Your Guide To Treating and Suppressing Herpes

The herpes simplex virus (HSV) consists of two types, HSV-1 and HSV2. HSV-1 type virus is responsible for causing oral herpes and the commonly known symptom, cold sores. The prevalence of HSV-1 is especially high, in the UK population approximately 66% of people are estimated to have the strain^[1]. HSV-2 is responsible for causing genital herpes, it is easily transmitted during sexual intercourse with an estimated 23% of sexually active adults in the UK believed to have genital herpes^[2]. Both virus types typically lie dormant in the nerve cells of the body, once you have HSV it remains in the body permanently. From time to time an outbreak of symptoms can occur which require antiviral treatment to clear and suppress the outbreak. There are many treatments available to treat both HSV-1 and HSV-2, so knowing which is best for you is essential.

What is the most recommended type of genital herpes treatment?

Genital herpes can be treated with both topical creams and oral antiviral medication. The efficacy of oral medication is significantly higher compared with topical creams and are seen as the most effective treatment type available^[3]. Oral antiviral medication works by inhibiting the HSV DNA, actively preventing the virus from multiplying; early use of antiviral medication following an outbreak is important to significantly reduce the duration of symptoms^[4].

The 4 recommended oral antiviral genital herpes treatments consist of:

• Aciclovir:
  Aciclovir (also known as Acyclovir) is an antiviral medication taken to both clear outbreak episodes and suppress gential herpes; it is recognised as a first-line therapy option and is most commonly used in the treatment of genital herpes^[5]. The efficacy of Aciclovir as a suppression treatment for genital herpes is significant, it can help to prevent up to 80% of outbreaks from recurring^[6].
• Valaciclovir:
  Valaciclovir (also known as Valacyclovir) is an antiviral medication used to both clear outbreaks and suppress genital herpes. Valaciclovir breaks down into Aciclovir in the body, which means it stays in the body for longer and does not need to be taken as often as Aciclovir.
• Valtrex:
  Valtrex is the branded version of Valaciclovir. Valtrex contains the active ingredient Valaciclovir and is used to clear outbreaks and suppress genital herpes. The main differences between the two are that Valtrex is a brand name, the excipients used to make the tablets may differ and Valtrex is considerably more expensive than valaciclovir. It is important to emphasise that Valtrex and Valaciclovir both have identical medical efficacy in treatment of genital herpes.
• Famciclovir:
  Famciclovir is an alternative oral antiviral treatment. It works in a similar way to the other available gential herpes treatments in that it targets the HSV virus to stop it multiplying. Famciclovir is equally effective at treating herpes outbreaks as the other medications, however, there is not a suppression dosage available.

The main differences between Aciclovir and Valaciclovir (Valtrex)^[7]:

• Aciclovir is more cost-effective.
• Valaciclovir has a better bioavailability so can be taken less frequently.
• Valaciclovir is deemed to be more tolerable when taken for suppression treatment.

What is the most recommended type of cold sore treatment?

The main symptoms of cold sores consist of itchy, sore blisters forming on the face and around the lips. An outbreak may be preceded by a tingling or burning sensation in the infection area. Following the formation of blisters, they can sometimes crack and bleed which can be very uncomfortable. Given the high degree of discomfort due to cold sores, clearing symptoms quickly is essential.

Oral antiviral medication offers exceptional efficacy and is considered a first line treatment for treating cold sores. Topical creams and patches are also considered to be highly effective at treating cold sores, especially at aiding the healing process of the sores.

The 3 recommended oral antiviral cold sore treatments consist of:

• Aciclovir:
  Aciclovir (also known as Acyclovir) is a highly effective antiviral medication taken to effectively treat cold sore outbreaks. Aciclovir is the most cost effective antiviral treatment available. Aciclovir works by preventing the HSV virus from multiplying, which significantly shortens the outbreak duration and severity accompanying symptoms.
• Valaciclovir:
  Valaciclovir (also known as Valacyclovir) is an alternative antiviral medication used to treat cold sores. Valaciclovir is a ‘prodrug’ and a prodrug of Aciclovir, which means it changes into Aciclovir in the body. Consequently, Valaciclovir stays in the body for longer and does not need to be taken as often as Aciclovir which may be more practical in some instances.
• Valtrex:
  Valtrex is the branded version of Valaciclovir. Valtrex contains the active ingredient Valaciclovir, the only difference is that Valtrex is a brand and Valaciclovir is the unbranded generic version. Both have identical efficacy, however, the excipients used to make the two medications may differ slightly. Valtrex is also more expensive than Valaciclovir due to the fact it is a brand.

Cold sore patches and creams:

• Zovirax Cream:
  Zovirax cream contains the active ingredient Aciclovir. Zovirax is clinically proven to treat cold sores within 3 days and is one of the most highly recommended topical treatments available.
• Bonjela Cold Sore Cream:
  Bonjela cold sore cream contains the active ingredient UV-Active™, which is highly effective at blocking UV radiation (a known cold sore trigger), whilst preventing the HSV from multiplying. Bonjela cold sore cream is a highly recommended alternative for treating HSV-1.
• Compeed Cold Sore Patch:
  Compeed cold sore patches provide excellent discretion, they work due to the active role of a hydrocolloid active gel to enhance healing and reduce scabbing.

Important treatment factors to consider

When selecting medication to treat cold sores (HSV-1) or gential herpes (HSV-2), it’s important to consider the series of factors that may contribute to selecting a treatment.

1. Episodic or Suppression Dosage (for gential herpes treatment only)
   The type and frequency of genital herpes outbreaks you are experiencing is important. The outbreak (episodic) dosage is effective at treating genital herpes outbreaks as they occur. This form of dosage may be more suitable where outbreaks are infrequent and only occasionally occur. All our available treatments offer an outbreak dosage; Aciclovir is acknowledged as the first-line therapy treatment option for episodic outbreaks.
   
   Suppression therapy involves a daily dose(s) of medication taken for a period of 3 months. Suppression therapy is highly effective at reducing the frequency of outbreaks and may be more suitable if you experience multiple outbreaks within a one year period. Aciclovir, Valaciclovir and Valtrex all offer suppression treatment options but Famciclovir does not. While the efficacy of all three treatments in suppressing gential herpes is equal, the bioavailability of Valaciclovir and Valtrex is slightly better which means that it stays active in the body for longer.
2. Dosage Strength
   The dosage strength of cold sore and genital herpes medications vary. Aciclovir has a dosage strength of 400mg, Valaciclovir and Valtrex have a dosage strength of 500mg while Famciclovir has a dosage strength of 125mg. While the dosage strengths differ across medications, the efficacy of each treatment remains the same.
3. Branded or Generic - what’s the difference?
   Prescription treatments are sold as either brands or generic versions. Aciclovir, Valaciclovir and Famciclovir are all active ingredients and their own generic treatment version. Valtrex, however, is the branded version of Valaciclovir. Both branded versions and generic versions are medically identical and work in exactly the same way. So what’s the difference?
   
   The only differences between generic and branded versions is the excipients used to make the tablets and the price. Branded treatments are often considerably more expensive than generic version treatments.
4. Treatment Cost
   In addition to the increased cost of branded medication compared to generic unbranded medication, there is some variability in price across the four medications. Aciclovir is the most cost-effective antiviral medication for treating episodic outbreaks of cold sores and genital herpes. It is also the most cost effective treatment at effectively suppressing the HSV-2 virus in the treatment of genital herpes. Valtrex is the most expensive suppression treatment option, with Valaciclovir offering a more affordable alternative. Famciclovir is the most expensive treatment for treating individual outbreaks.