To Medicate or Not to Medicate for Herpes

Oral herpes medication can improve your quality of life, give you a feeling of control and physical and mental relief from experiencing recurrences of herpes.

Knowing about the treatment options provides you with information to have an open and informed discussion with your Doctor about what is best for you.

Oral Antiviral Medication for Herpes

Most people who get herpes will not experience bothersome symptoms, but for those that do there is effective oral antiviral medication. It stops the herpes from multiplying but does not clear the virus from the body. The most common brand used in New Zealand is valaciclovir.  It is safe and works effectively for both Type 1 and Type 2 herpes simplex.

Treatment for First Episode of Genital Herpes

Because the first episode is often more severe and lasts longer than recurrences, treatment should always be offered to you after a clinical examination by a Doctor or Nurse Practitioner. You do not have to wait for swab results before receiving treatment.

After taking medication for 7 days it is recommended you visit your doctor again so they can check your symptoms and give you further advice and support.

The treatment is 500mg of valaciclovir twice daily for 7 days (the alternative is 400mg of aciclovir 3 times a day (8 hourly) for 5 to 7 days).

Most people have no side effects from the medication and it is safe to take with other drugs

Treatment of Recurrent Genital Herpes

Most herpes recurrences are so mild and infrequent that taking treatment isn't considered necessary or helpful.

For some people herpes recurrences, while infrequent, can be more prolonged and you may find taking a short course of medication when you recognise the signs of a recurrence lessens the length and severity of the symptoms and reduces the risk of transmission if you are sexually active. This is called EPISODIC TREATMENT as it is not taken all the time.

Because this therapy is most effective before you develop skin rashes or lesions (tiny lumps that form blisters), it is important you have a readily available supply of medication to start as soon as you experience signs that you are having a recurrence.

Episodic treatment is 500mg of valaciclovir twice daily for 3 days (the alternative is 800mg of aciclovir (2x400mg) taken 3 times daily for 2 days).

Ask your Doctor to prescribe 50 x 500mg tablets of valaciclovir (or 48 x 400mg tablets of aciclovir) and self-initiate treatment at the first sign of a recurrence starting.

Suppressive Therapy for Herpes

If you have frequent recurrences of genital herpes

Taking medication every day for many months will stop recurrences completely, or their frequency and severity are greatly reduced. This is called suppressive or prophylactic treatment. Generally, after a year, it is recommended you stop the medication for a few months to see if recurrences have become less frequent. This type of continuous treatment can be repeated if necessary. This type of daily treatment tends to be prescribed if you have frequent or severe recurrences of genital herpes more than six times per year.

Suppressive treatment is valaciclovir 500mg taken daily. This may be increased to 500mg taken twice daily on individual basis of clinical presentation and/or if you are having breakthrough recurrences on 500mg daily. The alternative is oral aciclovir 400mg taken twice daily (12 hours apart).

A Doctor can give you a prescription every 3 months for up to 12 months and ongoing if your recurrences are still frequent.

Effectiveness is optimised if taken regularly as prescribed.

For special events

A course of medication may help to prevent a recurrence during special times. This may be an option even if you do not have frequent recurrences, but want to have the least risk of a recurrence - for example, during a honeymoon, holiday or during exams.