Unfortunately, there is no cure for herpes simplex but that does not mean herpes is all bad news. For most of people with herpes, they never get another outbreak again. And the good news is that many people choose herpes treatments to ease the pain, shorten the symptoms or to prevent outbreaks and reduce the risk of transmitting herpes. The genital herpes treatment differs in the case of primary and recurrent infections. You need to know that genital herpes can be caused by two types of viruses, HSV-1 and HSV-2.
Treatment of Genital Herpes
Primary vs. Secondary Genital Herpes Infection
An HSV infection is termed as “primary” if the patient was never exposed to both HSV-1 and HSV-2, and hence does not have protective antibodies to HSV-1 and HSV-2 before the episode of genital lesions. The primary episode can be associated with a multitude of symptoms and signs, such as fever, tiredness, headache, and painful urination.
A nonprimary first episode of infection refers to HSV-2 infection in a patient who already has HSV-1 immunity as a result of prior encounter with HSV-1. The signs and symptoms of nonprimary infection are usually less severe than that of a primary infection.
Treatment Approach for Primary Infection of Genital Herpes
For most patients who present with a first episode of genital HSV, antiviral therapy ( drugs that kill herpes virus) is recommended. However, patients with nonprimary infection who present only with mild symptoms after several days may not need antiviral at all. Antiviral therapy decreases the duration and severity of disease by days to weeks with minimal side effects of the drug and reduces the development of new lesions. The treatment is most helpful if started within 72 hours of the appearance of lesions.
The treatment of first choice is oral valacyclovir (1000 mg twice daily for 7 to 10 days). There are other drugs with similar effects, but valacyclovir is chosen for patients’ comfort as it is dosed less frequently when compared to other medications.
In case of complicated infection, injectable acyclovir is advised, which dosed according to the tolerability of the patient.
Treatment Approach for Secondary Infection of Genital Herpes
The approach to treatment for recurrent genital is decided according to patient preference and risk vs. benefit ratio. Chronic suppressive therapy (e.g., daily valacyclovir) may be recommended for those with severe or frequent (i.e., six or more per year) recurrent episodes and for healthy patients who want to decrease the risk of transmitting HSV to an uninfected sexual partner.
Patients with less severe or frequent recurrent episodes and those who are sexually inactive may prefer episodic therapy (antiviral therapy for individual outbreaks started at the very first likely symptoms of infection) or no therapy at all.
The drugs administered are usually safe, and laboratory monitoring for severe drug effects is often not advised in otherwise healthy persons, even with prolonged use of drugs.
The need for ongoing suppressive antiviral therapy is discussed with patients on an annual basis since the number of recurrences decreases with time, regardless of the current treatment.
Role of Topical Therapy
Although oral ointments are available, topical therapy is only of little benefit to the patients for the treatment of genital herpes, and there does not appear to be any benefit of adding topical therapy to oral drugs. It may only add more cost to the treatment. Hence it is not recommended.
Treatment of Oral Herpes (Herpes Labialis)
The principal manifestation of primary HSV-1 infection is gingivostomatitis (inflammation of gums and mouth) with or without pharyngitis (throat infection). Reactivation of HSV-1 occurs in a nerve that supplies sensation to the face and may lead to herpes labialis ( burning pain followed and small blisters or sores on the lip. Recurrent herpes labialis is usually associated with less severe symptoms and a shorter duration of infection than primary disease.
Although gingivostomatitis and pharyngitis are self-resolving, severe infection can lead to significant oral pain, discomfort, and dehydration. Early antiviral therapy (e.g., acyclovir, valacyclovir) within 72 hours of symptom onset leads to more rapid healing of lesions, decreased pain and discomfort, and a shorter duration of fever.
Treatment Approach for Primary Infection of Oral Herpes
For patients with gingivostomatitis or pharyngitis due to primary HSV infection, oral antiviral therapy with Acyclovir (400 mg three times daily for 7 to 10 days) is recommended, which is suitable for both older children and adults.
Treatment Approach for Secondary Infection of Oral Herpes
The patients with HSV-1 reactivation disease have various treatment options, including episodic therapy, chronic suppressive therapy, or no treatment at all. A mild self-limited disease.may not require any treatment at all. For patients with multiple painful or disfiguring lesions, chronic suppressive therapy is the treatment of choice.
* If you think you have herpes, go to see your doctor as soon as possible. It is easier to diagnose when there are sores. Your doctor can start the treatment sooner and perhaps you will have less pain.
