Genital herpes is treated with one of three antiviral pills — acyclovir, valacyclovir, or famciclovir — taken either at the first sign of an outbreak (episodic) or every day (suppressive). None cures the infection, which is lifelong, but they shorten outbreaks, make them rarer, and daily use lowers the chance of passing it to a partner.
about 12%
but well controlled
| Item | Value |
|---|---|
| Adults 14–49 with HSV-2 | ~1 in 8 — about 12% |
| Unaware they have it | ~87% |
| Daily antivirals cut spread | ~50% |
| Cure | none — but well controlled |
How genital herpes is treated
Genital herpes is caused by two related viruses, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Once you have it, the virus stays in your nerve roots for life CDC. There's no cure. The three FDA-approved antivirals — acyclovir, valacyclovir, and famciclovir — block the virus from copying itself during an active flare. They don't clear the latent virus from your nerves, and they don't change how often or how badly outbreaks come back once you stop the drug CDC STI Guidelines.
There are two ways to take them. Episodic therapy means starting a short course of pills as soon as you feel an outbreak coming — the tingling, itching, or first sore — to cut the flare short. Suppressive therapy means a lower daily dose taken continuously. In people who get frequent recurrences, suppressive therapy reduces outbreaks by 70%–80% and reduces the odds of passing HSV-2 to a partner. For the full episodic-vs-suppressive breakdown and exact dosing, see our guide to herpes treatment.
Which drug? All three work, and the practical difference is dosing convenience. Acyclovir is the oldest and the cheapest, but it's taken more times a day. Valacyclovir is a pro-drug of acyclovir — your body converts it — so it's absorbed better and dosed less often. Famciclovir is another less-frequent option. Here's how they compare for most adults:
| Antiviral | What it is | Dosing convenience | Cost |
|---|---|---|---|
| Acyclovir | The original antiviral; well-studied and safe in pregnancy | Taken several times a day | Cheap generic |
| Valacyclovir | Pro-drug of acyclovir, better absorbed | Fewer doses per day | Cheap generic |
| Famciclovir | Pro-drug of penciclovir | Fewer doses per day | Generic, usually pricier than the other two |
What treatment is actually like
For most people, a herpes diagnosis lands harder emotionally than physically. It's a manageable skin condition. Many people have only a handful of outbreaks over the years, and outbreaks tend to get milder and less frequent over time. Daily antivirals can make them rare and lower the chance of passing it on, which takes a lot of the worry out of the picture.
The pills themselves are well tolerated. Acyclovir and valacyclovir are inexpensive generics, among the cheapest prescriptions in any pharmacy, so cost is rarely the barrier. The biggest practical step is getting an accurate diagnosis. If you have a sore, the best test is a swab of the sore itself (a NAAT or viral culture), and you want to go in while the lesion is fresh and hasn't crusted over. A clinic visit during an active outbreak gets you the most reliable answer. Routine herpes blood testing isn't recommended for people without symptoms, because false positives are common; see herpes testing for how the swab and blood options differ, and is herpes included in a standard std test? for why it's usually left off the default panel.
Do partners need treatment?
There's no "partner treatment" for herpes the way there is for chlamydia — you don't treat a partner to clear an infection they don't have. What matters instead is disclosure and prevention. Tell partners, because herpes can spread even when you have no sore at all: people with HSV-2 shed virus on about 10% of days with no symptoms, and most of that shedding leaves nothing visible JAMA. Assuming "no sore means no risk" is the single most common mistake people make.
If protecting a partner is a priority, daily suppressive therapy is your strongest tool. In a randomized trial of couples where one partner had HSV-2 and the other didn't, daily valacyclovir lowered the risk of transmission by about 48% Corey et al.. Condoms reduce transmission too, but they don't eliminate it, since they can't cover every patch of skin the virus may live on.
Follow-up and retesting
Herpes has no "test of cure." The virus is permanent, so there's nothing to re-swab to confirm clearance. Follow-up is about deciding which treatment strategy fits you. If you're getting frequent outbreaks, that's the conversation to have about switching from episodic to daily suppressive therapy. If your outbreaks are rare and mild, episodic treatment may be all you need. A good rule of thumb: if outbreaks are disrupting your life or you're worried about a partner, revisit the plan with your clinician rather than toughing it out.
If you were swabbed and the result was negative but you still have symptoms, timing matters — a swab taken late, after the sore has healed, can miss the virus. If you're trying to sort out a recent possible exposure, our guide on when to test after exposure explains the timing windows.
What happens if genital herpes goes untreated
Herpes itself isn't usually dangerous in healthy adults. Untreated, you'll have outbreaks that come and go, sometimes painful, often manageable. But two situations carry real risk when left unaddressed.
- HIV risk. Having HSV-2 increases the chance of acquiring HIV roughly two- to three-fold, because the breaks in the skin and the immune activity at sores give HIV an easier entry point. If you already have both, herpes can also make HIV more transmissible to others.
- Pregnancy and newborns. Neonatal herpes — herpes passed to a baby around delivery — is a potentially deadly infection in the newborn, and herpes acquired during pregnancy can lead to miscarriage or preterm delivery. This is why pregnancy management is handled carefully.
For pregnant people with recurrent herpes, suppressive acyclovir started near the end of pregnancy (around 36 weeks) reduces the need for a cesarean by lowering the chance of an active outbreak at delivery. If there are visible lesions when labor begins, a cesarean is recommended to protect the baby. These decisions belong with an OB, and they work well when planned ahead.
Preventing outbreaks and transmission going forward
The two infections behave differently, and that shapes your plan. Genital HSV-2 recurs often — roughly four times in the first year for many people — and sheds virus frequently. Genital HSV-1, the oral-type virus that increasingly causes genital infections through oral sex, recurs far less, often only about once in the first year HSV-1 cohort study. In one US young-adult cohort, the share of new genital herpes caused by HSV-1 rose from 31% to 78%, so a milder course is now common. If your testing identified the type, that tells you a lot about what to expect.
Going forward, your toolkit is: daily suppressive antivirals if you want to cut both outbreaks and transmission, condoms to reduce (not erase) skin-to-skin spread, and honest disclosure with partners. None of these is all-or-nothing, and they stack.
When to see a clinician
See a clinician if you have a new genital sore, blister, or ulcer — go in while it's fresh so it can be swabbed. Also seek care if your outbreaks are frequent or severe enough to interfere with daily life (a good reason to consider suppressive therapy), if you're pregnant or planning pregnancy, if you have a partner who doesn't have herpes and you want to lower transmission, or if your immune system is weakened. You can get tested through a clinic or testing service, and our compare testing providers page can help you find the right option.