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MANAGEMENT OF ORAL HERPES INFECTIONS
Current Strategies
by Dr. H., Medical Director
www.herpes.org
updated July, 2018
One of the most common problems that I hear about on this website is the management
of oral herpes infections. This paper is a "quick resource" about
the causes and treatment of recurrent oral herpes infections.
First, read the papers on the website about herpes infections in general. This
is good basic information for any herpes sufferer. Remember to follow the advice
given both in the treatments section and in the Smart Living section, including
keeping the wounds clean, bursting obvious lesions and keeping them clean, and
washing hands with soap and water after touching a lesion. Also, important comments
are made about kissing, oral-genital contact, and household contact in these
papers. Suffice it to say that when lesions are present, billions of viral particles
are present and the wound is quite contagious to the mouth or to the genitals
of another person. We also know that herpes lesions may be shedding virus at
any time, and it is impossible to predict when these lesions are shedding virus.
Finally, type 2 infections also occur on the mouth, though they tend to have
much milder recurrences. If someone already has type 1 on the mouth, the person
might also acquire a type 2 infection on the mouth.
Second, please understand that physicians and researchers generally believe
that recurrences are initiated by "triggers". We don’t
know all of these triggers by any means. Some herpes strains might just be able
to trigger themselves into recurrences. However, many people will have a pretty
good idea what triggers their recurrences. These include sunlight or ultraviolet
light, stress, fatigue, excessive alcohol and/or caffeine consumption, and trauma
to the mouth.
If you or someone you know suffers from frequent oral herpes outbreaks, it would
be extremely important that exposure to ultraviolet light and prolonged sunlight
be avoided. If the face must be exposed to the sun for any period of time, a
high grade sunblock, number thirty or higher, should be worn. Some lip protection
products have a sunblock in them. A hat should be worn with a brim large enough
to keep the sun off of the face.
Third, type 1 herpes is what usually causes frequent oral recurrences, tends to be
sensitive to acyclovir/Valtrex/Famvir, as is type 2, both of which are usually
well-controlled with these medications. Generally
I recommend prescription systemic drugs (meaning pills taken which get into
the blood stream) for oral herpes as a secondary or even third-line treatment.
Patients with very frequent oral infections may want to consider being on suppressive
therapy, though, which is typically recommended as 400 mg of acyclovir
twice daily or a gram of Valtrex daily.
On the other hand, a relatively new indication for one day therapy with Valtrex, two grams taken in the morning and two grams taken in the evening, presents an area of hope for the oral herpes patient. By taking medication for only one day initiated at the first sign of symptoms, the oral herpes patient may indeed abort an outbreak and prevent it from happening!
Generic acyclovir is generally a little cheaper than brand Valtrex and Famvir, though Valtrex does achieve some 400% higher blood levels of acyclovir and may be worth the additional expense to the person dealing with HSV chronically, especially for the once a day convenience of using the drug.
Fourth, new products are emerging. Denavir is a prescription medication
that has recently been released. It is a topical antiviral that has been shown
to decrease the severity of the outbreak and to reduce the duration of symptoms
to some degree. Abreva has recently been released and has been demonstrated
to shorten symptoms by as much as three days. Whereas Denavir is a topical
version of an anti-viral related to Famvir, Abreva on the other
hand is a new concept, containing a chemical called docosanol which apparently
prevents viral particles from entering into cells.(1) Both of these drugs are
topical ointments, and both must be begun very early in the outbreak to have
maximum effectiveness. Denavir is not cheap. A local study that I performed
in Georgia indicated that a typical cost for a two gram tube of Denavir was
between thirty and forty dollars.
Fifth, other herbal products are available. Olive leaf extract, red marine
algae, "prunella vulgaris", and the extract of the cactus Opuntia
streptacantha have all been shown to have anti-viral properties against herpes
simplex. I am especially interested in the possibilities that may come about with the use of Prunella vulgaris. Interestingly, one recent paper indicated that the application of red wine to the lesion (topically, not consumed) actually will assist in aborting an outbreak.
Finally, my CURRENT RECOMMENDATIONS to someone suffering from frequent
recurrences would be accordingly:
1. I would certainly follow the points in paragraphs one and two above.
2. Denavir might be tried next, but it is an expensive alternative, and one might want to go onto number 4 or number 5 below.
3. The oral, non-prescription herbals such as opuntia cactus (see above), olive leaf extract, red marine
algae, and prunella vulgaris would be next.
4. Acyclovir, Valtrex, or Famvir would be next, if prescription therapy is desired which has been shown to bring consistent relief to regular outbreaks. Of these, Valtrex has had the most study in the recent past, recently having been shown to significantly reduce the incidence of transmission of genital infections from infected persons to non-infected persons.
5. Remember to keep in mind about the viral suppressive effects of oral antivirals such as acyclovir which may help prevent transmission of the infection to a non-infected partner.
I feel sure that, by incorporating the concepts and treatments discussed above,
almost all persons suffering with recurrent oral herpes outbreaks can control
their medical conditions and improve the enjoyment of life, free from these
unsightly and irritating lesions.
If this website has helped you in any way,
then please support the work of organizations
that help those with chronic infections.
THIS PAPER WILL BE UPDATED AT PERIODIC INTERVALS
AS SCIENTIFIC LITERATURE, APPROVED THERAPIES, AND FEEDBACK
FROM USERS OF THIS SITE SUGGEST NEW INFORMATION THAT SHOULD
BE CIRCULATED.
HERPES.ORG DOES NOT PURPORT
TO ESTABLISH A PHYSICIAN-PATIENT RELATIONSHIP. ALL TREATMENT
DECISIONS SHOULD BE MADE BETWEEN A PATIENT AND HIS/HER PRIVATE
PHYSICIAN. NO TREATMENTS SHOULD BE ATTEMPTED WITHOUT A FIRM
AND CONVINCING DIAGNOSIS OF THE CONDITION BEING TREATED.
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