The efficacy of the oral medications valacyclovir and famciclovir in the treatment and suppression of cold sores has not yet been established. Acyclovir is the treatment of choice for infected newborns and also for those with herpes encephalitis. Acyclovir also suppresses asymptomatic or subclinical shedding of the virus in certain individuals. One study of women recently infected with genital herpes showed a 95 percent reduction measured by culture and an 80 percent reduction measured by PCR in the shedding of the virus when acyclovir was taken sup-pressively. Whether this suppression means that the virus will not be transmitted as easily remains to be seen. The benefits of taking the medication suppressively are seen after about two weeks. Studies are under way to determine whether the other medications are as effective or even more effective in suppressing asymptomatic shedding.

Otherwise healthy people who take these medications experience few side effects. In those who do develop side effects, the most common are headache, nausea, and dizziness. When valacyclovir was taken in dosages much higher than usual, people with serious immunodeficiency (such as those with an advanced stage of human immunodeficiency virus [HIV] infection or those taking drugs to suppress an immune reaction to a transplanted organ) developed a rare kidney and blood disorder called hemolytic uremic syndrome.

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