Herpes simplex
Infection caused by herpes simplex virus type 1 or 2. First-line treatment: nucleoside analogues (aciclovir, valacyclovir).
ICD-10 B0012 drugs
Also known as: HSV infection
Drugs used for this condition
- AAciclovirFirst line · Antiviral – nucleoside analogueFirst-line for HSV-1 and HSV-2 infections of various locations: primary and recurrent genital herpes, herpes encephalitis (IV), neonatal herpes. In primary genital herpes 400 mg three times daily for 7–10 days; recurrences – 800 mg three times daily for 2 days or 400 mg five times daily for 5 days. Suppressive therapy 400 mg twice daily for more than 6 recurrences per year reduces them by 70–80%.
- AValacyclovirFirst line · Antiviral – aciclovir prodrugFirst-line for genital herpes. Primary episode: 1000 mg twice daily for 7–10 days; recurrences: 500 mg twice daily for 3 days. Suppressive therapy 500 mg once daily for more than 6 recurrences per year reduces them by 70–80% and partner transmission (Corey 2004 – 48% reduction).
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DAlloferon (Allokin-alfa)Not recommended · Immunomodulators, antivirals (local classification). Russian development.For recurrent HSV-1 and HSV-2, allokin-alfa in Russia is indicated for short courses of subcutaneous injections. The CDC and the European IUSTI/EADV guidelines do not list the drug. Evidence-based antiherpetics are nucleoside analogues aciclovir, valacyclovir, and famciclovir, with efficacy confirmed in large RCTs on episode duration and recurrence frequency endpoints.
- DAnaferon (anti-human interferon gamma antibodies in homeopathic dilutions)Not recommended · Homeopathic medicinesAnaferon contains antibodies to human gamma-interferon in ultra-low (homeopathic) dilutions and is promoted for treating and preventing viral infections, including herpes simplex. There is no convincing evidence that it helps with herpes simplex, and the evidence base for this use is missing. What actually works against herpes are antiviral medicines such as aciclovir or valaciclovir, prescribed by a doctor. Anaferon should not be used in place of treatment with proven benefit, since that can mean missing the care you need.
- DErgoferon (antibodies to γ-interferon, CD4, and histamine in homeopathic dilutions)Not recommended · Homeopathic preparation marketed as an immunomodulator (local classification)Ergoferon combines antibodies to gamma-interferon, CD4 and histamine in ultra-low (homeopathic) dilutions, and is marketed as an antiviral and immune-modulating remedy, including for cold sores and other forms of herpes simplex. No convincing benefit for herpes simplex has been shown for it: there is no quality evidence base for this use. Herpes simplex responds to antiviral drugs of the aciclovir group (aciclovir, valaciclovir) prescribed by a doctor, and the earlier the course starts, the clearer the effect. Ergoferon is harmless in this role, but you should not use it instead of treatment with proven benefit, since that can mean losing time and the therapy you actually need.
- DMonolaurin (glycerol monolaurate)Not recommended · Lauric acid derivative, supplement. No medicinal status in EU or Russia. AEMPS and AESAN do not register monolaurin as a medicineMonolaurin (lauric acid monoglyceride) is a supplement derived from coconut and palm oil. It is promoted as an antiviral, including for herpes simplex. No convincing benefit has been shown for this use: the supporting data come only from low-quality studies. For herpes simplex flare-ups, antiviral drugs such as aciclovir and valaciclovir do work. The substance is safe in this role, but do not use it in place of therapy with proven benefit, or you may miss out on treatment that helps.
- DOlive leaf extract (Olea europaea, oleuropein)Not recommended · Plant antioxidant, supplement. In EU – traditional herbal medicinal product (EMA HMPC monograph 2014)Olive leaf extract (Olea europaea) and its compound oleuropein are marketed as an immune supplement and antiviral support, including for herpes simplex. No convincing benefit has been shown for herpes – there is no evidence base for this use. Herpes simplex flare-ups respond to antiviral drugs such as aciclovir, valaciclovir, and famciclovir, and the sooner treatment starts, the better it works. Olive leaf extract is harmless, but don't use it instead of treatment with proven benefit, since that can mean missing the care you actually need.
- FGlucosaminyl muramyl dipeptideNot recommended · Other immunostimulants (local classification)For herpes, Likopid is absent from IDSA guidelines. Proven antiherpetic agents are nucleoside analogues aciclovir, valacyclovir, and famciclovir.
- FInosine pranobexNot recommended · Other antivirals with claimed immunostimulant effectFor herpes, isoprinosine is absent from IDSA guidelines. Proven antiherpetic agents are nucleoside analogues aciclovir, valacyclovir, and famciclovir. Eastern European use for HSV rests on the manufacturer label, not on an independent clinical base.
- FKagocelNot recommended · Other antivirals (local classification)Evidence tier F. Kagocel for herpes simplex infection is not mentioned in international guidelines (CDC STI 2021, IUSTI 2017, IDSA). Evidence-based antiviral therapy for genital, orolabial and severe systemic herpes simplex consists of nucleoside analogues - aciclovir, valaciclovir and famciclovir - either episodically or as suppressive therapy in patients with frequent recurrences. Adding kagocel to nucleoside therapy has no demonstrated benefit and is not part of any international recommendation.
- FMeglumine acridone acetateNot recommended · Other immunostimulants (local classification)First-line therapy for herpes simplex remains aciclovir, valaciclovir, and famciclovir. Cycloferon is not mentioned in international protocols.
- FTiloroneNot recommended · Other antivirals (local classification)For herpes simplex management, international guidelines (CDC STI Treatment Guidelines 2021, IUSTI 2017) list aciclovir, valaciclovir, and famciclovir. Tilorone is not mentioned.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit