Currently there is no cure for genital herpes. The good news is that some drugs have been effective in reducing the duration and frequency of herpes outbreaks. The decision to use one treatment over another for genital herpes depends on many factors that must be discussed with your health care provider:

1. Have you had a previous outbreak?The first episode of genital herpes is usually the worst and often has other symptoms like fever and fatigue. Recurrent outbreaks aren’t usually as painful and don’t last as long.
2. How frequent are the outbreaks?People who have frequent outbreaks should consider suppressive therapy (daily medication) to reduce the number of outbreaks of the disease.
3. What is the status of your immune system?People with genital herpes who have HIV/AIDS, organ transplantation, leukemia or are on long term immune system suppressing drugs are at risk for more severe herpes infections. Elderly people also often have a weakened immune system and should discuss treatment options with their health care provider.
4. Are you pregnant?
   Women with genital herpes are examined carefully for any symptoms before giving birth. If sores or signs that an outbreak is coming show up at the time of delivery, the baby may be delivered by cesarean section (also called a C-section).

   Women taking antiviral drugs for herpes — either daily suppressive therapy or occasional therapy for outbreaks — should consult their doctor about whether to take the drugs during pregnancy. The answer is not set in stone: You and your doctor have to discuss the risks and benefits to decide what’s right for you.

• First outbreak therapy
• Episodic therapy (taking of medication with outbreaks only)
• Suppressive therapy (taking medicine every day).

The first two uses of these drugs attempt to shorten the length and severity of a specific outbreak. Taking medication with outbreaks, either first or future ones, has not been shown to impact future recurrence rates of herpes.  It also does nothing to reduce the frequency of outbreaks nor the transmission to sex partners.  It may be the most appropriate choice for people who are not bothered by the frequency of their outbreaks, has a partner who is already infected with their same type, or a person who has herpes, is not bothered by outbreaks, and does not have a sexual partner.
The third use of these drugs, for suppression of outbreaks (i.e., to prevent outbreaks from coming), is recommended for anyone who has frequent outbreaks, who is bothered by their outbreaks, or who has an uninfected partner. Studies with these drugs have found that 80-90% of the people who take the drug for suppression have greatly reduced frequency of outbreaks or do not have outbreaks while taking the drug. The virus is still present in the body, and after the drug is stopped, the outbreaks and shedding come back to a regular level. While the risk of asymptomatic shedding is significantly reduced by these medicines, it is not stopped altogether.
acyclovir (generic)
This anti-viral medication was first FDA approved as a topical treatment for first-time outbreaks. The topical form of the medicine was shown to shorten the first outbreak very slightly, but had no effect on recurrent disease, and the topical form has no place in the treatment of recurrent genital herpes.
Oral acyclovir is indicated for use in one of three ways:
First time outbreaks: 400 mg three times a day for 7-10 days.
Recurrences: 400 mg three times a day for 5 days or 800 mg three times a day for two days.
Suppression: 400 mg twice a day, every day.
Acyclovir is also available for intravenous use in babies and adults for whom more aggressive treatment is necessary.  It is available in a liquid form for people who have difficulty swallowing pills.
Valtrex (valacyclovir)
This FDA approved medicine may be used for first outbreaks, recurrent outbreaks and suppression and is also approved to reduce transmission of genital herpes from an infected person to an uninfected one.
First time outbreaks: 1000 mg twice a day for ten days.
Recurrent outbreaks: 500 mg twice a day for three days.
Suppression: 1000 mg once a day for people who have 10 or more outbreaks per year. 500 mg once a day for people who have 9 or fewer outbreaks per year.

Famvir (famciclovir)
This antiviral medication has been FDA approved for recurrent disease and suppression. The FDA has not approved Famvir for first episode treatment, though the CDC does describe a dosing regimen for this purpose:
First time outbreaks:  250 mg three times a day for ten days.
Recurrent outbreaks: 1000 mg twice a day, 12 hours apart, for one day
Suppression: 250 mg twice a day every day.

Acyclovir, famciclovir, and valacyclovir are antiviral medicines used to treat genital herpes. All are effective, but because valacyclovir and famciclovir are absorbed better by the stomach, they can be taken less often than acyclovir. Antiviral medicines are usually taken by mouth (orally), although they are sometimes given intravenously (IV) in severe genital herpes outbreaks or herpes in newborns.

The topical form of acyclovir (Zovirax ointment) offers little benefit in the treatment of genital herpes and is not recommended.

What To Think About

Treatment with antiviral medicines may reduce the length of time a person is able to transmit the genital herpes virus to others. Abstain from sexual contact while you are being treated for symptoms of an outbreak of genital herpes.

The effectiveness of the antiviral medicines acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) is equal in studies done so far.

Acyclovir is available in a generic form, which is less expensive. Taking any antiviral medicine on a daily basis may be expensive.

Taking antiviral medicine for a primary genital herpes outbreak does not keep genital herpes outbreaks from recurring.

People taking antiviral medicine every day (suppressive therapy) may want to talk to their doctor about whether they should stop taking the medicine for a short period each year . This can help determine whether genital herpes outbreaks recur as frequently. They can then decide whether they need to continue taking medicine. People who have six or more outbreaks per year may benefit from taking antiviral medicine every day.

People who have problems with their kidneys need to take a lower dose of acyclovir (Zovirax).

In rare cases, the genital herpes virus has developed a resistance to some antiviral medicines. This is more likely to occur in people who have impaired immune systems and who have taken antiviral medicines for an extended period. Other antiviral medicines are available in these cases, although they must be given intravenously (IV) and may not be as safe.

Aug. 2, 2006 — The FDA has approved the drug Famvir as the first and only one-day antiviral treatment for recurrent genital herpesgenital herpes and cold sorescold sores in people with healthy immune systems.

The drug’s maker, Novartis Pharmaceuticals Corp., announced the FDA approval in a news release dated July 28.

At least 45 million people age 12 and older in the U.S. have had a genital herpes infection — or about one in five in that age range, says the CDC.

Before, genital herpes required five days of Famvir treatment — although at a lower dose. Famvir was not FDA approved for cold sores in people with healthy immune systems (meaning those without aids).

The new approval shortens Famvir treatment to a single day at the start of an outbreak and adds cold sores to the drug’s approved uses.

Famvir Dosage

Patients would take 1,000 milligrams of Famvir twice daily for one day at the first sign of genital herpes symptoms, and 1,500 milligrams of Famvir once for one day at the first sign of cold sore symptoms to shorten outbreaks and reduce symptoms.

The drug, available only by prescription, is taken orally.

It does not cure genital herpes or cold sores. Currently, there is no cure for herpes. Antiviral drugs such as Famvir, Zovirax and Valtrex can only help treat or suppress the infection.

Famvir earned FDA approval in 1994 and is used to treat shinglesshingles, as well as the herpes virus which causes both genital herpes and cold sores.

Timing Counts

Single-day Famvir should be started within six hours of the first sign of symptoms, such as tingling, itching, burning, or the appearance of herpesherpes sores, says Novartis.

There is “a narrow window of opportunity for treatment” at the start of an outbreak of herpes or cold sorescold sores, says Novartis.

Timing is crucial because the virus copies itself most actively in an outbreak’s first hours. Interrupting that process may shorten the outbreak and reduce its severity.

Herpes Virus

There are two types of the herpes simplex virus: herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2).

Cold sores are typically caused by the former, which can spread by kissing an infected person or sharing eating utensils, towels, or razors.

Genital herpes Genital herpes is a sexually transmitted disease (STD) and is usually caused by HSV-2, although it can result from HSV-1.

Most genital herpes patients have few or no symptoms, the CDC notes.

When symptoms appear, there are usually one or more blistersblisters around the genitals or rectum. The blisters can break, leaving tender sores that may take several weeks to heal.

Clinical Trials

Single-day Famvir was tested in clinical trials for treatment of recurrent genital herpes and cold sores.

The genital herpes trial included 329 patients. At the first sign of a herpes outbreak, they got one of two treatments, without knowing which they received:

• 1,000 milligrams of Famvir twice daily for one day
• A pill containing no medicine (placebo).

The Famvir group had milder symptoms and shorter outbreaks that lasted about four days, instead of six days with the placebo, Novartis reports.

Single-dose Famvir had a similar effect on the length and severity of cold sores in the cold sores trial, which included 481 patients, according to Novartis.