Herpes labialis (classical cold sores)
The objective is to limit the size and intensity of the lesions.
At the first sensation of the development of a cold sore:
apply an ice cube to the site for up to 5 minutes every 60 minutes (for first 12 hours)
saturated solution of menthol in SVR.
topical applications include:
idoxuridine 0.5% preparations (Herplex D® liquifilm, Stoxil® topical, Virasolve®) applied hourly,
povidone-iodine 10% cold sore paint: apply on swab sticks 4 times a day until disappearance,
acyclovir 5% cream (Zovirax®), 5 times daily for 4 days.
Acyclovir or famciclovir or valaciclovir for 5 to 10 days or until resolution (reserve for immunocompromised patients and severe cases).
If exposure to the sun precipitates the cold sore, use a 30+ or 50+ sun protection lip balm, ointment or solarstick. Zinc sulfate solution can be applied once a week for recurrences. Oral acyclovir 200–400 mg bd or similar agent (6 months) can be used for severe and frequent recurrences (> six per year).
Genital herpes: Antimicrobial therapy
The proven most effective topical therapy is topical acyclovir (not the ophthalmic preparation).
Pain relief can be provided in some patients with 2% topical lidocaine, but be cautious of hypersensitivity.
Saline baths and analgesics are advisable.
Acyclovir for the first episode of primary genital herpes (preferably within 24 hours of onset).
Dosage: 400 mg 3 times a day for 5 to 7 days or until resolution of infection.
Famciclovir or valaciclovir can be given bd for 5 to 10 days.
This appears to reduce the duration of the lesions from 14 days to 5 to 7 days. These drugs are not usually used for recurrent episodes, which last only 5 to 7 days. Very frequent recurrences (six or more attacks in 6 months) benefit from low doses of these agents for 6 months (200 mg 2 to 3 times per day).