Does antiviral treatment completely clear Herpes Simplex Virus (HSV) or just shorten the duration and severity of outbreaks in a young adult with a history of cold sores and potential genital herpes?

Antiviral Treatment Does NOT Cure HSV—It Only Shortens Outbreaks and Reduces Recurrence Frequency

Antiviral therapy for HSV cannot eradicate the virus or cure the infection; it only blocks viral replication during active outbreaks to shorten symptom duration, accelerate lesion healing, and when used suppressively, reduce recurrence frequency by ≥75%. 1, 2, 3

Why Antivirals Cannot Clear HSV

• HSV establishes permanent latency in sensory ganglia after primary infection, making complete viral clearance impossible with current antiviral agents. 4
• The Centers for Disease Control and Prevention explicitly states that genital herpes is a "recurrent, incurable viral disease" and that antiviral medications control symptoms but do not eradicate the virus or prevent all recurrences. 2, 3
• Even systemic acyclovir treatment during primary infection does not prevent the virus from establishing ganglionic latency or reduce the frequency of subsequent recurrences. 5

What Antivirals Actually Accomplish

For Active Outbreaks (Episodic Therapy)

• The goal is to block viral replication during the critical first 24 hours when viral titers peak, thereby shortening symptom duration and accelerating lesion healing. 1
• Treatment must be initiated during the prodrome or within 24 hours of lesion onset for maximum effectiveness. 1, 3
• For recurrent genital herpes, episodic treatment with valacyclovir 500 mg twice daily for 5 days reduces median time to lesion healing from 6 days (placebo) to 4 days, and reduces viral shedding duration from 4 days to 2 days. 6
• For cold sores, treatment shortens the mean duration of episodes by approximately 1 day compared to placebo. 6

For Suppressive Therapy (≥6 Recurrences Per Year)

• Daily suppressive therapy reduces recurrence frequency by ≥75% but does not eliminate the virus or prevent all future outbreaks. 1, 2, 3
• In a 12-month trial, 34% of patients on valacyclovir 1 gram daily remained recurrence-free versus only 4% on placebo—meaning 66% still experienced at least one recurrence despite daily therapy. 6
• Suppressive therapy also reduces asymptomatic viral shedding, which decreases (but does not eliminate) transmission risk to partners. 2, 3

Critical Clinical Pitfalls

• Topical acyclovir is substantially less effective than oral therapy and should never be used as monotherapy. 1, 2, 3
• Treatment initiated after 24 hours of symptom onset has significantly reduced efficacy. 3
• Patients must understand that asymptomatic viral shedding can occur even on suppressive therapy, and transmission remains possible without visible lesions. 2, 3

Essential Patient Counseling

• HSV-1 is a chronic, incurable infection with potential for lifelong recurrence. 1
• Antivirals control symptoms and reduce outbreak frequency but cannot cure the infection or guarantee prevention of all future recurrences. 2, 3, 7
• Patients should abstain from sexual activity when lesions or prodromal symptoms are present and inform sexual partners about their HSV status. 1, 3
• Prophylactic measures like sunscreen or zinc oxide application may help reduce UV-triggered recurrences of herpes labialis. 1