What is suppressive therapy?
Suppressive therapy involves taking an oral antiviral drug every day for prolonged periods. It interferes with the herpes virus’ reproductive cycle and so prevents or dramatically reduces the number of recurrences. When recurrences do occur, they are usually less severe and shorter lasting.
If you find the frequency of your outbreaks unacceptable, or if you are finding it difficult to cope emotionally with having recurrences of genital herpes, tell your doctor and discuss the use of suppressive therapy.
How effective is suppressive therapy?
Studies have proven that continuous suppressive antiviral therapy for herpes can dramatically reduce the frequency of herpes outbreaks or prevent them all together and reduces the risk of transmission by 50%.
For example, a very large study found that people who had an average of over 12 herpes occurrences a year, could reduce the frequency of their herpes outbreaks to less than two a year after one year of continuous suppressive therapy.
The study also showed that if recurrences do occur during suppressive therapy, they are usually less severe and shorter lasting.
“I didn’t want to take any drugs, so I tried natural therapies. These didn’t work. I now take aciclovir 400mg twice a day and have not had any outbreaks since. If your outbreaks are frequent, I really recommend it.” – MK
Who is suppressive therapy suitable for?
Your doctor may agree that suppressive antiviral therapy is suitable for you if one of the following applies to you:
- You are having frequent herpes recurrences.
- You have less frequent but particularly severe or long-lasting herpes outbreaks.
- You find recurrences of genital herpes are making you depressed, anxious or withdrawn, or the emotional upset caused to you by genital herpes is disrupting your social activities or sex life. Such feelings can themselves bring on a recurrence and so you can easily get into a vicious cycle. Taking suppressive therapy, perhaps only for a short time, can help you break the cycle and give you a sense of control over the infection.
- You experience severe pain (neuralgia) due to recurrent herpes episodes.
- You have only a few herpes recurrences but they always occur during specific situations, for example, when you have exams or go on holiday. You may wish to start suppressive therapy before you go on holiday and continue on it until you return, thereby reducing the chance of a recurrence.
- You have recurrences when you are starting a new relationship – suppressive therapy may decrease the risk of herpes transmission to your partner.
- You know that stress is a trigger factor for your herpes recurrences, and you are going through a stressful period, for example, a new job or a recent death in the family.
- You want to avoid a situation which would be spoilt by a herpes recurrence, for example, if you are going on your honeymoon.
- You have another illness which triggers a recurrence of herpes – a course of suppressive therapy may be appropriate until the condition triggering the outbreak has resolved.
How do I take suppressive therapy?
There are two oral antivirals available for suppressive treatment in New Zealand:
- Aciclovir tablets 400mg taken twice daily, morning and night. If you start suppressive therapy, it is important not to miss any doses and to take it regularly at approximately 12 hourly intervals. If your recurrences are not suppressed by this dose, you should discuss this with your doctor as taking 200mg four times a day may be more effective. Aciclovir is also available in a soluble form if you are unable to swallow tablets.
- Valtrex tablets 500mg taken once a day. People who find aciclovir isn’t working in treating problematic recurrent herpes can now access Valtrex by fully subsidised prescription from their doctor through a Special Authority application. This is a new generation antiviral with better absorption.
How long will I need to take the treatment?
Many people who use suppressive therapy say that they get so used to taking the tablets or capsules they are happy to continue with the treatment.
If you choose suppressive therapy, you do not have to stay on it permanently. If you prefer, you can take it until you feel in control of the herpes infection, but this is usually a period of 6-12 months initially. Your doctor may suggest you stop the suppressive therapy for several months after you have taken suppressive therapy for some time, in order to assess how active your genital herpes remains. If you are still having problems with herpes recurrences, you and your doctor may then decide that you should start suppressive therapy again.
Is it safe to take the treatment for a long time?
Aciclovir has been reported to cause no serious side-effects, even after years of use. A few people taking suppressive therapy do experience minor side-effects such as a headache, nausea and diarrhoea. If you have a problem, discuss this with your doctor.
Research to date shows that people with normal immune systems who are on oral antivirals for a long period do not develop virus resistance or clinical breakthrough. Also, there is little interaction with other drugs, e.g. the contraceptive pill is unaffected by Aciclovir.
Will suppressive therapy make it easier to live with Genital Herpes?
Suppressive herpes therapy may give marked improvement to your emotional well-being. Many people find the fact that they can control the infection gives a boost to their sense of well-being and self-confidence. Even if only taken for a few months, suppressive therapy can help you to come to terms with emotions caused by recurrent genital herpes, including depression and anxiety.
However, suppressive therapy is only part of it. There are benefits gained from expert counselling from your doctor or nurse, or by speaking to a counsellor on the tollfree Herpes Helpline 0508 11 12 13. Make sure that you continue to talk to a health professional you are comfortable with, at least until you feel completely at ease with having genital herpes and in command of the infection.
Are any other treatments effective against Genital Herpes?
The antiviral drug Aciclovir was the first therapy which had been shown conclusively to be effective in treating genital herpes. New antiviral drugs have become available which work in a similar way to Aciclovir, are more effective and require less frequent dosing to treat or suppress the recurrence.
These are not available in New Zealand. Recent studies using an HSV-2 vaccine are showing some promise in both the prevention and transmission of HSV-2. However, these are still in the developmental research stage and will not be available commercially for some years.
Many people find that having a healthy diet, eating regularly and getting enough sleep are helpful in preventing recurrences.