Herpes simplex virus

There is no cure for herpes, so the goals of treatment are to reduce the number of outbreaks and to lessen symptoms when you do have an outbreak.

Cold sores usually go away by themselves within 2 to 3 weeks, however, they can last for up to 6 weeks. Using medications may shorten the outbreak and decrease discomfort.

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Antiviral medications for genital herpes can reduce outbreaks and help speed recovery when an outbreak does happen. They can also reduce the chances of spreading the virus.

Coping with the emotional and social aspects of having genital herpes is part of treatment. Relaxation techniques and support groups can help.

Lifestyle

For cold sores, applying either heat or cold to blisters may help relieve pain. Try ice or warm compresses.

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For genital herpes, wear cotton underwear and avoid tight fitting clothes as they can restrict air circulation and slow the healing of lesions.

Be sure to tell your partner or potential partner that you have herpes.

Medications

Antiviral medications may help shorten the length of a herpes outbreak and cut down on recurring outbreaks. These treatments can reduce outbreaks by up to 80%. For genital herpes, there are two types of therapy:

• Episodic
• Suppressive

With episodic therapy, you take medication at the first sign of an outbreak and for several days to shorten the length or prevent a full outbreak. With suppressive therapy, you may take medication daily to keep outbreaks from happening. Antiviral medications include:

• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

Topical medications (for oral herpes), include the antiviral cream Penciclovir (Denavir) and an over-the-counter cream, docosanol (Abreva).

Nutrition and Dietary Supplements

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Because supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider.

• Lysine. Several studies suggest that lysine may help reduce the number of recurring outbreaks of cold sores. A few studies also suggest that lysine may help shorten the length of an outbreak. Taking lysine supplements or getting more lysine in your diet (from foods like fish, chicken, eggs, and potatoes) may speed recovery and reduce the chance of recurrent breakouts of the herpes infection. If you have high cholesterol, heart disease, or high triglycerides (fats in the blood), ask your doctor before taking lysine because animal studies suggest that it may raise cholesterol and triglyceride levels. Lysine can increase the amount of calcium your body absorbs, so avoid high doses of calcium while taking lysine. Usually high doses of lysine are taken only for a short time.
• Propolis. A resin made by bees, propolis is loaded with antioxidants that help fight infection and boost immune function. Test tube studies show it can stop HSV-1 and HSV-2 from reproducing. One small study of people with genital herpes compared an ointment made from propolis to Zovirax ointment. People using propolis saw the lesions heal faster than those using topical Zovirax. In another study, a 3% propolis ointment helped reduce the duration and pain or cold sores in some people. More studies are needed to say for sure whether propolis works. People with asthma and those allergic to bee products should not use propolis.
• Zinc. In test tubes, zinc is effective against HSV-1 and HSV-2. In one small study, people who applied zinc oxide cream to cold sores saw them heal faster than those who applied a placebo cream. In another study, people who used a proprietary topical formulation with zinc oxide, l-lysine, and 14 other ingredients saw a decrease in symptoms and duration of lesions. High doses of zinc can be dangerous. Zinc may interact with some antibiotics and with cisplatin, a chemotherapy drug.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.

• Lemon balm (Melissa officinalis). Several studies suggest that topical ointments containing lemon balm may help heal cold sores. In one study, for example, people who applied lemon balm cream to their lip sores saw a reduction in redness and swelling after 2 days.
• Aloe (Aloe vera). Preliminary evidence suggests that aloe gel used topically may improve the symptoms of genital herpes in men. In 2 studies, men who used the aloe vera cream (0.5% aloe) saw lesions heal faster than those who used a placebo cream. It is not known whether aloe vera would also help heal cold sores.
• Rhubarb cream (Rheum palmatum). In one Swiss study, a topical cream made from sage (Salvia officinalis) and rhubarb was as effective as Zovirax in healing cold sores. Sage by itself was not beneficial. More research is needed.
• Eleutherococcus or Siberian ginseng (Eleutherococcus senticosus/Acanthopanax senticosus.). Although not all studies agree, one 6-month study of 93 people with genital herpes found that Siberian ginseng reduced the frequency, severity, and duration of outbreaks. People with high blood pressure, certain heart conditions; diabetes; obstructive sleep apnea; hormone-related cancers such as breast cancer, ovarian cancer, or uterine cancer; narcolepsy (frequent day time sleeping); mania; or who are pregnant or breastfeeding should not take Siberian ginseng. Siberian ginseng interacts with a number of medications, including digoxin (Lanoxin), lithium, diazepam (Valium), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), imipramine (Tofranil), olanzapine (Zyprexa), propranolol (Inderal), theophylline (Slo-bid, Theo-Dur, others), lithium, and others. Siberian ginseng can increase the risk of bleeding, especially if you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
• Peppermint oil (Mentha x piperita). In test tubes, peppermint oil has stopped a number of viruses from reproducing, including herpes. However, it is not known whether peppermint oil, applied topically, would have any effect on the herpes virus in humans.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the remedies described below for the treatment of herpes based on their knowledge and experience. One study of 53 people with genital herpes found that those who were treated with homeopathy experienced improvement in their symptoms and were less likely to have recurrent outbreaks. Participants in this study were followed for up to 4 years.

Before prescribing a remedy, homeopaths take into account a person’s constitutional type. A constitutional type is defined as a person’s physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual.

For cold sores:

• Natrum muriaticum. For eruptions at the corners of the mouth that occur during periods of emotional stress and tend to worsen in the daytime.
• Rhus toxicodendron. For eruptions consisting of many small blisters that itch intensely at night.
• Mercurius. For children who drool and may have a fever.
• Sepia. For outbreaks that do not improve with other homeopathic remedies. This remedy is most appropriate for individuals who tend to have a lack of energy and do not tolerate cold weather.

For genital lesions:

• Graphites. For large, itchy lesions in individuals who are overweight.
• Natrum muriaticum. For eruptions that occur during periods of emotional stress and symptoms that tend to worsen in the daytime.
• Petroleum. For lesions that spread to anus and thighs. Symptoms tend to worsen in winter and improve in summer.
• Sepia. For outbreaks that do not improve with other homeopathic remedies. This remedy is most appropriate for individuals who tend to have a lack of energy and do not tolerate cold weather.

Mind-Body Medicine

• Support groups. Having genital herpes can impact your social and emotional life. In fact, if you have herpes, it is common to feel depressed, angry, and even guilty. Worrying about possible rejection by someone with whom you want to be intimate is also common. Joining a support group where members share experiences and problems can help relieve the stresses associated with having genital herpes. If you are in a committed relationship, seeing a couples’ therapist with your partner may also help.
• Relaxation techniques. Using relaxation techniques, such as yoga, guided imagery, and meditation may help you feel better overall and cope with stresses related to having herpes.
• Self hypnosis. Self hypnosis using guided imagery may also help relieve stress. In one 6-week training program, people with frequently recurring genital herpes were able to reduce outbreaks by nearly 50% and improve their mood, including reduced feelings of depression and anxiety.
• Other. Individual therapy with a psychiatrist, psychologist, or social worker; and techniques such as biofeedback can help reduce emotional symptoms associated with herpes.

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