What is the treatment for oral herpes?

From the Guidelines

Treatment for oral herpes typically involves antiviral medications such as acyclovir, valacyclovir, or famciclovir, which work best when started at the first sign of an outbreak. The most effective treatment regimens include acyclovir (400mg three times daily for 5-10 days) 1, valacyclovir (1g twice daily for 7-10 days), or famciclovir (250mg three times daily for 7-10 days) 1. These medications work by inhibiting viral DNA replication, preventing the herpes simplex virus from multiplying and shortening the duration and severity of outbreaks.

Some key points to consider when treating oral herpes include:

• Starting treatment at the first sign of an outbreak, such as tingling or burning before sores appear
• Using over-the-counter options like acetaminophen, ibuprofen, or topical anesthetics containing benzocaine or lidocaine for pain relief
• Applying cold compresses to sores for 5-10 minutes several times daily to reduce pain and swelling
• Keeping the affected area clean and dry to promote healing
• Avoiding triggers like stress, sunlight exposure, and certain foods to prevent recurrences
• Staying hydrated and consuming soft, non-acidic foods to minimize discomfort while eating

For frequent recurrences (more than 6 per year), daily suppressive therapy with lower doses of antivirals may be prescribed to reduce outbreak frequency 1. It's essential to note that the safety of oral aciclovir, famciclovir, and valaciclovir for treatment of herpes labialis has been indicated to be generally well tolerated and associated with minimal adverse events in patients 1.

From the FDA Drug Label

The median time to healing among patients with non-aborted lesions (progressing beyond the papule stage) was 4.4 days in the famciclovir 1500 mg single-dose group

• Treatment for oral herpes: The treatment is famciclovir 1500 mg single dose or famciclovir 500 mg twice daily for 7 days in HIV-infected patients 2.
• Key points:
  • Median time to healing: 4.4 days for famciclovir 1500 mg single dose
  • Median time to loss of pain and tenderness: 1.7 days for famciclovir 1500 mg single dose
  • Famciclovir therapy was comparable to oral acyclovir in reducing new lesion formation and in time to complete healing in HIV-infected patients 2

From the Research

Treatment Options for Oral Herpes

• The treatment for oral herpes, also known as herpes simplex virus (HSV), typically involves antiviral medications such as acyclovir, valacyclovir, and famciclovir 3, 4, 5, 6.
• For recurrent oral herpes simplex infections, 5% acyclovir cream may reduce the duration of lesions if applied early, while systemic acyclovir or valacyclovir can be effective in treating and preventing recurrent episodes 4.
• Valacyclovir has been shown to be as effective as acyclovir in treating genital herpes and herpes zoster, with the added benefit of a more convenient oral dosage regimen 3, 5.
• The management of recurrent episodes of oral herpes is more controversial, but episodic treatment with oral acyclovir or valacyclovir initiated early by the patient appears to have favorable results 4, 7.

Antiviral Medications

• Acyclovir is the primary antiviral medication used to treat oral herpes, with a recommended dosage of 200mg 5 times daily for 5 days for initial genital HSV infection 7.
• Valacyclovir is a prodrug that undergoes rapid and extensive first-pass metabolism to yield acyclovir, with a bioavailability that is considerably greater than that of oral acyclovir 3, 5.
• Famciclovir is another antiviral medication that may have added clinical utility in the treatment of herpes virus infections, with animal studies suggesting it can affect subsequent latent infection with HSV-1 6.

Prevention and Suppression

• Sunscreen alone (SPF 15 or above) can be effective in preventing recurrent herpes labialis (RHL) in immunocompetent individuals 4.
• Systemic acyclovir or valacyclovir can be used to prevent RHL in immunocompetent individuals, with valacyclovir 500 mg twice a day also effective in suppressing erythema multiforme triggered by HSV 4.
• Suppressive therapy with oral acyclovir or valacyclovir should be considered for patients with frequent recurrences of oral herpes, with the goal of reducing the frequency and severity of episodes 4, 7.