Herpes is treated with antiviral medications that shorten outbreaks, reduce symptoms, and lower the risk of transmitting the virus to others. There is no cure that eliminates herpes from the body, but the available treatments are effective at controlling it. Most people with herpes take pills by mouth, either during active outbreaks or daily to prevent them.
How Antiviral Medications Work
The three main antiviral drugs used for herpes are acyclovir, valacyclovir, and famciclovir. All three belong to the same drug class and work the same way: they mimic one of the building blocks the virus needs to copy its DNA. When the virus tries to use the drug instead of the real building block, its DNA chain stops growing. Without the ability to replicate, the virus can’t produce new copies of itself, and the outbreak winds down faster.
These drugs are highly selective. The virus’s own enzymes activate the medication inside infected cells, so the drugs have relatively little effect on healthy cells. That’s why side effects tend to be mild for most people.
First Outbreak Treatment
A first herpes outbreak is typically the most severe, and treatment lasts 7 to 10 days. If sores haven’t fully healed by then, therapy can be extended. The CDC-recommended options are acyclovir (400 mg three times daily), famciclovir (250 mg three times daily), or valacyclovir (1 g twice daily). All three are taken by mouth.
Starting treatment as early as possible matters. When antivirals are begun within 24 to 48 hours of symptom onset, they reduce viral shedding by about two days and shorten healing time by roughly a day. The longer you wait, the less benefit you get, so if you suspect a first outbreak, getting a prescription quickly makes a real difference.
Episodic Therapy for Recurrent Outbreaks
After the first episode, many people experience recurrences that are shorter and less painful. Episodic therapy means keeping medication on hand and starting it at the first sign of an outbreak, ideally during the tingling or itching “prodrome” stage before sores appear. Treatment courses for recurrences are shorter than for a first episode, often just one to five days depending on the drug and dose.
Several regimens work. Valacyclovir can be taken as 500 mg twice daily for three days, or 1 g once daily for five days. Famciclovir offers a particularly short option: 1 g twice in a single day. Acyclovir is typically taken at 800 mg twice daily for five days, or 800 mg three times daily for just two days. Your provider will help you choose based on convenience and cost.
Daily Suppressive Therapy
If you have frequent outbreaks (generally six or more per year), daily suppressive therapy can dramatically reduce how often they occur. It also lowers viral shedding on days when you have no symptoms, which reduces the chance of passing herpes to a sexual partner.
Standard suppressive regimens include acyclovir 400 mg twice daily, valacyclovir 500 mg once daily, or famciclovir 250 mg twice daily. Valacyclovir at the lower 500 mg dose may be less effective for people who experience 10 or more outbreaks per year; in those cases, the dose can be increased to 1 g daily.
Suppressive therapy is safe for long-term use. Many people take it for years. Recurrence patterns change over time, though, so it’s worth reassessing periodically whether you still need it. HSV-1 genital herpes tends to recur less frequently than HSV-2, so daily suppression is usually reserved for those with HSV-1 who have frequent episodes.
Topical and Over-the-Counter Options
For oral herpes (cold sores), docosanol cream (sold as Abreva) is the main over-the-counter option. It works by blocking the virus from entering healthy skin cells. In clinical trials, docosanol shortened healing time by about 18 hours compared to a placebo, with a median healing time of 4.1 days. That’s a modest benefit, but it’s available without a prescription, which makes it a practical first step if you can’t get antivirals right away.
Prescription topical penciclovir cream is another option for cold sores. Both topical treatments work best when applied at the very first sign of tingling. For genital herpes, topical treatments are generally not recommended because oral antivirals are significantly more effective.
Pain Relief and Home Care
During an active outbreak, the sores themselves can be quite painful, especially in the genital area. Several simple measures help:
- Sitz baths: Sitting in 3 to 4 inches of warm water (around 104°F) for 15 to 20 minutes relaxes the muscles in the perineal area, improves blood flow, and eases pain. Plain warm water works fine. Avoid adding salts or oils, which can irritate open sores. You can repeat this three to four times a day.
- Loose clothing: Tight underwear and synthetic fabrics trap moisture and create friction against sores. Cotton underwear and loose-fitting clothes let the area breathe and heal.
- Keeping sores dry: After bathing, gently pat the area dry or use a hair dryer on a cool setting. Moisture slows healing.
- Over-the-counter pain relievers: Ibuprofen or acetaminophen can take the edge off pain and reduce inflammation during an outbreak.
Treatment for Drug-Resistant Herpes
In rare cases, the herpes virus develops resistance to acyclovir and related drugs. This happens almost exclusively in people with weakened immune systems, such as those with advanced HIV or organ transplant recipients on immunosuppressive medications. If standard antivirals stop working, the resistance typically involves a change in the viral enzyme that normally activates the drug.
Second-line treatments for resistant herpes include foscarnet and cidofovir, which work through a different mechanism and don’t depend on that same enzyme. Both are effective but carry a higher risk of kidney damage, so they’re used carefully and with monitoring. In some cases, cidofovir can be injected directly into the lesion rather than given through an IV, which reduces the systemic side effects while still clearing the sores.
Why Timing Matters
Across all treatment approaches, the consistent finding is that earlier treatment produces better results. During a recurrence, starting antivirals within 24 hours of the first symptoms reduces viral shedding by about two days and shortens total healing by roughly a day compared to waiting longer. Once sores are fully developed and crusting over, antivirals have much less to offer for that particular episode.
This is why many providers write prescriptions in advance so you can have medication ready at home. If you feel the characteristic tingling, itching, or burning that signals an outbreak, you can start treatment immediately rather than waiting for a clinic appointment. That head start is often the difference between a mild, short episode and a more drawn-out one.