DISCLAIMER: I’m no doctor. (And I don’t even play one on TV.) Any recommendations in this blog post — and on this entire site, for that matter — should be gone over with your doctor prior to acting on it. It’s just the smart thing to do.
There is no herpes cure (like a lot of sheisty snake oil salespeople out there would have you believe), but there are ways to keep the virus at bay. And medication is only the tip of the iceberg. My initial advice about medicating herpes is this: Don’t take it if you don’t have to. It’s a drug. And I try to stay as natural and drug-free as I can. You’d be amazed at how staying physically and mentally healthy can naturally suppress the virus (especially after you have given your body the 6-12 months to build up antibodies/immunity). That said, depending on your body, healthiness and a whole range of factors, taking herpes medication to make you more comfortable or to keep your herpes-free partner safe may be a viable option. Some people are under the impression that if they have herpes, they need to be taking herpes medication. That’s not necessarily true.
So before we even get into the actual medication options themselves, it’s important to determine for yourself whether medicating yourself is even necessary or beneficial. As far as I see it, there are only two solid reasons that you should take suppressive medication for herpes:
- To protect a partner who doesn’t have herpes. Taking suppressive medication will lessen the chance of passing herpes to your partner who doesn't have herpes. Even if you aren’t having an active herpes outbreak, herpes viral shedding happens 5-10% of the time, so taking the proper dose every day helps lessen the chance of passing the virus. 70% of new herpes infections are acquired from people who have no symptoms at the time of transmission and suppressive therapy has been shown to reduce the likelihood of transmission by half or more.
- If your outbreaks are severe and/or frequent. Especially when you initially get herpes, the first herpes outbreak and subsequent outbreaks within the first 6-12 months can be more extreme before your body builds up immunity to the new virus. But the good news is, the vast majority of people who have herpes report that their outbreaks lessen over time in both frequency and severity. A major determinant of that is how you take care of yourself mentally, emotionally and physically. So initially you may take daily suppressive therapy to lessen the outbreaks, but keep in mind that your body is working hard to build its own defenses. You may consider easing off of the medication after a few months to see how your herpes outbreaks have changed. Consider easing from suppressive to episodic therapy (only when you have outbreaks) as a midway point.
Suppressive vs. Episodic Therapy
Suppressive therapy involves taking the medication on a daily basis to suppress the herpes virus. This form of medicating applies mainly to the two reasons discussed above. Taking suppressive therapy doesn’t mean you will avoid herpes outbreaks altogether, but suppressive therapy has been shown to lessen the frequency, severity and length of time of outbreaks. It also helps lessen viral shedding by around 50%.
Episodic therapy refers to treating herpes outbreaks on an as-needed basis as they occur. If you are single or otherwise not having sex with a partner who doesn't have herpes, this may be the option for you to lessen the severity and length of herpes symptoms. As you get more knowledgeable about your prodrome symptoms that signal an outbreak is coming on (tingling, burning, itching in the area of your outbreak or pain in your butt/thighs), you can take medication to attempt to cut the outbreak off at the pass. The sooner you can medicate at the first sign of an outbreak, the better.
Types of herpes antiviral medications
There are three herpes antiviral medications available in tablet form:
- acyclovir
- valacyclovir (also known as Valtrex)
- famciclovir (typically used to treat shingles)
Valacyclovir/Valtrex is more bioavailable, which makes it absorb quicker and you only need to take it once per day vs. taking Acyclovir twice daily. But ultimately, Valtrex becomes acyclovir in the body to help minimize outbreaks.
How long does herpes medication take to work?
Depending on whether you're taking Valtrex (more bioavailable) or Acyclovir (less bioavailable), it might take a few days before it gets to work at minimizing symptoms and helping to protect partners from getting herpes. To be safe, after dry spells of not being in relationship, I would wait a week after starting to take acyclovir before having sex.
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