Genital herpes is treated with antiviral medications that shorten outbreaks, reduce symptoms, and lower the risk of passing the virus to a partner. There is no cure, but the right treatment plan can make outbreaks shorter, less painful, and less frequent over time.
Antiviral Medications: The Core of Treatment
Three oral antiviral drugs are used to treat genital herpes. All three work by blocking the virus’s ability to copy its own DNA, which stops it from multiplying inside your cells. The virus activates an enzyme that converts the medication into its active form, so the drug targets infected cells far more than healthy ones.
For a first outbreak, the CDC recommends one of these options, taken for 7 to 10 days:
- Acyclovir: 400 mg three times daily
- Famciclovir: 250 mg three times daily
- Valacyclovir: 1 g twice daily
If sores haven’t fully healed after 10 days, treatment can be extended. All three medications are similarly effective; the main difference is how often you take them. Valacyclovir’s twice-daily dosing makes it the most convenient option for many people.
What to Expect During a First Outbreak
A first episode of genital herpes is typically the worst one. Without treatment, it can last 2 to 4 weeks. Sores appear, break open and release fluid, then crust over and heal without scarring. Antiviral medication started early in the outbreak shortens this timeline and reduces the severity of symptoms noticeably.
Recurrent outbreaks are milder. Sores from later episodes generally heal within 3 to 7 days, and many people notice a tingling or itching sensation in the area before sores appear. That prodrome is your window to start medication, and treating at that point can make the episode even shorter.
Suppressive Therapy for Frequent Outbreaks
If you experience multiple outbreaks per year, daily antiviral therapy can prevent most of them. This is called suppressive therapy. You take a lower dose of medication every day rather than waiting for an outbreak to start. Many people on suppressive therapy go months or even years without a recurrence.
Daily valacyclovir also reduces the chance of transmitting the virus to a sexual partner. In studies of couples where one partner had genital HSV-2 and the other did not, a daily 500 mg dose of valacyclovir decreased the transmission rate. This makes suppressive therapy especially worth discussing if you’re in a relationship with someone who doesn’t carry the virus.
Outbreaks tend to become less frequent on their own over the first few years after initial infection. Your doctor may suggest trying a break from suppressive therapy after 12 months to see whether your outbreak pattern has changed.
Managing Pain and Discomfort at Home
Antivirals address the virus, but the sores themselves can be painful. Several simple strategies help with comfort during an outbreak:
- Over-the-counter pain relievers: Ibuprofen reduces both pain and inflammation around the sores.
- Topical lidocaine cream: Applied directly to the area, it numbs the skin and eases stinging.
- Warm baths: Soaking in warm water soothes irritated skin and helps keep the area clean.
- Cotton underwear: Breathable fabric reduces friction and moisture buildup, which can worsen discomfort.
- Urinating in water: If urine stinging the sores is a problem, urinating while sitting in a shallow bath or pouring warm water over the area at the same time can help significantly.
Rest and general immune support matter too. Stress, poor sleep, and illness are common outbreak triggers. Eating well and getting enough rest during an active episode can help your body clear the sores faster.
L-Lysine and Other Supplements
Some people explore supplements alongside antiviral medication. L-lysine, an amino acid available over the counter, has the most research behind it. In a six-month double-blind trial, participants taking oral L-lysine averaged 2.4 times fewer outbreaks than those taking a placebo, with shorter healing times and less severe symptoms.
L-lysine is not a replacement for antiviral medication, particularly during a first outbreak or for suppressive therapy. But for people looking for an additional measure to reduce recurrence frequency, it has reasonable evidence behind it.
Reducing Transmission Risk
Treatment is also about protecting partners. The virus can shed from the skin even when no sores are visible, which is how most transmission actually happens. Three strategies lower the risk:
- Daily suppressive therapy reduces both viral shedding and the chance of passing the infection to a partner.
- Condoms provide a physical barrier, though they don’t cover all potentially affected skin.
- Avoiding sex during outbreaks eliminates contact when viral levels are highest.
Combining daily antivirals with consistent condom use offers the greatest reduction in transmission risk. Having an open conversation with a partner about your status lets both of you make informed decisions together.
Episodic vs. Daily Treatment
You and your provider will choose between two treatment approaches based on how your outbreaks affect your life. Episodic treatment means keeping a prescription on hand and starting it at the first sign of a recurrence. This works well if you have infrequent outbreaks, perhaps a few per year, and they resolve quickly.
Daily suppressive therapy makes more sense if outbreaks are frequent (roughly six or more per year), if they cause significant pain or emotional distress, or if reducing transmission to a partner is a priority. Neither approach is permanent. You can switch between them as your situation changes. Many people start with suppressive therapy after diagnosis, then transition to episodic treatment as outbreaks naturally become less frequent over time.