GENITAL HERPES

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Checklist for Genital Herpes

Rating	Nutritional Supplements	Herbs
	Lysine Propolis (topical) Zinc (topical)	Aloe vera (topical) Lemon balm (topical)
	Lithium (topical)	Cloves (topical) Eucalyptus (topical) Licorice root (topical) Seaweed (topical) Turmeric (topical)
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of genital herpes? People with genital herpes may have outbreaks of small, often painful, fluid-filled blisters (vesicles) in the genital or anal region. Fever, general weakness, and painful urination often accompany the initial occurrence. Subsequent outbreaks may appear with colds, fevers, menstrual periods, or during periods of stress,¹ and usually disappear within two weeks. Initially there may be tingling or prickling at the site of the blisters even before they are visible, then the blisters often weep a clear fluid and form a scab.

How is it treated? Doctors may recommend antiviral medications, such as topical acyclovir or oral acyclovir (Zovirax®) and penciclovir (Denavir®), which may be taken internally or applied as an ointment. For symptomatic relief of herpes blisters, over-the-counter analgesics, such as aspirin (Bayer®), ibuprofen (Advil®), and acetaminophen (Tylenol®), may also be recommended.

Dietary changes that may be helpful: Many alternative healthcare practitioners recommend that people with herpes simplex infections eat a diet high in the amino acid lysine and low in arginine. Foods high in lysine include red meat, poultry, fish, and dairy products, while foods such as chocolate, nuts, peas, and cereals are high in arginine. This recommendation is based on test tube research indicating that growth of the herpes virus is inhibited by lysine and promoted by arginine.² However, no research has investigated whether making these dietary changes helps prevent outbreaks of genital herpes. In fact, one preliminary study found that patients with and without genital herpes did not differ from each other in how much dietary arginine and lysine they consumed.³

Lifestyle changes that may be helpful: Since genital herpes is highly contagious, people with active herpes infections should avoid direct sexual contact. Also, infected pregnant women should inform their obstetrician if their herpes becomes active around their delivery date, as HSV can be transmitted to the newborn during birth and cause a more serious infection in the child.

Nutritional supplements that may be helpful: Most research on lysine has been done on people with cold sores or on groups that include both cold sores and genital herpes sufferers. However, some evidence exists that supplemental lysine may be effective in the prevention and treatment of genital herpes. In one preliminary survey, 81% of people with HSV infections (including genital herpes) reported lysine was effective for reducing recurrences and shortening healing time in amounts averaging about 1,000 mg per day.⁴ A small double-blind trial of people with oral and genital herpes examined the effects of 1,248 mg or 624 mg of lysine daily versus placebo.⁵ The study found that 1,248 mg per day of lysine, but not the lower dose, was effective in reducing the recurrence rate of herpes outbreaks by 57% to 65%, while neither dose helped reduce the healing time. Another small double-blind trial found that using 3,000 mg per day of lysine in divided doses led to a decrease in severity of symptoms and a reduction in healing time of both oral and genital herpes.⁶ One preliminary report found no benefit of lysine for a group of patients with either oral or genital herpes.⁷

In a test tube, zinc is capable of inactivating the type of herpes virus responsible for the majority of genital herpes cases.⁸ Topical zinc may therefore help prevent outbreaks of genital herpes. One preliminary study treated people (four of whom had genital herpes) with a 4% zinc sulfate solution applied to the site of the initial outbreak.⁹ In all cases, the pain, burning, and tingling stopped within 24 hours of beginning the topical zinc therapy. The use of lower concentrations of zinc (0.025–0.05%) has also been shown effective against oral and genital herpes outbreaks.^{10 11} While topical zinc has been shown to be helpful, there is no convincing evidence that oral zinc offers the same benefits.¹²

Lithium is a mineral available in an ointment or in the prescription drug lithium carbonate. In small studies, pharmacological doses of lithium carbonate have helped prevent outbreaks of genital herpes.^{13 14} However, there is no evidence that smaller amounts of oral lithium in nonprescription supplements would be similarly effective. A controlled study using a topical ointment containing 8% lithium succinate with 0.05% zinc sulphate diminished the pain and discomfort of genital herpes and shortened the healing time.¹⁵ In light of the known benefits of topical zinc, it is unclear whether lithium was an important component of this treatment

A test tube study found that flavonoids present in propolis are responsible for the supplement’s antiviral action.¹⁶ A controlled study found that an ointment containing propolis, used four times daily, was almost twice as effective as topical antiviral medication or a placebo ointment.¹⁷

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Licorice root (Glycyrrhiza glabra) contains antiviral substances¹⁸ and ointments containing related substances are effective in treating herpes infections.^{19 20} While the use of topical licorice preparations to prevent or treat genital herpes has not been studied, some alternative healthcare practitioners recommend applying creams or gels containing licorice three to four times a day.

A double-blind trial found that topical application of a cream containing a highly concentrated extract of lemon balm  (Melissa officinalis) four to five times a day helped heal oral and genital herpes sores faster than use of a placebo.²¹

Aloe vera may also benefit those with genital herpes. A double-blind trial using a 0.5% Aloe vera cream found that applying the cream three times a day shortened the healing time of genital herpes outbreaks. All but 3 of 22 persons in the study who showed healing with the aloe cream had no recurrences 15 months after stopping treatment.²²

Test tube and animal research suggests that substances found in turmeric, cloves, eucalyptus, and seaweed have potential benefit for topical prevention of genital herpes, but no human research using available herbal products has been performed.²³

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: Stress plays a major role in the recurrence of genital herpes outbreaks. One preliminary study found that persistent stress (stress lasting more than seven days) increased the recurrence rate by about 25%,²⁴ but another preliminary study found no connection between stress and genital herpes outbreaks.²⁵ In addition, short-term stress, mood changes, and menstrual cycles do not appear to affect herpes recurrences.²⁶ Treatments aimed in part at stress reduction may be helpful for treating genital herpes. One controlled trial showed that patients had fewer outbreaks, shorter episode duration, and less episode severity when they were treated with a series of sessions involving education about genital herpes, stress management, deep breathing exercises, and guided imagery.²⁷ A preliminary study suggested that applied relaxation (a technique that guides the participant through a series of muscle relaxation exercises) reduces recurrences of genital herpes outbreaks.²⁸ Two case reports indicate that self-hypnosis, practiced on a daily basis, helps ease the pain and severity of genital herpes lesions.²⁹

1. Cohen F, Kemeny ME, Kearney KA, et al. Persistent stress as a predictor of genital herpes recurrence. Arch Intern Med 1999;159:2430–6.

2. Tankersley RW. Amino acid requirements of herpes simplex virus in human cells. J Bacteriol 1964;87:609–13.

3. Algert SJ, Algert SJ, Stubblefield NE, et al. Assessment of dietary intake of lysine and arginine in patients with herpes simplex. J Am Diet Assoc 1987;87:1560–1.

4. Walsh DE, Griffith RS, Behforooz A. Subjective response to lysine in the therapy of herpes simplex. J Antimicrob Chemother 1983;12:489–96.

5. McCune MA, Perry HO, Muller SA, O’Fallon WM. Treatment of recurrent herpes simplex infections with L-lysine monohydrochloride. Cutis 1984;34:366–73.

6. Griffith RS, Walsh DE, Myrmel KH, et al. Success of L-lysine therapy in frequently recurrent herpes simplex infection. Dermatologica 1987;175:183–90.

7. Simon CA, Van Melle GD, Ramelet AA. Failure of lysine in frequently recurrent herpes simplex infection. Arch Dermatol 1985;121:1678 [letter].

8. Arens M, Travis S. Zinc salts inactivate clinical isolates of herpes simplex virus in-vitro. J Clin Microbiol 2000;38:1758–62.

9. Wahba A. Topical application of zinc solutions: A new treatment for herpes simplex infections of the skin? Acta Derm Venereol 1980;60:175–7.

10. Finnerty EF. Topical zinc in the treatment of herpes simplex. Cutis 1986;37:130–1.

11. Brody I. Topical treatment of recurrent herpes simplex and post-herpetic erythema multiforme with low concentrations of zinc sulphate solution. Br J Derm 1981;104:191–4.

12. Eby GA, Halcomb WW. Use of topical zinc to prevent recurrent herpes simplex infection: review of literature and suggested protocols. Med Hypotheses 1985;17:157–65.

13. Amsterdam JD, Maislin G, Hooper MB. Suppression of herpes simplex virus infections with oral lithium carbonate—a possible antiviral activity. Pharmacotherapy 1996;16:1070–5.

14. Amsterdam JD, Maislin G, Potter L, Giuntoli R. Reduced rate of recurrent genital herpes infections with lithium carbonate. Psychopharmacol Bull 1990;26:343–7.

15. Skinner GRB. Lithium ointment for genital herpes. Lancet 1983;2:288 [letter].

16. Debiaggi M, Tateo F, Pagani L, et al. Effects of propolis flavonoids on virus infectivity and replication. Microbiologica 1990;13:207–13.

17. Vynograd N, Vynograd I, Sosnowski Z. A comparative multi-centre study of the efficacy of propolis, acyclovir and placebo in the treatment of genital herpes (HSV). Phytomedicine 2000;7:1–6.

18. Pompei R, Flore O, Marccialis MA, et al. Glycyrrhizic acid inhibits virus growth and inactivates virus particles. Nature 1979;281:689–90.

19. Csonka GW, Tyrrell DA. Treatment of herpes genitalis with carbenoxolone and cicloxolone creams: a double blind placebo controlled clinical trial. Br J Vener Dis 1984;60:178–81.

20. Partridge M, Poswillo D. Topical carbenoxolone sodium in the management of herpes simplex infection. Br J Oral Maxillfac Surg 1984;22:138–45.

21. Wolbling RH, Leonhardt K. Local therapy of herpes simplex with dried extract of Melissa officinalis. Phytomedicine 1994;1:25–31.

22. Syed TA, Afzal M, Ahmad SA, et al. Management of genital herpes in men with 0.5% Aloe vera extract in a hydrophylic cream: a placebo-controlled, double-blind study. J Dermatol Treat 1997;8:99–102.

23. Bourne KZ, Bourne N, Reising SF, Stanberry LR. Plant products as topical microbicide candidates: assessment of in vitro and in vivo activity against herpes simplex virus type 2. Antiviral Research 1999;42:219–26.

24. Cohen F, Kemeny ME, Kearney KA, et al. Persistent stress as a predictor of genital herpes recurrence. Arch Intern Med 1999;159:2430–6.

25. Rand KH, Hoon EF, Massey JK, Johnson JH. Daily stress and recurrence of genital herpes simplex. Arch Int Med 1990;150:1889–93.

26. Cohen F, Kemeny ME, Kearney KA, et al. Persistent stress as a predictor of genital herpes recurrence. Arch Intern Med 1999;159:2430–6.

27. Longo DJ, Clum GA, Yaeger NJ. Psychosocial treatment for recurrent genital herpes. J Consult Clin Psychol 1988;56:61–6.

28. Koehn KA, Burnette MM, Stark C. Applied relaxation training in the treatment of genital herpes. J Behav Ther Exp Psychiatry 1993;24:331–41.

29. Gould SS, Tissler DM. The use of hypnosis in the treatment of herpes simplex II. Am J Clin Hypn 1984;26:171–4.

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