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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. My first recommendation is to read the papers on this website about herpes infections in general. This is good basic information for anyone with herpes. Also remember to follow the advice given in the Herpes Treatments article and in the Smart Living with Herpes paper, including keeping the wounds clean, bursting obvious lesions, and then cleaning them well, and washing hands with soap and water after touching a lesion. It is also important to note the recommendations regarding kissing, oral-genital contact, and household contact in these articles.
Suffice it to say that when lesions are present, billions of viral particles are also present and the wound is quite contagious to the mouth or to the genitals of another person. As well, herpes lesions may be shedding virus at any time and it is impossible to predict when this is happening.
Second, herpes recurrences are initiated by "triggers", not all of which are known. While some herpes strains may be able to trigger themselves into recurrences, many people have a good idea as to what triggers their outbreaks. These include ultraviolet light from the sun or tanning beds, stress and fatigue, poor diet including excessive alcohol and/or caffeine consumption, and trauma to the mouth.
If a person suffers from frequent oral herpes outbreaks, it is recommended that they avoid exposure to ultraviolet light. If the face must be exposed to the sun, then a high grade sunscreen (SPF 30 or higher) should be worn. Some lip protection products have sunblock in them and may also be used. Additionally, a hat can be worn with a brim large enough to keep the sun off of the face.
Third, type 1 herpes is the usual cause of frequent oral outbreaks but Type 2 (genital herpes) infections can also occur on the mouth, though they tend to have much milder recurrences. It is also important to know that if someone has type 1 on the mouth, they can also acquire a type 2 infection on the mouth.
Many types of treatments for oral herpes have proven effective. These include non-prescription natural topical remedies and oral supplements, over-the-counter and prescription topical ointments and gels, as well as the standard prescription antiviral oral medications (acyclovir/Valtrex/Famvir) used to treat genital herpes.
It is my experience that most patients can keep their oral outbreaks under control firstly by avoiding UV light, managing their stress better, eating right, and getting sufficient sleep. Then, at the first sign of an outbreak, they may use one of the topical anti-virals such as H Balm or Abreva. In addition, Lysine, (either orally or topical formulas), red marine algae, resveratrol (found in red grapes), opuntia cactus, prunella vulgaris, and propolis (all taken orally) also help many people. They have all been studied extensively in the laboratory and have shown significant anti-viral effects against herpes simplex virus.
Denavir is a prescription topical antiviral cream that may also be useful. It has been shown to decrease the severity of outbreaks and to reduce the duration of symptoms. Interestingly, acyclovir ointment sold as Zovirax is no longer recommended because it is little better than placebo.
Generally I recommend prescription systemic drugs (meaning pills taken which get into the blood stream) for oral herpes only after the previous methods have failed, or in a patient with an otherwise compromised immune system. For these patients, daily suppressive therapy using anti-viral medication may be needed. The typical dose is 400 mg of acyclovir twice daily or a gram of Valtrex daily.
A different type of therapy with Valtrex is also available. It involves taking two grams in the morning and two grams in the evening for only one day. When initiated at the first sign of symptoms, the oral herpes patient may thus be able to prevent an outbreak from ever happening.
Generic acyclovir is less expensive than the brand name medicines, Valtrex and Famvir. However, studies have shown that Valtrex achieves some 400% higher blood levels of acyclovir than generic acyclovir. Thus, it may be worth the additional expense, especially for the convenience to the patient of one day therapy.
In addition, a novel approach to oral herpes includes the use of a transdermal skincare product called "Dermaseptic" (www.dermaseptic.com). This device uses a silver electrode and a very small electric current to deliver ionized silver across the cell membrane. A small study showed a modest reduction in time to healing of oral cold sores (1 to 2 days depending on patient compliance). Of note however, patients must use the device every three hours for the first five days, and a brownish discoloration is noted on the skin following its use. The product is also expensive, selling for about $100.
Below is additional information that patients may find useful regarding the above mentioned treatments.
Abreva- The first non-prescription oral herpes medication approved by the FDA. It is a topical ointment that has been shown to shorten healing time and duration of symptoms by as much as three days. It contains a chemical "docosanol" which apparently prevents viral particles from entering into cells. It is best to start treatment very early in the outbreak to have maximum effectiveness.
Denavir- A topical anti-viral ointment related to Famvir. It has been shown to heal cold sores on average in four and a half days. It has also been shown to reduce lesion pain by about a half-day when compared to a placebo. It is best to start treatment very early in the outbreak to have maximum effectiveness.
H-Balm- A natural remedy composed of essential oils of Melissa, Lemonbalm, and six separate anti-viral essential oils and plant extracts all medically proven to inactivate the herpes virus and to stop new outbreaks. I have personally sent a number of clients to that site, and the reports that I have received have been encouraging. For additional information, please see www.fonoils.com (Peter Klapper is the founder and can also be reached at the website)
Lysine- One of nine essential amino acids that the body needs for growth and tissue repair. Clinical studies suggest decreased rates of recurrences and severity of outbreaks when it is used in fairly large dosages, compared to placebo. Anecdotal reports also support that it decreases the rate of recurrences of outbreaks for many people.
Opuntia Streptacantha- Extracted from a Cactus plant, it has been shown to kill viruses (including type 1 and type 2 herpes) in laboratory experiments. Sold as Nopal by HealthForce Nutritionals and as Exanol by Henderson-Morley.
Propolis- A nutrient made by honey bees. One study comparing a propolis ointment to acyclovir and placebo ointments showed a significant improvement in the rate of healing.
Prunella Vulgaris- A perennial plant commonly found in China and Europe. Extracts of this herb have been found to be effective against both herpes simplex 1 and 2 viruses. It is also believed to work against acyclovir-resistant strains of the herpes virus.
Red Marine Algae- Often referred to as a sea vegetable, research has shown that the sulfated polysaccharides in it may provide nutritional support for immune health and thus may assist the body's immune response to viruses.
A host of other natural extracts have been examined and have demonstrated anti-viral activity in the laboratory against herpes simplex viruses, including geranium, astragalus, sandalwood oil, and the Thai medicinal plants Aglaia odorata, Moringa oleifera, and Ventilago denticulata.
One study published in China found that all of the following medicinal plants had substantial activity against herpes simplex in the laboratory: Aristolochia debilis, Artemisia anomala, Lindera strychnifolia, Patrinia villosa, Pinus massoniana, Pyrrosia lingua, Rhus chinensis, Sargussum fusiforme, and Taraxacum mongolicum.
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 make life easier for persons with chronic infections.
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