Cold Sores

Herpes simplex virus (HSV) infections are very common worldwide. HSV-1 (oral-facial herpes) is transmitted through kissing or sharing drinking utensils and HSV-2 (genital herpes) through sexual contact. Both HSV-1 and HSV-2 can cause infections around the face mouth and genitals. The infection may not show symptoms for a long time and then become activated by ultraviolet light fever menstruation emotional stress a weakened immune system and trauma to the skin or nerves. Herpes infections in infants and in people who have weak immune systems or herpes infections that affect the eyes are serious and potentially life-threatening.

Signs and Symptoms

You may experience swelling and redness in your face and mouth areas including your gums and throat. You may feel tired have a fever and feel pain in your face and muscles. Blisters may appear on your lips face gums tongue inside your mouth and on your genitals. You may also have vaginal (in women) or urethral (in men) discharge.

What Causes It?

You can get herpes simplex if you come in close contact with an individual infected with HSV-1 or HSV-2 such as a family member or sexual partner. Herpes simplex can also be transmitted through certain occupations (such as dentistry) or sports (such as wrestling). You can get herpes simplex from an infected person even if he or she does not have active symptoms. A mother can also pass the infection to her baby during vaginal birth.

What to Expect at Your Provider's Office

Your provider will explain that there is no cure for herpes simplex but that you can treat the symptoms.

Treatment Options

Treatment Plan

There are various antiviral medications that can successfully treat an active HSV infection. They cannot cure the disease. However some of the drugs can help reduce the number of times that you have an infection.

Drug Therapies

Prescription

• Intravenous acyclovir—for herpes in newborns and for HSV encephalitis; various side effects
• Oral acyclovir oral valacyclovir oral famciclovir—for genital herpes; may help to reduce severity and the number of times that you have an infection; various side effects
• Oral acyclovir—for oral facial lesions; various side effects
• Idoxuridine trifluridine or topical vidarabine acyclovir or interferon—for herpes infection of the cornea (herpetic keratitis); various side effects
• Intravenous foscarnet—for HSV that does not get better with acyclovir; various side effects

Over the Counter

• Mild HSV infections may be treated with over-the-counter preparations of antiviral drugs.

Complementary and Alternative Therapies

Nutritional and herbal support can help you fight the herpes infection and strengthen your immune system.

Nutrition

• Avoid alcohol caffeine refined foods sugars saturated fats and arginine-containing foods (seeds grains nuts nut butters chocolate).
• Increase intake of high lysine-containing foods (fish chicken eggs potatoes and dairy products) during active herpes infection.
• Vitamin C (1 000 mg three times per day) and acidophilus (one capsule with meals) may reduce the length of outbreaks.
• Beta-carotene (50 000 to 100 000 IU per day) slows viral activity.
• Zinc (30 mg per day) slows viral reproduction.
• L-lysine (500 to 1 000 mg per day for prevention 2 000 mg two to four times per day during an outbreak)
• Thymus extract can help strengthen the immune system.
• Selenium (250 mcg per day) may reduce length and frequency.
• Vitamin A (200 000 IU per day for 3 days at onset of outbreak) can help decrease length and severity of symptoms. Pregnant women and those with liver disease should not take these doses of vitamin A.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots.

Topical cream applications of concentrated extracts of lemon balm (Melissa officinalis) or glycyrrhizic acid (from licorice root) can provide relief of symptoms and reduce severity and length of outbreak. They may be applied to both oral and genital lesions.

Internal treatment supports antiviral activity and immune function. For acute infection combine equal parts of the following herbs in a tincture (30 to 60 drops three to four times per day) or a tea (3 to 4 cups per day). Coneflower (Echinacea purpura) licorice root (Glycyrrhiza glabra) lemon balm (Melissa officinalis) yarrow (Achillea millefolium) chamomile (Matricaria recutita) and St. John's wort (Hypericum perforatum). Do not use licorice if you have high blood pressure. For recurrent infections substitute lomatium (Lomatium dissectum) and astragalus (Astragalus membranosus) for yarrow and chamomile and use the new formula in tincture form 30 drops three times per day. Lemon balm (Melissa officianalis) can be used internally for prevention and treatment.

Homeopathy

Some of the most common remedies used for HSV are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Apis mellifica when lesions are swollen stinging and burning
• Graphites for genital herpes on inner thigh with tremendous itching
• Petroleum for genital herpes that have spread to anus and thighs

Physical Medicine

Ice packs applied to oral lesions or to the sacral (lower back) area for genital lesions may help reduce pain and inflammation.

Acupuncture

To boost the immune system and relieve pain.

Massage

Massage helps reduce the effects of stress which may make HSV worse.

Following Up

Identifying and avoiding triggers (such as using sunscreen if ultraviolet light activates your symptoms) can help reduce recurrences.

Special Considerations

Getting herpes in the third trimester of pregnancy can be dangerous for both mother and baby. Your health care provider should know that you have had herpes.

Supporting Research

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Bartram T. Encyclopedia of Herbal Medicine. Dorset England: Grace Publishers; 1995:226–227.

Fauci AS Braunwald E Isselbacher KJ et al eds. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998:1080–1086.

Holmes KK Mardh PA Sparling PF. Sexually Transmitted Diseases. 2nd ed. New York NY: McGraw-Hill; 1995:391–408.

Krugman S Katz SL Gershon AA et al. Infectious Diseases of Children. St. Louis Mo: Mosby-Year Book; 1992:175–188.

Lad VD. The Complete Book of Ayurvedic Home Remedies. New York NY: Harmony Books; 1998:200–201.

Mandell GL Douglas RG Jr Bennett JE. Principles and Practice of Infectious Diseases. 3rd ed. New York NY: Churchill Livingstone; 1990:1144–1151.

Milman N Scheibel J Jessen O et al. Lysine prophylaxis in recurrent herpes simplex labialis: a double-bline controlled crossover study. Acta Derm Venereol. 1980;60:85–87.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993:29 171 172 289.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif: Prima Publishing; 1998:360 520–524.

Thein DJ Hurt WC. Lysine as a prophylactic agent in the treatment of recurrent herpes simplex labialis. Oral Surg Oral Med Oral Pathol. 1984;58:659–666.

Tyler VE: Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York NY: PharmaceuticalProducts Press; 1994:162–166.

Werbach M. Nutritional Influences on Illness. New Canaan Conn: Keats Publishing; 1988:213–215.

Wöbling RH Leonhardt K. Local therapy of herpes simplex with dried extract from Melissa officinalis. Phytomedicine. 1994;1:25–31.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.