Genital herpes: latent virus and aciclovir treatment
In genital herpes, herpes simplex virus (HSV) stays latent (dormant but still present) in nerves, so antivirals such as aciclovir can shorten episodes but do not cure it.
Remember
Herpes simplex virus stays latent in nerves, so antivirals reduce symptoms and shorten outbreaks but do not cure genital herpes, and the virus can be passed on without visible sores.
Memory aid
antivirals slow herpes down, they do not clear it out
It reminds you that antivirals ease and shorten episodes but leave the latent virus in the nerve.
Genital herpes is a viral infection caused by herpes simplex virus (HSV), which has two types, HSV-1 and HSV-2. Traditionally HSV-1 is linked with oral ulcers and HSV-2 with genital ulcers, but in practice both types can cause oral ulcers and genital ulcers.
The virus is not cleared after the first infection: it stays in the body. It becomes latent, which means dormant but still present, in a nearby sensory nerve (one that carries feeling from the skin). From there it can reactivate and cause blisters and sores in the same area again. These recurrences are usually milder than the first episode and tend to become less frequent over time. In the first year it is not unusual to have 5 of them, and they may continue lifelong.
Oral aciclovir is the first choice of treatment. It is an antiviral, a medicine that acts against viruses, and it acts on virus that is multiplying during an outbreak, so ulcers heal sooner. It works best when started early, and it can shorten an outbreak by a day or two. It does not cure the infection, because the latent virus stays in the nerve.
People with frequent recurrences may be offered daily suppressive treatment, which lowers how often outbreaks happen while it is taken.
From time to time the virus is shed from the skin, so it can be passed on even when no sores are visible. This is called asymptomatic shedding, and passing the virus on is more likely with ulcers (open sores).
Key facts
- Cause
- herpes simplex virus (HSV), type 1 or type 2, and both types can cause oral and genital ulcers.
- First choice
- oral aciclovir, which works best when started early and shortens an outbreak.
- Outcome
- there is no cure, because the virus stays latent in nerve ganglia (clusters of nerve-cell bodies), so recurrences can happen.
- Suppression
- daily antivirals lower how often recurrences happen while taken, but recurrences may return when treatment stops.
- Spread
- the virus can be passed on without visible ulcers, though it is more likely when ulcers are present.
- Pregnancy
- a first infection or an outbreak at the time of birth can cause neonatal herpes (a serious illness of the newborn), so women are offered antiviral treatment in late pregnancy to reduce this risk.
Exam traps
- Cream (a topical antiviral) put on the ulcers does not clear the virus: it lies dormant in nerve ganglia, where cream is unlikely to reach. Topical antivirals have little value and their use is discouraged; oral antivirals are the treatment, though they do not clear the latent virus either.
- Daily suppressive aciclovir does not clear the latent virus: it lowers how often recurrences happen while treatment continues, but recurrences may return after treatment stops.
- Starting aciclovir early can shorten the first outbreak, but it is not a cure: early treatment does not prevent recurrences, and the dormant virus stays in the nerve.
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