Herpes is an incredibly common yet misunderstood virus. In the United States, around one in two people have oral herpes, and more than one in six people ages 15-49 have genital herpes. There are two types of the herpes simplex virus, called HSV-1 and HSV-2. HSV-1 more commonly causes oral herpes and HSV-2 more commonly causes genital herpes, but either HSV-1 or HSV-2 can cause either oral or genital herpes. While there is no cure for herpes, there are several different options when it comes to managing the virus.
“I always encourage a holistic approach — healthy diet, healthy exercise, decreasing stress levels, hydration,” Sheila Loanzon, D.O., author of Yes, I Have Herpes: A Gynecologist’s Perspective In and Out of the Stirrups. While some people treat herpes with natural remedies such as lysine tablets, tea tree oil, or coconut oil, these treatments haven’t been medically studied over the long-term. Dr. Loanzon says, “Being a physician, I am a bigger fan of using antiviral medications such as acyclovir, because I find they decrease the viral shedding, the length of the outbreak, the pain that comes with the outbreak, and they have a tendency to speed up the healing.”
For genital herpes
There are three types of antiviral medications typically used to treat genital herpes: acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). People can take antivirals either as episodic treatment, meaning that they’re taken at the first sign of an outbreak to shorten the length, or as suppressive therapy, meaning they’re taken daily to prevent outbreaks and decrease the risk of transmission.
“It really depends on what patients feel the most comfortable with and how many outbreaks someone has in a year,” Dr. Loanzon explains. If someone has more than five or six outbreaks a year, it’s generally recommended that they take antivirals daily as a suppressive treatment. On the other hand, people may prefer episodic treatment if they have outbreaks rarely, or if they’re not sexually active. Treatment costs are also a factor. Ultimately, it’s a personal decision that you should maket after discussing your options with your healthcare provider.
“Everybody's a little different,” Dr. Loanzon says. “Even if someone has never had an outbreak since their initial one, they may want to take an antiviral daily — because outbreaks may cause significant emotional stress, or they’re sexually active and they want to reduce transmission.”
Along with antivirals, it’s a good idea for people to identify when they’re likely to have an outbreak. For example, many people are more prone to outbreaks when they're stressed, so learning stress-management techniques can be helpful. If you're sexually active, Dr. Loanzon says, “I would encourage safe sex, using condoms, and having conversations with their future partners about what the risks might be.”
During an outbreak, people can relieve pain by taking a bath (particularly a sitz bath — a shallow bath covering the genital area in warm water) or taking an over-the-counter pain reliever such as ibuprofen or acetaminophen.
For oral herpes
Oral herpes is often treated similarly to genital herpes: with antiviral pills, either taken at first sign of an outbreak as episodic treatment, or as a daily suppressive therapy. Avoiding triggers is a good idea, too. While oral herpes and genital herpes share some common potential triggers — such as stress — oral herpes outbreaks may also be triggered by prolonged exposure to sunlight.
Unlike genital herpes, oral herpes can be treated with a topical antiviral cream. Either acyclovir ointment (Zovirax) and penciclovir cream (Denavir) may be prescribed. You can discuss your treatment options with your heath care provider to decide on the best option for you.
After a herpes diagnosis
Dr. Loanzon says that many people experience worse outbreaks during their first year after a herpes diagnosis than during subsequent years. “There might be more frequent outbreaks, they may be more painful, and they may linger a little longer than future outbreaks,” she explains.
Additionally, receiving a herpes diagnosis can be emotionally distressing. “It’s important to go through a grieving process, to ask questions,” Dr. Loanzon says. “Go to a respectful professional resource, and don’t necessarily believe everything you read on the internet. You may need several visits to your healthcare provider to get all of your questions answered.”
Ultimately, herpes is a common virus that doesn’t deserve the stigma it gets. “It’s a very survivable diagnosis. People can have beautiful, loving relationships with one partner or with multiple partners, and it’s not limiting,” Dr. Loanzon says. “It can be very scary in the beginning, but they’re not alone. There are plenty of people thriving with the virus without any issues.”