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Herpes Simplex Infections (Non-Genital) (cont.)

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What is the treatment for cold sores, are there any home remedies, and what medications treat oral herpes?

Currently, there is no cure or vaccine for herpes simplex virus. Avoiding risk factors, such as sunburn and stress, can help prevent additional outbreaks. Cold sores will usually heal within two weeks without treatment. However, there are established treatments available to help decrease healing time, reduce pain, and in specific cases, suppress the recurrence of the virus.

  • Nondrug therapy: Applying a cool compress to the lesion may decrease pain and keep the lesion from drying and cracking.
  • Over-the-counter (OTC) treatments: Most topical OTC products provide symptomatic relief but they do not speed up healing time. Using topical anesthetics that contain benzocaine (5%-20%), lidocaine (0.5%-4%), tetracaine (2%), or dibucaine (0.25%-1%) will help relieve burning, itching, and pain. Commonly used products include Lipactin gel and Zilactin. It is important to keep in mind that these topical anesthetics have a short duration of action, usually only lasting 20-30 minutes. Skin protectants, such as allantoin, petrolatum, and dimethicone-containing products help keep the lesion moist and prevent cracking of the lesion. Sunscreen-containing lip balms may also help prevent additional outbreaks if the sun is a precipitating factor. For additional pain relief, using anti-inflammatory drugs such as aspirin, ibuprofen (Advil), or acetaminophen (Tylenol) may be beneficial. These products should be used according to package instructions.

    Docosanol 10% cream (Abreva) is the only OTC topical product that is known to decrease healing time when applied at the first sign of recurrence (for example, the prodrome or tingling sensation). Docosanol is applied five times per day until the lesion is healed. Common side effects include rash and itching at the site of application.
  • Prescription-strength topical medications: Treatment with topical acyclovir (Zovirax 5% cream) or penciclovir (Denavir 1% cream) will reduce healing time by approximately half a day and decrease pain associated with the lesion. Topical treatment is limited in its effectiveness because it has poor penetration to the site of replication of the virus and therefore is restricted in its healing ability. Acyclovir cream should be applied five times per day for four days, and penciclovir cream should be applied every two hours while awake for four days. A cream containing 5% acyclovir and a topical steroid (hydrocortisone) called Xerese is also available.
  • Oral prescription-strength medications: The current FDA-approved oral antiviral drugs used in the treatment of herpes simplex virus in adults are acyclovir, valacyclovir (Valtrex), and famciclovir (Famvir). These oral medications have been shown to decrease the duration of the outbreak, especially when started during the prodrome before the rash appears. Acyclovir, valacyclovir, and famciclovir are considered relatively safe and effective when used in pregnancy, although topical treatment would be preferred when appropriate. Acyclovir and valacyclovir have been used while breastfeeding. However, pregnant women and nursing mothers should contact their physician or pharmacist prior to using any medication. These medications are generally well tolerated with few side effects, though they may cause headache, nausea, or diarrhea. Doses may vary depending on the individual situation as determined by the prescriber.

Treatment for the first outbreak of oral herpes in an otherwise healthy person may include the following medications:

  • Acyclovir, 400 mg (milligrams) orally three times a day for 10 days or until the lesions have crusted
  • Valacyclovir, 2,000 mg orally every 12 hours for one day
  • Famciclovir, 250 mg orally three times a day for seven to 10 days

Treatment doses for recurrent oral herpes are as follows:

  • Acyclovir, 400 mg orally three times a day for five days: It may also be given as 800 mg orally twice a day for five days or 800 mg three times a day for two days.
  • Valacyclovir, 2,000 mg orally every 12 hours for one day
  • Famciclovir, 1,500 mg orally once

Suppressive treatment for those with frequent outbreaks may be given for 12 months, but it may be extended if needed:

  • Acyclovir, 400 mg orally twice a day
  • Valacyclovir, 500 mg orally once a day
  • Famciclovir, 250 mg orally twice a day

Other treatment options such as lysine supplements, citrus bioflavonoids, lactobacillus acidophilus and bulgaricus, vitamin C, vitamin E oil, and vitamin B12 have also been considered in the potential treatment of herpes simplex virus. However, there is no good clinical evidence to support these treatments, and they are not recommended.

Treatment for children is similar to that in adults (other than being dosed by weight), except that famciclovir does not have an approved pediatric dose.

Medically Reviewed by a Doctor on 6/15/2016


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