By Kerry Bone, BSc

Two closely related viruses of herpes simplex, HSV-1 and HSV-2, can infect the human body.¹ HSV-1 mostly infects the gums and skin, although it can cause more serious infection in the brain. HSV-2 mostly infects around the genital area. Infection with the virus can be unsightly and painful, especially for HSV-2.

One of the problems with herpes infection is that the virus establishes a dormant infection in nerve cells. When immunity is low due to stress, lack of sleep, excessive sun exposure or other factors, active infection can occur again. The hallmark of active herpes infection is the skin blister, followed by a shallow ulcer. The whole process can take up to 10 days before the skin is completely healed.¹

Current drugs used to fight viruses often only yield modest results. The antiviral drugs prescribed for herpes include valacyclovir, famcyclovir and acyclovir. They all run the risk of side effects, sometimes quite serious. Thus, it is useful to know that herbs can play a very helpful role in the management of recurrent herpes. They can help both prevent the reactivation of the dormant virus and treat the skin outbreak. In my clinic I recommend the topical use of herbs such as lemon balm, propolis and Calendula to hasten healing of the skin. In addition, the internal use of immune-supporting herbs, especially Echinacea root, in conjunction with St John's wort (Hypericum perforatum) will help prevent outbreaks and support the healing process after an outbreak. The approaches described are also useful for the treatment of shingles, which is caused by a different virus in the herpes family.

St John's Wort

It may be surprising, but this well-known herb for depression is also clinically active against the herpes virus. The probable reason for this activity is the discovery that St John's wort contains the phytochemicals hypericin and pseudohypericin, which are active at killing viruses containing an envelope (such as the herpes virus).²

A tablet of St. John's wort dry extract was compared with placebo in patients suffering from recurrent orofacial herpes (trial 1; 94 patients) or genital herpes (trial 2; 110 patients) in two separate double blind, randomized clinical trials.³ For both trials the total observation time was 90 days and patients received 3 tablets a day in symptom-free periods and six tablets a day during skin outbreaks. Each tablet contained 300 mg of dried extract standardized to contain 0.3 percent of hypericin and pseudohypericin. The main measure of efficacy was a symptom score, calculated as a total of the severity ratings of major symptoms (such as presence and number of blisters, intensity of complaints, size of affected area) during the skin outbreak.

The total symptom score was significantly lower in the St. John's wort group compared with placebo in both trials. Average scores were 20.3 for the herb vs. 32.1 for placebo for trial 1 and 15.6 vs. 29.4 for trial 2. The herb also led to a superior reduction of the number of patients with herpetic episodes (skin sores) in both trials. Individual symptoms were also noticeably improved by the herbal treatment.

The authors commented that the positive outcome was unexpected, because laboratory studies on hypericin indicated that the presence of light was necessary to activate the antiviral effect. (This is despite the fact that many herbalists have been using St. John's wort extract in this way and enjoying good clinical success.) They also pointed out that their study does not establish a mechanism of action for the herb, which could be antiviral, but might also be acting via the immune system, perhaps in turn mediated by the antidepressant activity.

Echinacea

My clinical experience is that while St John's wort is a very useful herb to help fight herpes, it works even better when combined with immune-supporting herbs. In the case of herpes, I have found that Echinacea root (as a combination of both Echinacea purpurea and E. angustifolia) has been very effective, as the following case history illustrates.

A 27-year-old woman was suffering from recurrent HSV-1 infections. She had been experiencing an outbreak at least every month and the sores were large and painful. This had been happening for many years. The following herbal formula was prescribed: Echinacea angustifolia (1:2; 70 mL); St John's wort (high in hypericin) (1:2; 30 mL). Dose: 5 mL with water three times a day.

Topical application of Calendula tincture was also prescribed during skin outbreaks. After four weeks, there was a noticeable improvement. The patient still had an outbreak but it was not as severe and healed more quickly. During the next four weeks, she was free from outbreaks. Treatment was continued for another eight weeks, again with no outbreaks. For the following four months, the patient remained free of lesions without herbal treatment.

Topical Treatments

Lemon Balm: An early study on lemon balm (Melissa officinalis) found that the plant extract possessed good antiviral activity against a number of viruses including HSV.⁴ The extract appeared to directly inactivate viruses. Subsequent studies demonstrated that the antiviral activity of lemon balm was due to its tannin content,⁵ but also a non-tannin polyphenolic fraction was active.⁶

Clinical trials with lemon balm for the topical treatment of recurrent HSV-I infections have yielded conclusive results. One study found an improved healing rate for 75 percent of patients, with the time between outbreaks prolonged in 50 percent of cases.⁷ Compared to conventional treatments average healing time of lesions was halved to about 5 days and the interval between outbreaks was approximately doubled.⁷ This is a good result and suggests that if you treat the current sores the next outbreak will be substantially delayed.

In another multicenter study on 115 patients, the treatment of lesions was commenced between 24 and 72 hours from their outbreak.⁸ It was found that the lesions in 87 percent of patients were completely healed within six days of treatment. The time between outbreaks was again prolonged for 69 percent of patients. The average time between outbreaks was 2.3 months with lemon balm treatment compared to only 1.3 months for conventional treatments. Minor side effects were observed in only 3 percent of patients. As noted above, a significant finding of these studies was that the lemon balm cream prolonged the average time between outbreaks. This was without any preventative application, and it is possible that such an application to normally affected areas would further increase the time between outbreaks.

In another trial, 116 patients were studied over five to six days of treatment; 58 used lemon balm and 58 used a placebo cream.⁹ Redness and swelling were significantly reduced at day two of treatment, but by day five there was no difference between lemon balm and placebo. This accelerated healing was verified by the assessment of both physicians and patients. A sub-group analysis of patients with HSV-2 demonstrated a significantly smaller lesion at day 5 of treatment for the lemon balm group.

More recently, another trial with lemon balm cream has been published.¹⁰ Sixty-six patients with recurrent HSV-1 either used the active herbal cream or a placebo four times a day for five days on any herpes outbreaks. By day two, the symptom score was significantly lower for the herbal cream.

The lemon balm cream used in all these studies was highly concentrated. It contained 1 percent of a 70:1 lemon balm extract, so it effectively contained 70 percent lemon balm actives.

Propolis: Ninety men and women with recurrent genital HSV-2 participated in a randomized, single blind, controlled, multicenter study. The efficacy of a propolis ointment was compared with topical acyclovir and placebo. Thirty patients were randomized to each group and treatment was commenced in the blister phase. In the case of women with vaginal or cervical lesions, a tampon with the appropriate ointment was inserted four times daily for 10 days. The propolis ointment was observed to be more effective than both the acyclovir and placebo ointments in terms of healing the sores and reducing local symptoms.¹¹

Other Herbs: The efficacy of a topical preparation combining rhubarb and sage extracts was compared to sage extract alone or acyclovir in a double blind, randomized trial. A total of 145 patients (111 female, 34 male) with HSV-1 completed the trial, of whom 64 received the rhubarb-sage cream, 40 the sage cream and 41 the reference cream. The sage and rhubarb preparation proved to be as effective as the topical acyclovir cream and tended to be more active than the sage cream.¹²

Even locally applied tea has been found to be effective against herpes. A patent has been filed for a simple cure for herpes infections. The inventor (presumably a medical doctor) has found that ordinary tea works better than acyclovir, is far less expensive and has fewer side effects.¹³ Tea, preferably Earl Grey, is brewed and the liquid cooled and applied to the herpes lesion. The easiest way to do this is to stand a tea bag in boiling water for a few minutes, cool it, then apply it to the skin for a few minutes.

According to the inventor, within four or five days the lesions crust over, then disappear and do not recur for at least several months after treatment. The inventor does not know why tea has this effect, but the tannins in tea (similar to what is found in lemon balm) probably account for tea's antiviral activity.

Finally, there is one other herb I often recommend for herpes outbreaks. A strong yellow Calendula tincture painted on the lesions has worked wonders in many of my patients. The use of Calendula in this way is traditional; there have not yet been any clinical trials. But it works well!

Kerry Bone is a practicing herbalist; co-founder and head of research and development at MediHerb; and principal of the Australian College of Phytotherapy. He also is the author of several books on herbs and herbal therapy, including Principles and Practice of Phytotherapy and The Essential Guide to Herbal Safety