Antiviral Medications for Herpes: How Suppressive Therapy Actually Works
If you have read about herpes treatment online, you have probably seen the same three medication names over and over: acyclovir, valacyclovir, and famciclovir. It can feel confusing at first, especially when people use terms like “episodic treatment,” “daily suppression,” and “viral shedding” in the same conversation.
The short version is this: antiviral meds do not cure herpes, but they can make a big difference in day-to-day life. For many people, they reduce outbreak frequency, shorten symptom duration, and lower transmission risk when combined with condoms and avoiding sex during outbreaks.
First, what these medications can and cannot do
According to the CDC STI Treatment Guidelines, antiviral therapy is a core part of genital herpes management. The goals are to treat or prevent recurrent symptoms, improve quality of life, and reduce the chance of transmission to partners.
What antivirals can do:
- Help first outbreaks heal faster
- Reduce pain and healing time during recurrent outbreaks
- Reduce the number of outbreaks when taken daily
- Lower, but not eliminate, transmission risk
What antivirals cannot do:
- They do not remove latent HSV from the body
- They are not a permanent cure
- They do not make transmission risk zero
That distinction matters. A realistic treatment plan is not about perfection. It is about meaningful risk reduction and symptom control.
Acyclovir vs valacyclovir vs famciclovir
All three are FDA-approved options for genital herpes treatment. They are broadly effective, and many clinicians choose based on dosing convenience, insurance coverage, and how your body responds.
- Acyclovir: older and widely used, often taken more times per day.
- Valacyclovir: a prodrug of acyclovir with better absorption, often allowing less frequent dosing.
- Famciclovir: another well-established option with convenient dosing schedules for many patients.
The CDC notes these medications are all useful for first episodes, recurrent outbreaks, and daily suppression. In practice, convenience often drives adherence, and adherence drives results.
Suppressive therapy: the daily approach
Suppressive therapy means taking antiviral medication every day, even when you feel fine. This is usually considered when outbreaks are frequent, painful, stressful, or when reducing transmission to a partner is a major priority.
Here is one of the most cited data points: the CDC reports that suppressive therapy can reduce recurrence frequency by 70% to 80% in people with frequent recurrences. Many people on suppression report having no symptomatic outbreaks while on treatment.
Another key point from CDC guidance: daily valacyclovir 500 mg has been shown to reduce HSV-2 transmission in discordant heterosexual couples, meaning one partner has HSV-2 and the other does not. It is best viewed as part of a package: medication + condoms + avoiding sex during active symptoms.
Data from ASHA also supports what many patients notice in real life: daily therapy can dramatically reduce outbreak burden and make the condition feel more manageable over time.
Episodic therapy: treat only when symptoms start
Episodic therapy is different. Instead of taking medication daily, you start treatment at the first sign of an outbreak, often during the prodrome phase (tingling, burning, or itching before sores appear).
This strategy can still work well, especially if outbreaks are infrequent. But timing is important. Starting early usually gives better results than waiting several days.
Many people begin with episodic treatment and switch to suppression later, or use suppression during specific life periods, like a new relationship, high-stress months, or times when outbreaks are clustering.
How big is the global context in 2026?
Herpes remains extremely common worldwide. The WHO fact sheet estimates that in 2020, about 3.8 billion people under 50 had HSV-1 and about 520 million people aged 15 to 49 had HSV-2. Most infections are asymptomatic or unrecognized.
This is a helpful reminder that treatment decisions are not niche or unusual. They are part of mainstream sexual health care.
When should you talk to a clinician about daily suppression?
- You have frequent outbreaks (for example, several per year)
- Outbreaks are emotionally or physically disruptive
- You are in a discordant relationship and want extra protection
- You want a clearer plan instead of reacting to each flare
Also, if you have genital herpes, ask about HIV testing and prevention. CDC guidance notes HSV-2 infection is associated with increased HIV acquisition risk.
Bottom line
Suppressive therapy is not about fear. It is about control. The best regimen is the one you can actually follow, with side effects you can tolerate, and goals that fit your life.
If you are comparing options and trying to estimate your personal risk, use the tools at herpeschance.com. The risk calculators can help you turn broad statistics into a practical conversation you can have with your clinician or partner.