This article explores the treatment options for oral herpes (cold sores) and genital herpes, including home remedies, over-the-counter medications, prescription drugs, and complementary and alternative therapies.
Home Remedies and Lifestyle
At-home treatments for herpes are used to relieve pain. They do nothing to alter the course of the infection but can make you more comfortable as the herpes sores begin to heal.
There are several things you can do if have an outbreak of oral or genital herpes:
Use a cold compress. Place a cloth-covered ice pack on the sores for 15 minutes several times daily to reduce pain. Keep the ice pack moving to prevent frostbite. Do not touch or scratch. Avoid touching and rubbing the sores. Doing so can spread the infection to other areas of the skin. Keep the sores clean. Herpes sores can become infected with bacteria if touched with soiled hands. Wash your hands thoroughly with soap and water after going to the bathroom or before applying medications. Reduce stress. Stress can increase your sensitivity to pain during a herpes outbreak. You can reduce stress by performing gentle exercises or practicing mind-body therapies like meditation, yoga, and guided imagery.
To reduce the risk of spreading herpes, avoid kissing and sharing objects that come into contact with saliva, like drinking straws and eating utensils.
It’s important to note that oral herpes can be spread to the genitals, and that genital herpes can be spread to the mouth. To reduce the risk of infection, use condoms and dental dams during oral sex. Better yet, avoid sex altogether if you are having an active herpes outbreak (or feel an outbreak coming on).
Over-the-Counter Therapies
Over-the-counter (OTC) medications are available to help reduce pain and speed recovery from a herpes outbreak. There is even one OTC drug called Abreva (docosanol) that has antiviral properties.
OTC medications commonly used to treat herpes include:
Topical pain relievers: These are medications applied to the skin that has a numbing effect. These include creams or ointments containing lidocaine (such as Aspercreme and Anbesol), camphor and phenol (Campho-Phenique), and benzocaine (Orajel and Carmex Cold Sore). Oral pain relievers: Tylenol (acetaminophen) is an oral painkiller that can ease the pain of a herpes outbreak. OTC nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) can also relieve pain while reducing redness and swelling. 1% hydrocortisone cream: This is a low-dose topical steroid that can reduce inflammation and ease redness and burning caused by a herpes outbreak. Hydrocortisone cream is often used in combination with a prescription antiviral drug to treat genital herpes. Abreva 10% docosanol cream: This is the only OTC antiviral drug approved by the U. S. Food and Drug Administration (FDA) for the treatment of cold sores. It is a topical cream applied to the skin five times daily at the first signs of an outbreak (such as tingling, itching, or bump). Research has shown that early treatment can reduce the duration of an outbreak by one to two days. Abreva is not approved for the treatment of genital herpes. Lysine ointment: Lysine is an amino acid that some people believe has antiviral effects. There are numerous lysine-based ointments available for the treatment of cold sores, including Quantum Leap Lip Care and Lip Clear Lysine Plus. Evidence supporting their use is weak. FemiClear: This is an OTC ointment used to treat genital herpes. It contains natural ingredients, including lemongrass and willow bark, and claims to kill 99. 9% of herpes viruses. There is currently no evidence that FemiClear alters the course of a herpes infection in any way.
Prescription Herpes Medicine
Antiviral drugs can be used to block the herpes virus’s ability to make copies of itself, bringing the infection under control faster. Most cases of oral herpes are caused by herpes simplex virus type 1 (HSV-1), while genital herpes is commonly caused by herpes simplex virus type 2 (HSV-2).
Antivirals included oral tablets that are taken by mouth and topical creams that are applied to the skin. These relieve some of the pain and discomfort of an outbreak and help heal herpes sores faster. Antivirals can also help to prevent future outbreaks.
Indications for Treatment
Not every herpes outbreak requires antiviral treatment. Mild outbreaks can often clear on their own without consequence, including the occasional cold sore.
The decision to treat is ultimately based on whether this is a first outbreak or a recurrence. The frequency and severity of your recurrences are also considered.
This is especially true for herpes infections in people with weakened immune systems, such as those with advanced HIV. In these individuals, herpes can sometimes spread (disseminate) to multiple organs, including the liver, brain, lungs, and kidneys.
In people who are immunocompromised, herpes can sometimes spread from the mouth or genitals to distant organs, including the liver, brain, lungs, and kidneys. This is called disseminated herpes. In such cases, antiviral drugs are injected directly into the bloodstream, or intravenously.
Types of Antiviral Drugs
There are three oral antivirals recommended for the treatment of oral or genital herpes:
Famvir (famciclovir) Valtrex (valacyclovir) Zovirax (acyclovir)
Additionally, three topical antivirals can be used to treat recurrent oral herpes:
Denavir (penciclovir) creamXerese (acyclovir + hydrocortisone) creamZovirax (acyclovir) cream
Dosage Recommendations
The dosage of antiviral used to treat genital herpes can vary depending on whether this is your first outbreak or a recurrence. The dosage is also adjusted if used to prevent a recurrence.
The Centers for Disease Control (CDC) issued the following dosing schedule—in grams (g) and milligrams (mg)—for adults with primary genital herpes.
Complementary and Alternative Medicine (CAM)
Some people use natural therapies to treat herpes, either on their own or to support standard medical care. The research supporting their use is generally weak, with little evidence that they can reduce either the severity or duration of an outbreak. Even so, many people swear by their effectiveness and consider them a vital part of managing herpes outbreaks.
Complementary and alternative therapies sometimes used to treat herpes include:
Propolis: This is a sticky substance produced by bees that may help speed the healing of genital herpes. A 2017 study found that people who used propolis ointment experienced better healing by the 10th day of treatment compared to those who used a sham ointment. Algae extract: Lab studies suggest that algae extract can inhibit the growth of HSV-2 in test tubes. Whether it can do so in humans has yet to be proven. Acupuncture: A 2022 review of research on the use of acupuncture to treat symptoms of herpes zoster (shingles) concluded that “acupuncture had a good effect on [herpes zoster], quickly reduced patient pain, [and] shortened the course of the treatment. ” While this suggests that acupuncture may be useful in easing genital herpes pain, this has yet to be proven.
Summary
There is no cure for herpes, but you can manage outbreaks with at-home treatments and over-the-counter medications that can help ease pain.
Antiviral drugs directly treat herpes infections and may help reduce the severity or duration of an outbreak. This includes Abreva (docosanol), a topical antiviral available over the counter, and prescriptions antivirals like Zovirax (acyclovir) and Valtrex (valacyclovir). Antivirals can also be taken on a daily basis to prevent outbreaks in people with frequent recurrences.
Complementary and alternative therapies are sometimes used to treat oral or genital herpes, but there is little clinical evidence to support their use.
A Word From Verywell
The key to successfully treating any herpes outbreak is a timely response. The sooner you recognize the signs and start treatment, the shorter and less severe the episode will likely be. For the best results, start treatment within 48 hours of the first appearance of symptoms.
If your primary care provider is unable to see you, do not hesitate to get an antiviral prescription from a telehealth provider. The visit may be partially or fully covered by insurance.
Zovirax (acyclovir)Valtrex (valacyclovir)Famvir (famciclovir)
African rue (Peganum harmala)Green algae (Stypopodium zonale)Red seaweed (Hypnea musciformis)Verbena (Verbenaceae)Yu Xing Cao (a traditional Chinese medicine)
For fastest healing, use antivirals at the first sign of an outbreak. Keep the area clean and dry and avoid picking or scratching sores.
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