The message, though, is that desperate people who are suffering will often jump at offers of “cures” from various medical and quasi-medical solutions which have not been substantially examined by peer-reviewed research. The results of these “solutions” in fact may include increased suffering by the victim and a worsened public health outcome both for the victim and the victim’s consorts.
The author respectfully requests that the reader take a few minutes and review this paper. The reader will find a broad, readable discussion about the current recommended treatments for HI. After reading this discussion, hopefully the appropriate treatment(s) for the condition will become apparent.Herpes is a virus that infects the nervous system, modifying the DNA of the nerve cells supplying the skin through which the virus entered. The infection is permanent. Most patients suffer from recurrences that may vary in frequency from once in a lifetime to non-stop infections that never go away. The average rate of recurrences is about four times per year, plus or minus one or two, with some variation of recurrence rate by gender. Recurrences typically take about a week or so to heal. This means that the average untreated person with HI spends about a month out of the year with lesions.

Another fact about having an infected nerve cell is that the cell may be making viral particles at any time, perhaps most of the time. The signs of recurrence on the skin apparently are related to the production of a large amount of viral particles. Probably when the nerve cell makes fewer viral particles, the skin may not show signs. Put another way, the nerve cell may be actively producing viral particles even though the skin has no rash or redness. This condition is called “asymptomatic viral shedding”. The general consensus is that any person with HI who does not have any symptoms currently in fact is shedding virus about 4% of the time. Put another way, an asymptomatic person with HI has a 1 in 25 chance of being contagious at any given time. This is true assuming of course that the person is not on medications (see below). Current research in female patients puts the asymptomatic viral shedding rate in genital Herpes infections (GHI) even higher in one published study.

The problem with HI, therefore, is that a piece of viral DNA resides permanently in a nerve cell . This viral DNA is periodically copied and turned into viral particles that may generate contagious viral shedding or cause a contagious rash. It is through interfering with the process of the formation of viral particles where the opportunity comes to “treat” the problem and prevent the spread of these particles to non-infected patients.

The mainstay of treatment is in the identification of the illness and forming a rational plan to manage the condition. Evidence exists that patients “auto-inoculate” themselves. In this condition, the patient makes him/herself worse, either through the spreading of the infection on the skin to adjacent skin areas OR actual spread from nerve cell to nerve cell in the area where the nerve cell lives beside the spinal cord (called the ganglion). The former occurs in part when the untreated rash is allowed to remain undrained and uncleaned. The latter probably occurs at various time, including when the patient has symptoms and does not take medication to terminate the symptoms.

The first point of care then is that a person with symptoms needs a diagnosis. Any person with an oral or genital/rectal rash, especially associated with blisters, pain, or pain referred into the buttocks or legs, should be seen and evaluated by a physician or other trained medical professional skilled in the evaluation and management of HI. A viral culture should be taken of a lesion at some point in the person’s medical history to attempt to identify the organism. The patient’s consort should be counseled and possibly evaluated along with the patient.

Blood tests to establish diagnosis of HI are not always very helpful. The only REAL way to document that a patient has suddenly developed HI from a blood test is to draw blood quickly after the onset of symptoms and to document that the patient’s blood test is negative. Then 4 to 6 weeks later a second blood test is drawn to document that the patient has suddenly developed antibody against the virus. Even then, these tests are not completely reliable and often do not give clear and concise answers.

Smart living prevents infections. It is clear from various studies that educated patients and educated consorts can drastically reduce the transmission of infections. While it has been shown in earlier studies that consorts do often become infected, it is also clear that the use of anti-viral medications (see below) decreases both recurrence frequency and viral shedding. Medication combined with smart living and use of condoms can drastically lower disease transmission. This is not a guarantee, of course, but it does offer some reassurance that in the symptom-free patient who is taking medications as directed and using a latex condom, the risk of transmission is very, very low, possibly as low as one chance in a thousand per exposure.

The combination of smart living with anti-viral medications (in patients for whom these medications work) can potentially create a vast public health improvement affecting literally millions of individuals.

Anti-Viral Medications

About twenty years ago it was noticed that certain viral infections could be treated through the use of chemicals that are part of DNA. Specifically, modified “bases” could be applied topically (on the outside of the body) in the setting of virus infections in the eye, for example, that could improve the infection. Soon to follow was the use of a modified “guanosine”, called acyclovir, as a cream to be applied onto HI lesions, which produced some modest improvement in symptoms. The rash would clear up a couple of days quicker than if no cream were used. Recurrence frequency was not affected.

About 15 years ago acyclovir became available for oral use. Studies rapidly appeared indicating that the medication was not only safe but highly effective. When taken as directed, patients’ symptoms of both acute infections and recurrences rapidly improved. When the medication was taken ONLY for recurrences, little influence was found upon recurrence frequency.

About 10 years ago it was found that acyclovir, when taken on a daily basis, could decrease recurrence frequency to about once per year. Also, it was found that when a recurrence DID occur, it was milder and of shorter duration. Further, recent studies have indicated that asymptomatic viral shedding was reduced as much as 80% in patients who took acyclovir regularly.

How does Acyclovir work? Its actual effect in killing virus has not been definitely proved. Acyclovir has several actions in the test tube. It inhibits the enzymes that copy viral DNA, and it also inhibits the replication of virus. Also, again in the test tube, acyclovir is taken up into the growing chains of viral DNA, causing termination of these chains. Acyclovir seems to be “selectively” taken up by infected cells. Acyclovir is much less toxic for normal cells because less is drug is taken up, less is converted to active form, and normal cell enzymes are less sensitive to the chemical (to paraphrase the PDR online).

The problem with acyclovir is this: It doesn’t stay in the body very long, and when taken by mouth, its blood levels are fairly low. A modification of the acyclovir molecule, called valacyclovir, gives higher blood levels. As a matter of fact, valacyclovir is able to achieve blood levels almost equivalent to the intravenous administration of acyclovir.

The use of any anti-infective chemical can be associated with increasing the occurrence of resistant organisms. Certainly this is also true in the case of acyclovir for HI. Resistant organisms have occurred, in some cases requiring multiple anti-viral medications to control symptoms. Interestingly, one study suggested that allowing break periods in the administration of acyclovir allowed sensitivity to the drug to return. This technique is speculative and not currently recommended.

That being said, however, HI resistance to acyclovir and the other antiviral medications is relatively rare. Specifically, the percentage of cases of acyclovir resistance seems to be stable at about 0.3% of all persons with herpes infections. This means that 99.7% of people with herpes infections carry viruses that are sensitive to acyclovir, and this is great news for almost everyone that has a herpes infection. If outbreaks occur, then if acyclovir is taken (or the other antivirals such as famciclovir or valacyclovir), almost certainly the outbreak will come under control.

Almost all patients can control symptoms through Smart Living concepts along with medication. The medication is very well tolerated and has few side effects.

How much medication is enough? For acute episodes the recommended dosage of acyclovir is 200 mg taken five times per day for approximately ten days, possibly longer. This author’s clinical experience indicates that 400 mg taken two or three times daily is probably equally effective.

The dosage of valacyclovir is 500 to 1000 mg daily for outbreaks. This medication can be taken once or twice daily, which is more convenient for most people. The duration of the therapy is the same as for acyclovir. The cost of the brand product of valacyclovir is much higher than generic acyclovir, so the consumer will have to weigh if an additional benefit is brought by the additional cost.

Therapy for recurrences can be performed in two ways: Episodic therapy, and chronic suppressive therapy. In the first, the patient takes about 400 mg of acyclovir two or three times per day (whichever level it takes to reduce symptoms) for about a week or ten days. The dosage of valacyclovir is 500 to 1000 mg once or twice daily, depending on the responsiveness of the patient. Most patients will promptly clear their symptoms on this level of medication. Depending on the patient’s “disease level”, either the condition will go away for an indefinite period OR the patient will then have another recurrence once off the medication.

Patients who seem to have regular recurrences in spite of Smart Living and/or in spite of episodic therapy are candidates for chronic suppressive therapy. In this treatment method, the patient will take a daily dosage of acyclovir or valacyclovir either once or twice daily. The dosage per pill will be 200 mg to 800 mg for acyclovir and 500 mg to 1000 mg for valacyclovir. The minimal dosage that will control symptoms is the dosage that should be taken. Given this treatment method, recurrences in almost all patients can be reduced to once or twice per year, and the recurrences that occur will be milder. One should also remember that asymptomatic shedding will be substantially reduced on chronic suppressive therapy, which should reduce how contagious a person with GHI will be.

Herpes.Org can provide links to an on-line pharmacy if you wish. Please contact the Medical Director of Herpes.org by clicking Here if you wish for a referral to a low cost provider. Herpes.org researches the cost of medications on-line to help our readers obtain the lowest cost of medication possible.

Famvir, a drug similar to acyclovir (penciclovir), theoretically, would seem to offer some advantage for therapy because of the increased presence of the medication within the cell, due to the manner in which the medication is phosphorylated. One would think that a medication which is more rapidly absorbed AND which persists longer inside the target area would in fact give a substantially improved effect. At this point, this does not seem to be the case based upon readily available patient treatment data.

How long can a patient safely be on acyclovir or other antivirals.? Two papers (Baker from Stony Brook and Goldberg from Baylor, possibly reporting the same data) report a study going out five years. No side effects were reported in the abstracts, and viral resistance to acyclovir was “not observed”. Recurrences were diminished from a mean of about 13 recurrences per year to less than one, a reduction of 92%. They found that the recurrence frequency continued to be reduced into the third year on medication, and beyond that no further reduction in recurrence frequency was noted. In this study the dose of acyclovir was 400mg twice daily. The reader is referred to the quoted New England Journal article above suggesting that the patient should tailor the dosage to the minimum needed to “control symptoms”.

Studies going out nearly a decade of patients on continuous acyclovir therapy continue to reveal the safety of antiviral medications for herpes infections when taken daily for many years. No toxicity was reported in these studies, nor was there an increase in viral resistance to the medication.

How should a patient actually take the medication when on suppressive therapy? This author suggests placing the dosage alongside a patient’s daily vitamins: Vitamins C, E, B complex, selenium (for males), and tomato juice (especially for males because of the lycopene) are suggested. (One might also consider taking dosages of atragalus, echinacea, and possibly red marine algae. These three have had various articles suggesting immune system benefits that could possibly reduce recurrence frequency, though the results of these studies are less clear). In this manner the prescription medication will not be forgotten.

The problem with acyclovir is this: It doesn’t stay in the body very long, and when taken by mouth, its blood levels are fairly low. A modification of the acyclovir molecule, called valacyclovir, gives higher blood levels. As a matter of fact, valacyclovir is able to achieve blood levels almost equivalent to the intravenous administration of acyclovir.

The use of any anti-infective chemical can be associated with increasing the occurrence of resistant organisms. Certainly this is also true in the case of acyclovir for HI. Resistant organisms have occurred, in some cases requiring multiple anti-viral medications to control symptoms. Interestingly, one study suggested that allowing break periods in the administration of acyclovir allowed sensitivity to the drug to return. This technique is speculative and not currently recommended.

That being said, however, HI resistance to acyclovir and the other antiviral medications is relatively rare. Specifically, the percentage of cases of acyclovir resistance seems to be stable at about 0.3% of all persons with herpes infections. This means that 99.7% of people with herpes infections carry viruses that are sensitive to acyclovir, and this is great news for almost everyone that has a herpes infection. If outbreaks occur, then if acyclovir is taken (or the other antivirals such as famciclovir or valacyclovir), almost certainly the outbreak will come under control.

Almost all patients can control symptoms through Smart Living concepts along with medication. The medication is very well tolerated and has few side effects.

How much medication is enough? For acute episodes the recommended dosage of acyclovir is 200 mg taken five times per day for approximately ten days, possibly longer. This author’s clinical experience indicates that 400 mg taken two or three times daily is probably equally effective.

The dosage of valacyclovir is 500 to 1000 mg daily for outbreaks. This medication can be taken once or twice daily, which is more convenient for most people. The duration of the therapy is the same as for acyclovir. The cost of the brand product of valacyclovir is much higher than generic acyclovir, so the consumer will have to weigh if an additional benefit is brought by the additional cost.

Therapy for recurrences can be performed in two ways: Episodic therapy, and chronic suppressive therapy. In the first, the patient takes about 400 mg of acyclovir two or three times per day (whichever level it takes to reduce symptoms) for about a week or ten days. The dosage of valacyclovir is 500 to 1000 mg once or twice daily, depending on the responsiveness of the patient. Most patients will promptly clear their symptoms on this level of medication. Depending on the patient’s “disease level”, either the condition will go away for an indefinite period OR the patient will then have another recurrence once off the medication.

Patients who seem to have regular recurrences in spite of Smart Living and/or in spite of episodic therapy are candidates for chronic suppressive therapy. In this treatment method, the patient will take a daily dosage of acyclovir or valacyclovir either once or twice daily. The dosage per pill will be 200 mg to 800 mg for acyclovir and 500 mg to 1000 mg for valacyclovir. The minimal dosage that will control symptoms is the dosage that should be taken. Given this treatment method, recurrences in almost all patients can be reduced to once or twice per year, and the recurrences that occur will be milder. One should also remember that asymptomatic shedding will be substantially reduced on chronic suppressive therapy, which should reduce how contagious a person with GHI will be.

Herpes.Org can provide links to an on-line pharmacy if you wish. Please contact the Medical Director of Herpes.org by clicking Here if you wish for a referral to a low cost provider. Herpes.org researches the cost of medications on-line to help our readers obtain the lowest cost of medication possible.

Famvir, a drug similar to acyclovir (penciclovir), theoretically, would seem to offer some advantage for therapy because of the increased presence of the medication within the cell, due to the manner in which the medication is phosphorylated. One would think that a medication which is more rapidly absorbed AND which persists longer inside the target area would in fact give a substantially improved effect. At this point, this does not seem to be the case based upon readily available patient treatment data.

How long can a patient safely be on acyclovir or other antivirals.? Two papers (Baker from Stony Brook and Goldberg from Baylor, possibly reporting the same data) report a study going out five years. No side effects were reported in the abstracts, and viral resistance to acyclovir was “not observed”. Recurrences were diminished from a mean of about 13 recurrences per year to less than one, a reduction of 92%. They found that the recurrence frequency continued to be reduced into the third year on medication, and beyond that no further reduction in recurrence frequency was noted. In this study the dose of acyclovir was 400mg twice daily. The reader is referred to the quoted New England Journal article above suggesting that the patient should tailor the dosage to the minimum needed to “control symptoms”.

Studies going out nearly a decade of patients on continuous acyclovir therapy continue to reveal the safety of antiviral medications for herpes infections when taken daily for many years. No toxicity was reported in these studies, nor was there an increase in viral resistance to the medication.

How should a patient actually take the medication when on suppressive therapy? This author suggests placing the dosage alongside a patient’s daily vitamins: Vitamins C, E, B complex, selenium (for males), and tomato juice (especially for males because of the lycopene) are suggested. (One might also consider taking dosages of atragalus, echinacea, and possibly red marine algae. These three have had various articles suggesting immune system benefits that could possibly reduce recurrence frequency, though the results of these studies are less clear). In this manner the prescription medication will not be forgotten.