MANAGEMENT OF ORAL HERPES INFECTIONS
Current Strategies by Dr. H., Medical Director
updated November 1, 2003
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 herpes 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 s horten 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 chemicals have been shown to have efficacy. Peter Klapper's "essential oils" for herpes infections have antiviral properties according to scientific research. He can be reached at www.fonoils.com. His reports to me indicate that these oils have been quite effective at aborting new outbreaks. I have personally sent a number of clients to that site, and the reports that I have received have been encouraging. Contact him for more information. Another product is a topical echinacea plus makeup, available at www.viramedx.com. The products from both of the above manufacturers are reasonably priced.
Sixth, a novel approach to oral herpes includes the use of the transmembrane electrode product from www.dermaseptic.com. This very interesting approach uses a silver electrode and a very small electric current to deliver silver ions across the cell membrane by electrophoresis. These silver ions delivered across the cell membranes seem to have anti-viral properties. This seems to make scientific sense, and their case by case reports seem to be encouraging. However, the product is expensive. I have seen it listed for a hundred dollars through "www.skymall.com".
Seventh, 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. Many manufacturers are available for these products, but a new website, www.opuntia.us, is a one-stop-shopping site for opuntia and lysine. Talk to us at the here at www.herpes.org about this if you have any questions. I am especially interested in the possibilities that may come about with the use of Prunella vulgaris. If a reader of this paper uses Prunella for the treatment of herpes, I would ask the reader to please contact me at the website and let me know if it seemed to help. 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. Beyond that, mild infections might well benefit from Klapper’s oils, Viramedx, or Abreva. Any of these may offer benefit.
3. Denavir might be tried next, but it is an expensive alternative, and one might want to go onto number 4 or number 5 below.
4. The oral, non-prescription herbals such as opuntia cactus (see above), olive leaf extract, red marine algae, and prunella vulgaris would be next.
5. 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.
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.