Genital herpes cannot be cured, but antiviral medications effectively shorten outbreaks, reduce their frequency, and lower the risk of transmitting the virus to a partner. Three oral antiviral drugs form the backbone of treatment: acyclovir, valacyclovir, and famciclovir. Which one you take, and how you take it, depends on whether you’re dealing with a first outbreak, a recurring episode, or trying to prevent outbreaks altogether.
Treatment for a First Outbreak
A first episode of genital herpes is typically the most severe, with more painful sores, longer healing times, and sometimes flu-like symptoms. Antiviral treatment during this initial outbreak lasts 7 to 10 days, and can be extended if sores haven’t fully healed by then. The standard options are acyclovir (taken three times daily), famciclovir (three times daily), or valacyclovir (twice daily). All three are similarly effective. Valacyclovir’s main advantage is fewer daily doses, which makes it easier to stick with.
These medications work by interfering with the virus’s ability to copy its own DNA. They don’t kill the virus outright or remove it from your body, but they stop it from multiplying in active cells, which shortens the outbreak and reduces symptom severity. Starting treatment as soon as possible after symptoms appear gives the best results, ideally during the tingling or burning “prodrome” phase before sores fully develop.
Episodic Therapy for Recurring Outbreaks
After the first episode, recurrences tend to be shorter and less intense. If you get occasional outbreaks and prefer to treat them as they come, episodic therapy is an option. You keep medication on hand and start taking it at the first sign of symptoms. The treatment courses are shorter than for a first episode, ranging from as little as one day to five days depending on the drug and dosing schedule.
Some of the shortest regimens include famciclovir taken twice in a single day, or acyclovir taken three times daily for just two days. Valacyclovir can be taken twice daily for three days or once daily for five days. Speed matters here. The earlier you start, the more you shorten the outbreak. Many people learn to recognize their personal warning signs, such as tingling, itching, or localized soreness, and begin treatment before blisters appear.
Daily Suppressive Therapy
For people who experience frequent outbreaks (generally six or more per year), or who want to reduce the chance of passing herpes to a sexual partner, daily suppressive therapy is the most effective approach. This means taking a low dose of antiviral medication every day, whether or not you have symptoms. The most commonly prescribed regimen is valacyclovir once daily, though acyclovir twice daily and famciclovir twice daily are equally effective alternatives.
Suppressive therapy reduces outbreak frequency by 70% to 80% in most people, and many experience no recurrences at all while on it. It also significantly reduces viral shedding, the periods when the virus is active on the skin surface without visible symptoms. This shedding is the most common way herpes is unknowingly transmitted. Combining daily antivirals with condom use provides the strongest protection for an uninfected partner.
There’s no set time limit on suppressive therapy. Some people take it for years. Doctors typically reassess once a year to see if outbreaks have become infrequent enough to switch to episodic treatment instead. Long-term use of these antivirals has a strong safety record, with minimal side effects for most people.
Treatment During Pregnancy
Pregnant women with a history of genital herpes are typically started on suppressive antiviral therapy at 36 weeks of gestation. The goal is to prevent an active outbreak at the time of delivery, since a newborn exposed to herpes during vaginal birth can develop a serious infection. Acyclovir (three times daily) and valacyclovir (twice daily) are both used in pregnancy and have well-established safety profiles for this purpose.
Treatment for People With HIV
Herpes outbreaks can be more frequent and more severe in people with weakened immune systems, including those living with HIV. Treatment regimens for this group use the same three antiviral drugs but at higher doses and for longer durations. Episodic treatment courses last 5 to 10 days rather than the shorter courses used for otherwise healthy individuals. Suppressive doses are also higher, with valacyclovir and famciclovir both taken twice daily.
When Standard Antivirals Don’t Work
Drug resistance is rare in people with healthy immune systems but can develop in immunocompromised patients who take antivirals for extended periods. Standard herpes drugs all work through the same mechanism, targeting a specific viral enzyme, so resistance to one usually means resistance to all three.
For resistant infections, alternative medications that bypass that enzyme are available. Foscarnet and cidofovir, given intravenously, have long been the fallback options, though both carry a risk of kidney toxicity that limits their use in some patients. Cidofovir can also be injected directly into lesions that won’t heal, which concentrates the drug where it’s needed while reducing systemic side effects.
A newer drug called pritelivir works through an entirely different mechanism, blocking the virus’s ability to unwind and copy its DNA. In a Phase 3 trial of immunocompromised patients with resistant herpes infections, pritelivir achieved complete lesion healing in about 63% of patients and was significantly more effective than the older alternatives. It also caused fewer kidney-related side effects and far fewer treatment discontinuations. Pritelivir is taken as a daily pill, which is a major practical advantage over intravenous options.
L-Lysine and Other Supplements
L-lysine, an amino acid available as an over-the-counter supplement, is one of the most commonly discussed natural remedies for herpes. The evidence is mixed but leans modestly positive at higher doses. Multiple clinical studies have tested lysine for reducing herpes recurrences, and the pattern is fairly consistent: doses below 1 gram per day show little to no benefit, while doses of 1.25 grams or more per day appear to reduce how often outbreaks occur. In one study, patients taking about 1,250 mg daily had roughly half the recurrences of those on placebo. Another found that 3 grams daily led to 74% of participants reporting milder symptoms, compared to 28% in the placebo group.
However, lysine does not appear to speed up healing once an outbreak has started, and the overall quality of the research is limited. Most studies have been small and short. Doses up to 3 grams per day are generally considered safe. Lysine is not a replacement for antiviral medication, but some people use it as a complement to their treatment plan, particularly those who prefer to minimize medication use and have infrequent, mild recurrences.
Vaccines in Development
No vaccine for genital herpes is currently available, but several candidates are in clinical testing. An mRNA-based therapeutic vaccine (designed to reduce outbreaks in people already infected, rather than prevent initial infection) completed Phase 1/2 trials in early 2025. Therapeutic vaccines aim to train the immune system to suppress the virus more effectively, potentially reducing or eliminating the need for daily antiviral medication. Multiple other candidates using different vaccine technologies are also in various stages of development.