Is there a cure for herpes simplex virus (HSV) infection?

Is There a Cure for HSV?

No, there is currently no cure for herpes simplex virus (HSV) infection—the virus persists for life in a latent form in neurons and cannot be eradicated by any available therapy. 1

Current State of HSV Treatment

What Antiviral Therapy Can and Cannot Do

• Acyclovir and related antivirals (valacyclovir, famciclovir) do not eradicate latent virus and do not affect the subsequent risk, frequency, or severity of recurrences after the drug is discontinued. 1, 2

• These medications only provide partial control of symptoms and signs during active episodes or suppress viral reactivation when taken continuously—they do not cure the infection. 1

• The virus remains dormant in sensory ganglia for the lifetime of the host, periodically reactivating regardless of treatment history. 3, 4

Available Management Strategies (Not Cures)

Suppressive Therapy

• Daily antiviral therapy reduces recurrence frequency by ≥75% among patients with frequent outbreaks (≥6 per year) and reduces transmission risk to sexual partners. 5, 2

• Recommended regimens include valacyclovir 500 mg to 1 g daily, acyclovir 400 mg twice daily, or famciclovir 250 mg twice daily. 5

• Safety has been documented for up to 6 years of continuous acyclovir therapy, but this represents disease management, not cure. 5, 2

Episodic Therapy

• Short-term treatment during outbreaks can reduce duration and severity of symptoms when initiated at first sign of prodrome. 2

• Standard regimens include acyclovir 400 mg three times daily for 5 days or valacyclovir 1 g twice daily for 5 days. 2

Investigational Approaches (Still Not Cures)

Helicase-Primase Inhibitors

• Pritelivir and other helicase-primase inhibitors represent the most promising new drug class, showing superior efficacy in animal models with a novel mechanism of action. 1, 3, 6

• These agents are currently in clinical trials (including an open-label study for acyclovir-resistant HSV in immunocompromised patients, NCT03073967) but are not FDA-approved and do not cure infection. 1

• An early-access program to pritelivir has been initiated for select cases. 1

Other Investigational Agents

• Brincidofovir, imiquimod, and topical cidofovir have shown potential in case reports for acyclovir-resistant infections but do not eradicate latent virus. 1

• Tenofovir preparations showed no difference in viral shedding or lesion frequency compared to standard therapy. 1

Vaccine Development

• Vaccine development has been challenging and no effective preventive or therapeutic vaccine is currently available. 6

Gene Therapy

• Gene therapy approaches remain in early experimental stages with no clinical availability. 6

Critical Clinical Implications

Patient Counseling Points

• Patients must understand that HSV infection is lifelong and incurable—treatment only manages symptoms and reduces transmission risk. 1, 5

• Asymptomatic viral shedding occurs even without visible lesions, and transmission can occur during these periods. 1, 5

• Condom use should be encouraged during all sexual exposures to reduce (but not eliminate) transmission risk. 1, 5

Common Pitfalls to Avoid

• Do not promise patients that antiviral therapy will eliminate their infection or prevent all future recurrences. 1, 2

• Do not discontinue suppressive therapy expecting the virus to be "cleared"—recurrences will resume at baseline frequency. 1

• Avoid suggesting that newer therapies under investigation represent potential cures—they are improved management strategies only. 3, 6