advice. Every STI test result at Discreet Test is reviewed by a BIG-registered doctor. Always discuss symptoms or treatment decisions with your GP, the GGD or a Centre for Sexual Health.