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This page discusses prescription antiviral medications that have been approved by the FDA for the treatment of colds sores (fever blisters). The mode of action associated with prescription antiviral medications is one where they are used to interfere with herpes virus replication (the production of more virus particles, called virions). In comparison, once a lesion has reached the Blister stage (the point of maximum viral presence) or beyond, an antiviral will have no practical effect because the stages involving the bulk of virus production have already passed. Even when a lesion is being treated with an antiviral, the risk of transmission of the herpes virus to others, or to other parts of your own body, remains and therefore precautions should still be taken. Topical medicines for cold sores are those that are applied as an ointment or cream directly to the surface of the lesion.
Denavir® cream was the first antiviral medication to be granted FDA approval for use in the treatment of cold sores. Its instructions state that it should be applied repeatedly throughout the day every 2 waking hours (roughly 9 times a day) for 4 days on those external areas of the lips or face where the cold sore is forming. Zovirax® cream received FDA approval for use in the treatment of cold sores in late 2002, although other formulations of this medication have been used in treating herpes for many years (including an "off-label" use in the treatment of cold sores in the years prior to 2002).
The cream is applied to the area where the cold sore is forming 5 times per day, for 5 days. The idea with this product is that the steroid component helps to stifle the extent of the inflammation reaction that takes place in response to the presence of the virus particles and the destruction they have caused.
We think that the answer to this question is best answered by your health care professional. A study by Hull (2014) evaluated the use of an acyclovir (5%) and hydrocortisone (1%) cream (Xerese®). Opstelten (2008) reviewed 10 studies that had evaluated the use of acyclovir cream (found in Zovirax®).
This same literature review stated that two penciclovir studies (the compound found in Denavir®) reported findings that were similar as those for acyclovir. We found three studies (Femiano 2001, Lin 2002, McKeough 2001) that each studied the head-to-head effectiveness of acyclovir cream (the compound found in Zovirax®) and penciclovir cream (the compound found in Denavir®) in the treatment of cold sores. Historically, oral antiviral medications have not routinely been used in the treatment of cold sores. Depending on the practitioner, it may be that these medicines are more likely prescribed in situations where there's a history of especially severe or disfiguring lesions, cases involving newborn babies or immunocompromised patients. As with all other antiviral approaches, starting the medication as early as possible (during the Tingle stage) is key for effectiveness.
All prescription medications should only be used under the direction and supervision of a health care professional. The drug is also used for prophylaxis against herpes family viruses in immunocompromised patients (such as patients undergoing cancer chemotherapy). Alghough Acyclovir is considered a narrow range antiviral agent and presents a relatively low cytotoxicity, it negatively and aggressively affects the state of biological equilibrium in a living organism. The drug’s toxicity should be considered in all patients where any organs have an impaired function, especially liver or kidneys. When using the drug, it is advised to reduce dietary calcium as it alters calcium metabolism and drink plenty of water to reduce the strain on the kidneys. Acyclovir should only be used as a last measure of the viral control if other methods are not effective. Information DisclaimerBy using this website the user assumes all responsibility and risk associated with using the information provided herein. In jurisdictions which do not allow some or all of the usage exception provided, liability shall be limited to the maximum extend allowed by an applicable law. It is estimated that at least one in five adults is infected with the virus, but many of these have no symptoms and do not know they have the virus. Herpes infectionGenital herpes is an infection caused by herpes simplex virus type 2, which is transmitted through sexual intercourse.
Herpes simplex virus type 2 is transmitted through sexual contact, being highly contagious when the patient has active lesions (the symptoms will be explained below). The frequency of virus shedding is becoming smaller as the years pass from the first appearance of herpes.
Herpes simplex virus Whenever the patient has a crisis, its transmission rate rises again, going back to last fall as the crisis is getting older. HIV-positive patients who also have genital herpes are the group with the highest transmission possibility during the asymptomatic phase. The herpes simplex virus type 1 often causes lesions only in the mouth, but can be transmitted to the genitals during oral sex. The herpes simplex virus type 2 survives for a very little time in the environment, transmission through clothing or towels is uncommon.


The use of condoms reduces the chance of transmission, but does not eliminate it completely, since the herpes lesions can appear in the genital areas that are not covered by the condom. Most patients who become infected with herpes simplex virus type 2 do not develop the disease, remaining asymptomatic and unaware of the infection. Herpes infection The first time that the lesions of genital herpes occur after the patient has been infected is called the primary infection.
The symptoms of genital herpes tend to develop in three to seven days after intercourse responsible for the infection, but in some cases may take up to two weeks. Besides the typical lesions of herpes, primary infection is usually accompanied with other symptoms such as fever, malaise and body ache. The lesions in primary infection of genital herpes usually take on average 20 days to disappear. Herpes recurrencesAfter primary infection genital herpes lesions disappear remaining silent for several months. The recurrent lesions tend to be less painful and last for about 10 days, half the time of primary infection.
Days before the lesions recur, the patient may experience some symptoms of warning, like an itchy labia majora, a penile numbness or tingling in the genital region.
In some cases the patient may not develop symptoms of primary infection soon after infection, ulcers can appear only years later, after some event that reduces your immunity. Herpes diagnosis The lesions of genital herpes are typical during the crisis and are easily recognized by experienced physicians.
The tests can identify the virus, but do not provide information on when the patient was infected. Herpes drugsAlthough there is no cure for genital herpes, infection can be controlled with antiviral therapy. Three antiviral drugs are used for the treatment of genital herpes: Acyclovir (Zovirax), Famciclovir (Famvir), Valacyclovir (Valtrex). In patients with more than six outbreaks per year can be indicated suppressive therapy, which consists of continuous daily use of an antiviral at low doses to avoid recurrences. In addition to the antiviral drugs, certain home therapy can be used to alleviate the symptoms of an outbreak of genital herpes. But by reducing the total number of virions that are involved, they limit the lesion's extent and severity. That's because at this point the rate of viral replication has not yet reached its peak and can still be stifled. The FDA has given approval for 3 topical products for the treatment of cold sores:  1) Denavir® 1% (penciclovir). The cream is applied to those external areas of the lips or face where the cold sore is developing, 5 times a day for 4 days. Having said that, research seems to suggest that the combination medication Xerese® (antiviral plus steroid) is more effective than just-antiviral medications. It found that the total area of the cold sore lesions that formed were 50% smaller than when no treatment was used.
However, one of these studies also reported a reduction in the duration of pain, by 0.5 days. The conclusions drawn by all three of these studies seem to suggest that penciclovir cream is the more effective of the two. However, short-course regimens of valacyclovir (Valtrex®) and famciclovir (Famvir®) now do have FDA approval for this use and have been shown to accelerate lesion healing and decrease pain.
However, in immune-compromised people, continuous use of the drug can lead to development of a viral resistance (viral mutation), significantly decreasing the effectiveness of the agent. Other methods of viral control are low carbohydrate diet, restoration of the digestive function, particularly protein absorption with protease enzymes, restoration of the intestinal flora particularly with acidophilus probiotics, reduction of stress, staying warm, dietary avoidance of coffee, beverages that contain citric acid, arginine rich foods, and raising body alkalinity with foods and especially with consumption of lemons. Individuals who have genital herpes are encouraged to talk to a sexual partner, use condoms and take other measures to prevent transmission.
The herpes simplex virus type 1 can cause genital herpes as well, but is usually associated with herpes labialis.
A big problem is that genital herpes transmission can occur even in times when the patient is asymptomatic. The disposal out of the crisis is greatest in the first three months after primary infection. 70% of transmissions of genital herpes occur in the asymptomatic phase, since during the crises the patient usually avoids having sex. Once infected, patients with type 1 herpes can transmit the disease in the same way that patients infected with the second type. For example, a herpes lesion on the scrotum remains exposed even with the proper use of condoms.


They can arise in lymph nodes groin area, and if the ulcers are close to the urethra, there may be intense pain while urinating. In women lesions may be visible outside the vagina, but they usually occur inside, where they are hidden.
In most patients the infection emerges from time to time, in some cases, more than once a year.
Among the most common are extreme physical exertion, emotional stress, illness, recent surgery, excessive sun exposure and immunosuppression. In these cases, in spite of the first appearance of the wounds, the disease behaves more like a recurrence than as primary infection, being shorter and less painful.
If there is need for laboratory confirmation, or if the damage is not very typical, the doctor may take samples of ulcers for virus identification. The antiviral treatment serves to accelerate the healing of injuries, alleviate the symptoms to prevent complications and reduce the risk of transmission to others. People with a history of recurrent genital herpes are often advised to keep a stock of antiviral medication at home, in order to start treatment as soon as the first signs of a recurrence.
The advantage of suppressive therapy is that it reduces the frequency and duration of relapse, and can also reduce the risk of transmission of herpes virus to the uninfected partner. Some experts recommend pause treatment periodically (every few years) to determine if the suppressive therapy is still required.
The virus will still reside in your body and your risk for continued outbreaks will remain the same.
Once the drug resistance is developed, it would also reduce the effectiveness of other antiviral drugs such as valaciclovir and famciclovir. If any kidney discomfort continues with usage of the drug, it should be immediately discontinued.
Supplementation of L-Lysine amino acid at 250-500mg daily in mornings for a couple of weeks can be helpful. Therefore, even when the virus is eliminated intermittently, the patient can transmit genital herpes to your partner(s).
After 10 years of infection, the transmission out of the crisis is becoming increasingly less common.
The difference is that crises are usually milder and less frequent, and the transmission out of the crisis is less common.
In patients who develop symptoms, the clinical picture is divided into two situations: primary infection and recurrence.
90% of patients experience a recurrence in the first interval of 18 months after primary infection.
In asymptomatic phases it is possible to investigate the herpes infection through serology, which can identify both the herpes simplex virus type 1 and type 2. Women who are having pain urinating may feel less discomfort during the sitz bath or a shower with warm water. Therefore, in order for the medication being effective, it has to be taken every few hours to sustain its concentration in the blood stream. If a long term acyclovir administration is warranted, the agent’s blood plasma concentrations should be measured regularly to avoid severe intoxication, especially in patients with renal dysfunctions. Usually in a period of 100 days, the patient has 2 or 3 times of eliminating the virus asymptomatically. 400 patients with genital herpes were studied for more than 10 years and sampled out of the genitals of seizures for a period of 30 days.
The lesions of genital herpes can also arise at any point of the perineum and around the anus of the patient who practice anal sex.
However, there are cases in which recurrence is not possible to identify any triggering factor.
The problem is that, as the first appearance of the wound, the patient tends to think he has been infected recently, and this often causes problems in couples with a stable relationship for years. Immunomodulatory herbs such as andrographis paniculata can be very helpful short term as well. Patients usually having frequent recurrences are those who have a prolonged primary infection with herpes initial lesions lasting more than one month. In these situations it is very difficult to establish precisely when the patient was infected and whoor what was the cause.



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