Herpes Simplex Virus

Important Points to Consider: Herpes Simplex Virus

• The virus cannot pass through a latex condom, but condoms do not completely prevent skin contact. People with any symptoms of herpes should abstain from sexual activity with uninfected partners.

• Early treatment does not seem to decrease the risk for recurrent infection.

• Asymptomatic HSV shedding occurs at some point in most people infected with herpes, and this may represent the most common form of HSV-1 and HSV-2 transmission.

  
  

Prevention Prescription

• Follow safe sexual practices, with the use of condoms and avoidance of oral sex if infectious status is unknown.

• Avoid contact with vesicular fluid to others or other body areas.

• Avoid trauma to the skin (physical trauma, rough intercourse, sunburns).

• Maintain a regular sleep-wake cycle with 8 hours of sleep daily.

• Avoid known food triggers.

• Eat lysine-rich food (vegetables, beans, fish, chicken, and turkey).

• Avoid excessive arginine-richfoods (chocolate, peanuts, almonds, cashews, sunflower seeds, and gelatin).

• Make lifestyle choices to reduce stress levels. Prevent and treat depression.

• Consider antiviral medications if outbreaks are frequent or you are immunosuppressed.

Therapeutic Review: Herpes Simplex Virus

Acute Treatment

Supplements

• Zinc sulfate: Topical solution 0.025% to 0.05%: applied daily at the start of an outbreak, then once weekly for 1 month, then twice a month

• Oral: 25 mg zinc added to 250 mg of vitamin C each twice a day for 6 weeks Vitamin C: 200 to 250 mg three times a day for 3 days

• Lysine: 1 g three times a day

• Emphasis is placed on lifestyle and mind-body techniques and reduced reliance on medication.

• Vitamin E oil (20,000 to 28,000 units/oz): applied topically to crusted lesions for 15 minutes three times a day for 3 days

Botanicals

• Lemon balm 1% cream or ointment (70:1 extract): applied two to four times daily at onset of symptoms to 2 to 3 days after healing

• Siberian ginseng (eleutheroside E 0.3% standardized extract): 400 mg by mouth daily (higher doses and long-term use can lead to significant adverse effects)

• Rhubarb and sage extract cream containing 23 mg/g each: applied topically every 2 to 4 hours for 7 days

• Propolis 3% ointment: applied topically 4 times a day (use caution if patient has a bee allergy)

• Sangre de Grado (SP-303) 15% ointment: applied topically to lesions three times a day for 21 days

• Aloe vera 0.5% extract cream: applied topically three times a day for 2 weeks

Pharmaceuticals

Primary infection

• ⁠Acyclovir: 400 mg orally three times daily or 200 mg orally five times daily for 7 to 10 days

• Famciclovir: 500 mg orally three times daily for 7 to 10 days

• Valacyclovir: 1000 mg orally twice daily for 7 to 10 days

• Recurrent infection

Topical

• Acyclovir cream or ointment: applied 6 times a day for 7 days

• Pencilovir cream: applied every 2 hours while awake for 4 days

Oral

• Acyclovir: 200 to 400 mg five times daily for 5 days Famciclovir: 750 mg twice daily for 1 day or 1500 mg single dose

• Valacyclovir: 2g twice a day for 1 day

Prevention of Recurrences

Lifestyle

• Avoid trauma to genital and oral mucosa.

• Use sun protection.

• Encourage 8 hours of sleep each night.

Nutrition

• ⁠Encourage seven to eight servings of fruits and vegetables a day.

• Increase lysine-rich foods.

• Decrease arginine-rich foods.

• Consider an elimination diet.

Mind-Body Therapy

• Make lifestyle changes to reduce chronic stress, anxiety, and depression. Educate patients on techniques for relaxation such as breath work and meditation. Treat depression when present.

Supplements

• ⁠Zinc

• Topical: 0.05% solution before and during sun exposure at the site of previous HSV infection

• Oral: 25 mg twice a day (supplement with copper if long-term use)

• Lysine: 1 g three times a day

Botanicals

• ⁠Siberian ginseng (eleutheroside E 0.3% standardized extract): 400 mg a day (high doses and long-term use can lead to significant adverse effects).

Pharmaceuticals

• Acyclovir: 400 mg orally twice daily

• Valacyclovir: 500 mg orally once a day

Key Web Sources

• University of Maryland Medical Center http://www.umm.edu/patiented/articles/what_herpes_simplex_000052_1.htm.

• American Academy of Dermatology. http://www.aad.org/public/publications/pamphlets/viral_herpes_simplex.html.