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 that eliminates the virus from your body, but the right treatment approach can make outbreaks less frequent, less severe, and shorter in duration.
Antiviral Medications for Outbreaks
Three prescription antiviral drugs are the foundation of genital herpes treatment: acyclovir, valacyclovir, and famciclovir. All three work by blocking the virus from copying itself, which slows the outbreak and helps sores heal faster. They are taken as pills, and your provider will choose one based on cost, convenience, and how often you need to take it.
For a first outbreak, treatment typically lasts 7 to 10 days. First episodes tend to be the most painful and longest-lasting, so starting medication as early as possible makes a noticeable difference in how quickly sores heal and how much discomfort you experience. If you suspect a first outbreak, getting a prescription promptly matters more than which specific drug you take.
For recurrent outbreaks, treatment courses are shorter, usually 1 to 5 days depending on the medication. The key is timing: antiviral therapy works best when you start it during the prodrome, the tingling, burning, or itching sensation that often appears before sores break out. Many people learn to recognize this warning phase and keep medication on hand so they can begin treatment immediately.
Daily Suppressive Therapy
If you experience frequent outbreaks (roughly six or more per year), daily antiviral medication can dramatically reduce how often they occur. Suppressive therapy means taking a low dose of an antiviral every day, whether or not you have symptoms. For most people, this cuts the number of outbreaks by 70% to 80%, and some people on daily therapy stop having noticeable outbreaks entirely.
Daily suppressive therapy also reduces the amount of virus your body sheds between outbreaks. This matters because genital herpes can be transmitted even when no sores are visible, a process called asymptomatic shedding. Taking daily antivirals cuts the risk of passing HSV-2 to a sexual partner by about half. Combined with condom use, this gives couples a practical way to significantly lower transmission risk.
Suppressive therapy is safe for long-term use. Many people take it for years without significant side effects. You and your provider can reassess once a year whether to continue, since outbreak frequency often decreases naturally over time.
Home Care for Symptom Relief
Antiviral medication handles the virus, but day-to-day comfort during an outbreak comes down to simple self-care. Over-the-counter pain relievers like acetaminophen or ibuprofen help with the aching and soreness that often accompanies active sores.
Cool compresses applied to sores several times a day can ease both pain and itching. Keep the area clean by washing sores gently with soap and water, then patting dry rather than rubbing. Moisture and friction slow healing, so wear loose-fitting cotton underwear and avoid synthetic fabrics like nylon. Women with sores on the vaginal lips sometimes find that urinating in a shallow tub of warm water prevents the stinging that urine causes on open sores.
Condoms and Transmission Risk
Condoms reduce the risk of spreading genital herpes, but the protection is not equal in both directions. A study published in JAMA found that consistent condom use reduced the risk of women acquiring HSV-2 from male partners by roughly 90% when condoms were used for more than 25% of sex acts. However, condoms did not show a statistically significant protective effect for men acquiring HSV-2 from female partners. This likely reflects the larger area of genital skin exposed during sex that a condom does not cover.
The practical takeaway: condoms help, but they are not a complete barrier against herpes transmission. Combining condom use with daily suppressive antiviral therapy and avoiding sex during active outbreaks provides the strongest protection for an uninfected partner.
Treatment During Pregnancy
Genital herpes during pregnancy requires careful management because the virus can be transmitted to the baby during delivery. The risk depends heavily on timing. Women who acquire genital herpes near the time of delivery face a 30% to 50% chance of transmitting the virus to the newborn. By contrast, women with a history of recurrent herpes or who were infected earlier in pregnancy have a transmission risk below 1%.
To reduce the chance of an active outbreak at delivery, suppressive antiviral therapy is recommended starting at 36 weeks of pregnancy. This lowers the likelihood of needing a cesarean delivery. If active sores or prodromal symptoms (tingling, burning at the usual site) are present when labor begins, a cesarean is recommended to reduce the baby’s exposure to the virus. Women without symptoms or signs of an outbreak at the time of labor can deliver vaginally.
Partners play a role too. If you are pregnant and your partner has genital herpes, avoiding vaginal intercourse during the third trimester significantly reduces the risk of a new infection close to delivery. The same caution applies to oral sex if a partner has a history of cold sores, since HSV-1 can cause genital herpes through oral contact.
What Outbreaks Look Like Over Time
The first genital herpes outbreak is almost always the worst. It can involve multiple painful sores, flu-like symptoms, swollen lymph nodes, and general discomfort lasting two to four weeks. Recurrent outbreaks are typically milder, with fewer sores that heal faster, often within a week.
For most people, outbreaks become less frequent over the first one to two years after infection. Some people eventually stop having recognizable outbreaks altogether, though the virus remains in the body and asymptomatic shedding can still occur. This natural decline is one reason providers sometimes suggest reassessing suppressive therapy annually: if your outbreaks have tapered off, you may no longer need daily medication.
New Treatments on the Horizon
A new class of antiviral drugs called helicase-primase inhibitors works differently from existing medications. Instead of targeting the same step in viral replication that acyclovir-based drugs do, these drugs block a different part of the process. The most advanced candidate, pritelivir, has shown promising results in clinical trials. In a Phase 2 trial of immunocompromised patients with drug-resistant herpes, 93% of those treated with pritelivir had their lesions heal, compared to 57% treated with the current alternative. Side effects were also considerably lower. A Phase 3 trial has met its primary endpoint, with full results expected in early 2026. If approved, pritelivir would be the first genuinely new mechanism for treating herpes in decades, and could be especially important for people whose infections do not respond well to current antivirals.