Suppressive Therapy for Herpes:
How It Works, Dosage & Risks

Written by Kathleen Morrison
Medically Reviewed by Andrea Sleeth WHNP-BC, MSCP

Key takeaways

• Suppressive therapy for herpes means taking a daily oral antiviral, rather than only reaching for antiviral medication when an outbreak starts.
• Suppressive antiviral therapy may also help lower the risk of transmitting genital herpes to a partner.
• Three prescription antiviral drugs are commonly used for suppressive therapy: Acyclovir, Valacyclovir, and Famciclovir. Each follows a different dosage schedule.
• Your provider will recommend a medication and dosage based on your health history, outbreak pattern, and lifestyle.
• Episodic therapy is the alternative approach, where a short course of oral antiviral is started at the first sign of an episode of herpes.

Herpes has a talent for showing up uninvited. (Rude, honestly.) And, if surprise outbreaks keep crashing your plans, or the worry alone feels heavy, daily suppressive therapy may be worth a conversation with a provider.

So let's walk through what suppressive therapy actually involves, which antiviral therapies are used, and what to expect along the way.

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What is suppressive therapy for herpes?

Suppressive therapy for herpes means taking a prescription oral antiviral every day on an ongoing basis, rather than only during a flare.

It applies to both HSV-1 and HSV-2, which can each show up orally or genitally. HSV-2 is behind most recurrent genital herpes and tends to involve more frequent recurrence and shedding. Genital HSV-1 infection recurs less often, so chronic suppressive therapy is usually reserved for those with frequent recurrences.

HSV-1 more commonly causes oral herpes, and daily antivirals may also be considered for frequent cold sores. Either way, it's something to work out with your provider.

Antiviral treatment options for suppressive therapy

Three FDA-approved antiviral drugs are used in the treatment of herpes simplex virus infection.

Which one your provider recommends, and at what dosage, depends on your outbreak pattern, kidney health, other medications, and how easily a given schedule fits your routine.

This isn't a menu you pick from solo; it's a shared conversation with your provider.

Acyclovir

Acyclovir is an antiviral drug that helps slow the growth and spread of the herpes virus in the body. It won't cure herpes, but it can help lessen symptoms of the infection.

Centers for Disease Control and Prevention (CDC) lists Acyclovir 400 mg orally twice a day for suppressive therapy of recurrent genital HSV-2.

Common side effects of Acyclovir may include:

• Mild skin pain
• Rash or itching
• Nausea, vomiting, or diarrhea
• Headache

This is not a complete list of risks and side effects, and others may occur. If symptoms worsen or you notice signs of an allergic reaction, contact a provider right away.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Valacyclovir

Valacyclovir is another antiviral medication that works to help slow the growth and spread of the herpes virus so the body can better fight herpes simplex virus infections.

If Acyclovir and Valacyclovir sound suspiciously alike, that's because they're closely related.

Valacyclovir is the valine ester of Acyclovir, meaning your body converts it into Acyclovir after you swallow it.

The same active antiviral is doing the work at the end of the line; Valacyclovir is just absorbed more efficiently, which is why it allows for less frequent dosing.

For suppressive therapy for genital herpes, CDC lists Valacyclovir 500 mg orally once a day for standard, or Valacyclovir 1 gm orally once a day, for increased recurrences that need more control.

Valacyclovir therapy 500 mg daily is also the regimen CDC cites in the context of lowering HSV-2 transmission between partners.

Common side effects of Valacyclovir may include:

• Nausea
• Stomach pain
• Headache

This is not a complete list of risks and side effects, and others may occur. If symptoms worsen or you notice signs of an allergic reaction, contact a provider right away.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Famciclovir

Famciclovir is another antiviral medication used to treat herpes infections, including genital herpes and cold sores.

It has high oral bioavailability, though it appears somewhat less effective than the other two for suppression of viral shedding.

For chronic suppression of recurrent genital herpes, CDC lists famciclovir 250 mg orally twice a day.

Common side effects of famciclovir may include:

• Headache
• Nausea

This is not a complete list of risks and side effects, and others may occur. If symptoms worsen or you notice signs of an allergic reaction, contact a provider right away.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Wisp does not prescribe or manage famciclovir. If you believe it may be appropriate for your situation, please consult an in-person provider for evaluation, treatment recommendations, and ongoing monitoring.

How long do people continue daily suppressive therapy for herpes?

Duration is something you and your provider decide together. Many people with herpes stay on long-term suppressive therapy for a year or more, then reassess.

Some continue indefinitely, especially if they're in a relationship with an HSV-negative partner or have a history of HSV infection with frequent recurrence.

Others take a break after a year to see if their outbreak pattern has changed.

Tips for living well with herpes

Beyond antiviral therapies, a few everyday habits can help you feel steadier:

• Mind your stress load: Stress is a commonly reported trigger for herpes simplex virus reactivation. Building in regular outlets, such as exercise, sleep, and time with people who fill your cup, can help.
• Protect your sleep: Being run down taxes your immune system, basically rolling out the welcome mat. Aim for healthy, uninterrupted sleep.
• Use barriers: Consistent, correct condom use may help lower, though not eliminate, the risk of transmission of herpes to a partner.
• Notice patterns: Sun exposure is a common trigger for recurrent herpes simplex labialis (oral herpes). Tracking your own triggers gives your provider better information.
  

Suppressive therapy versus episodic therapy for HSV infection

There are two main approaches to managing HSV infection with antiviral medication, and the right one depends on your situation.

Suppressive therapy means taking medication every day. It addresses the pattern itself and is generally recommended if herpes infections are frequent or disruptive. Episodic therapy means taking a short course of oral antiviral medication at the first sign of an outbreak, typically for one to five days, depending on the location.

Your provider may recommend suppressive therapy versus episodic therapy based on how often you experience recurrence, the severity of your herpes symptoms, and whether you're looking to reduce the risk of transmitting the virus to a partner.

For treatment of recurrent herpes, both options are well-supported, but daily therapy is usually the more comprehensive path for people with frequent recurrence of herpes.

Think of it this way: episodic therapy with oral antivirals is your "break glass in case of emergency" plan. Suppressive treatment is your daily umbrella because you already know it rains sometimes, and you'd rather not get caught off guard.

Honestly? Umbrella life is underrated!

Get the care you deserve, on your terms

Living with herpes doesn't mean white-knuckling it between flares. Whether you're newly navigating a first episode or recurrent herpes, daily antiviral therapy is worth a real conversation with a provider.

And you don't have to wait weeks for one. Wisp makes it simple to connect with a licensed provider online and, if medically necessary and appropriate, get a prescription antiviral sent to your pharmacy or delivered free to your door.

Most prescriptions are sent to your pharmacy within 3 hours of completing your patient intake form and secure chat or video call when necessary. Pending retail pharmacy hours.

This blog post is for informational and educational purposes only and should not be taken as professional advice. Always consult with a qualified professional before making any decisions based on the information provided here.