Herpes Simplex Virus, or HSV, is currently a non-curable disease. The severity and frequency of outbreaks differs widely among those who experience them, especially in the case of Type 2 HSV. Because of this and the factors that can instigate an outbreak, including current health status of the patient, doctors not only have a solid foundation of prescription topical and oral medications, but a choice in type of drug therapy when managing Type 2 HSV. Drug therapies applied either to the treatment of Type 2 HSV or shingles are considered “suppressive” or “episodic” therapies.

Suppressive Therapy

A suppressive therapy for treating HSV is aimed at those whose outbreaks generally recur with high frequency -- more than 6 times annually. A suppressive therapy dictates long-term, daily use of prescription medications in order to control viral flare-ups. This long-term use has proven results of vastly cutting the frequency of recurrent outbreaks and reducing the viral shedding that is indicative of HSV. Viral shedding is a characteristic of HSV in which skin cells harbor the virus in the absence of a lesion outbreak, making the area viable as a means of infection to a sexual partner.
It should be noted that prescription oral antiviral medications other than acyclovir, are relatively new and studies on their long-term use in suppressive therapy are not available.

Episodic Therapy

An episodic therapy approach is an HSV management plan that deals with the viral outbreaks when and if they occur. Generally this applies to patients whose frequency of outbreaks is less than 6 per year. Patients with 6 or more should consult their physician for suppressive therapy options. To be most effective, episodic treatment should begin immediately at the initial signs of an outbreak, often called the “prodrome” period, in which the skin at the outbreak site might tingle, burn, or itch. This treatment is often efficient at reducing the length of outbreak and severity; however, it will offer no relief from frequent attacks.

Associated Therapy

There are some cases of shingles patients and HSV patients who suffer long-term neuralgia—pain along the nerve pathways that includes tingling, burning and numbness. This “post herpetic” neuralgia can often be managed with a regimen of pain medications. Some studies have shown that even specific antidepressants can relieve the pain of neuralgia associated with either shingles or HSV outbreaks.