My doctor just told me I have genital herpes. She wrote me a prescription and sent me on my way. I didn’t even know what to ask at the time, and now I’m confused. I’ve read a bit but I don’t really understand the different kinds of treatments, how they work, and how they differ from one another. I’m not even sure I want to take any medication at this point, since the diagnosis was a surprise and I haven’t had any symptoms. I’m not in a relationship so I’m not worried about passing this on. Can you offer me some insight?
This is a very common question. Most people who find out they have herpes have questions about treatment that sometimes get overlooked in that initial diagnostic visit.
First, you don’t have to take any medication if you don’t want to. A lot of people don’t have regular outbreaks and don’t find it useful to take medications. Some have such mild outbreaks that they’d just prefer to take over-the-counter pain medications like acetaminophen and ibuprofen as needed.
But people decide to take antiviral therapy not only to treat symptoms but also to reduce the risk of infecting sexual partners. Studies show that daily treatment with valacyclovir reduces the risk of transmitting HSV-2 to a partner by almost half. You mention you aren’t concerned about that right now, but an overview of the options may help you make informed decisions in the future.
There are two ways to treat genital herpes with antiviral medications. Episodic therapy means treating outbreaks as they occur. Some people can even avoid an outbreak if they start the medications very soon after noticing the first sign of an outbreak (such as itching, tingling, pain). On average, episodic therapy helps to heal lesions about two days faster than doing nothing.
Patients may want to take suppressive therapy when they have frequent or troublesome outbreaks. Suppressive therapy means taking antiviral medication every day. Others may choose suppressive therapy to reduce the risk transmission to their partner, as mentioned above.
There are currently three FDA-approved antivirals to treat genital herpes: acyclovir, famciclovir, and valacyclovir. Acyclovir is available in a generic form, makes it more affordable, but one may have to take as many as three pills a day. Valacyclovir and famcyclovir have a two-staged delivery, allowing these medications to deliver higher levels of medication to the body so a patient can take fewer pills to suppress an outbreak. In terms of effectiveness, clinical studies have not found any significant differences between acyclovir, valacyclovir and famciclovir, but there may be significant differences in terms of cost.
If and when you decide on a treatment regimen, you’ll no doubt take all these factors (necessity, convenience, cost) in mind. You may want to visit your doctor with a list of prepared questions to discuss as well.