Oral herpes

Dr. Roach writes: A recent column on oral herpes generated numerous letters. Most of these asked about using valacyclovir (Valtrex) or another oral antiviral. These drugs can be given at earliest onset of symptoms (usually 2 grams given twice, 12 hours apart) or taken all the time to prevent outbreaks (usually 500 mg once a day).

When used at the onset of an attack (it should be started at the first appearance of reliable symptoms, which for some people is noticeable tingling, burning or itching), it can shorten the duration of the blisters by about a day. People who do not have any early symptoms are less likely to benefit, and can consider taking medications all the time. This would be reasonable for people with pain or disfiguring lesions (I had a patient, a professional actor, for whom I prescribed valacyclovir). Valacyclovir is expensive (average wholesale price is about $10 a pill, but I found it much cheaper through the drug discount site Goodrx.com) and has the potential for serious side effects, so it is not a medication that I prescribe frequently.

Other readers asked about tea tree oil. Although this herbal product has some antiviral and antibacterial activity, I was not impressed by the research done so far, and don’t recommend it; however, it is safe for most people, and several readers say that it helped them. Finally, many asked about lysine, with several personal stories of effectiveness. The literature remains equivocal, but most studies have found that lysine is no more effective than placebo for treatment or prevention of herpes cold sores. However, lysine may be effective in canker sores, which are not related to herpes.

Readers: The booklet on herpes explains this common infection in detail. Readers can obtain a copy by writing:

Dr. Roach

Book No. 1202

628 Virginia Dr.

Orlando, Fla. 32803

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow 4-6 weeks for delivery.