Is honey better than acyclovir for cold sores?

October 7, 2025 •

4 min read

An estimated two-thirds of the world's population under 50 are infected with the herpes simplex virus type 1, the primary cause of cold sores. When considering treatment, a common question arises: is honey better than acyclovir? Research suggests that medical-grade honey can offer comparable or, in some studies, superior healing effects to topical acyclovir for herpetic lesions.

Quick Summary

Studies comparing medical-grade honey and topical acyclovir for cold sore treatment yield mixed results, with some showing similar effectiveness and others indicating honey may promote faster healing. Honey's antiviral and wound-healing properties, versus acyclovir's targeted viral inhibition, provide different mechanisms for symptom relief. The most effective option can depend on the specific honey type, individual preference, and stage of the outbreak.

Key Points

Equivalence in Efficacy: Large studies have shown medical-grade honey can be therapeutically equivalent to acyclovir cream for treating cold sores, with similar healing times and pain resolution.
Faster Healing Potential: Some systematic reviews and older studies suggest honey can promote faster healing of herpetic lesions compared to acyclovir.
Multifaceted Mechanism: Honey's action is due to its osmotic effect, low pH, and antiviral compounds, unlike acyclovir which specifically inhibits viral replication.
Product Quality Matters: Not all honey is equal; the effectiveness observed in clinical studies is primarily based on medical-grade honey, such as Manuka or Kanuka, not standard store-bought varieties.
Low Resistance Risk: Honey's multi-targeted action makes it less likely to induce viral resistance, a potential concern with long-term antiviral drug use.
Consult a Professional: Always speak with a healthcare provider before switching from a prescribed medication to a natural remedy like honey.

Understanding the Treatments: Acyclovir vs. Honey

When a cold sore, caused by the herpes simplex virus (HSV), erupts, it can be a painful and uncomfortable experience. The two main approaches for topical treatment are pharmaceutical antivirals like acyclovir cream and natural remedies, particularly honey. Acyclovir is a well-established synthetic drug, while honey has been used medicinally for centuries. Recent clinical studies have directly compared these options, offering insights into their relative effectiveness.

How Acyclovir Works

Acyclovir is a prescription antiviral medication that targets the herpes simplex virus directly. It works by inhibiting the viral DNA polymerase, thereby stopping the virus from replicating and spreading. For maximum effectiveness, topical acyclovir cream should be applied at the very first sign of a cold sore, typically the tingling or burning sensation. While effective, topical acyclovir offers minimal clinical benefit and is considered less reliable than oral formulations.

How Honey Fights Herpes

Honey, particularly medical-grade varieties like Manuka or Kanuka honey, possesses a range of properties that make it a potent anti-herpetic agent. These include:

Antiviral compounds: Honey contains phenolic compounds, flavonoids, and other substances that have been shown to inhibit the herpes simplex virus in in vitro studies.
Osmotic effect: The high sugar content of honey draws water out of the wound, creating an environment that inhibits microbial growth and promotes healing.
Low pH: The naturally acidic pH of honey is unfavorable for viral survival and bacterial contamination.
Hydrogen peroxide production: When in contact with moisture, honey produces low levels of hydrogen peroxide, providing a mild antibacterial effect.
Wound healing: Honey is known to have strong wound-healing properties, assisting with the re-epithelialization of lesions.

Clinical Evidence: Direct Comparisons

Research comparing honey and acyclovir has yielded somewhat varied results, largely dependent on the type of honey and the study's design.

Studies Suggesting Honey is Superior or Equivalent
- A 2022 systematic review and meta-analysis confirmed honey's effectiveness against herpetic lesions. The pooled results from several studies showed honey had a better overall healing effect than acyclovir, with a healing time of 8 days compared to 9 days for acyclovir. It also provided similar pain reduction.
- An older 2004 pilot study on labial and genital herpes found that topical honey application was more effective and better tolerated than acyclovir cream for recurrent lesions. The study reported a significantly shorter duration of pain and healing time with honey.
- A 2021 study focused on medical-grade honey (L-Mesitran Soft) found it healed cold sores faster and eased itching more effectively than conventional treatments. The study noted a strong patient preference for the honey treatment.
Studies Suggesting Similar Efficacy
- A large-scale 2019 randomized controlled trial compared medical-grade Kanuka honey cream with topical 5% acyclovir cream for herpes simplex labialis. The study found no statistically significant difference in the time to complete healing between the two treatments, concluding they were therapeutically equivalent.

A note on quality and type

The variability in results highlights the importance of using medical-grade honey, as used in these controlled studies. The composition of honey, depending on its floral source and processing, can greatly influence its medicinal properties. For example, Manuka honey's high concentration of methylglyoxal (MGO) is linked to strong antiviral activity. Raw, unpasteurized honey from a local store may not provide the same benefits as a standardized medical-grade product. Always consider this when choosing a natural remedy.

Acyclovir vs. Medical-Grade Honey: A Comparison


Feature	Acyclovir (Topical)	Medical-Grade Honey	Comparison Insight
Mechanism	Inhibits viral DNA replication	Antiviral compounds, low pH, osmotic effect	Acyclovir has a specific antiviral target, while honey's effect is multi-pronged and less targeted.
Healing Time	Varies; some studies show slightly longer than honey	Varies; some studies show faster healing than acyclovir	Results are mixed, but honey appears to perform comparably or better in some cases.
Pain Relief	Equivalent to honey	Equivalent to acyclovir	Both offer similar levels of pain and discomfort reduction.
Adverse Effects	Possible local itching or irritation	Rare allergic reactions to bee products possible	Acyclovir has a generally well-known safety profile, while honey-related side effects are typically minor.
Availability	Prescription required for oral form, some creams OTC	OTC, but medical-grade versions may be pricier	Acyclovir is widely available, while specific medical-grade honey might require more effort to find.
Resistance Risk	Overuse can increase resistance	No documented resistance	Honey's multifaceted mechanism makes it less prone to viral resistance development.

Conclusion: Which is the right choice?

Determining whether honey is better than acyclovir depends on individual priorities, specific outbreak characteristics, and access to medical-grade products. For those seeking a natural alternative with a strong safety profile and good wound-healing capabilities, particularly in cases of recurrence, medical-grade honey presents a compelling option, supported by studies showing equivalent or sometimes superior results. However, the quality and type of honey are critical factors in its effectiveness. Acyclovir remains a scientifically validated and widely available treatment, especially for first-time or more severe infections when prompt viral inhibition is key.

Given the varied results in clinical trials and the importance of using a high-quality product, it is crucial to consult a healthcare professional before replacing a prescribed medication with honey. They can provide guidance based on the severity of the outbreak and personal health history. Ultimately, both options can provide effective symptomatic relief and help speed up the healing process for cold sores. For more detailed information on clinical trials comparing honey and acyclovir, the BMJ Open article on Kanuka honey versus aciclovir offers valuable insight.

Frequently Asked Questions

No, clinical studies showing honey's effectiveness have typically used medical-grade varieties like Manuka or Kanuka honey, which have specific antimicrobial and antiviral properties. Standard supermarket honey may not provide the same therapeutic benefits.

Some research suggests that honey can induce faster healing, with one meta-analysis finding an average healing time of 8 days for honey versus 9 days for acyclovir. However, other large studies found no significant difference in healing time.

According to a 2022 meta-analysis, honey provides a reduction in pain equivalent to that of acyclovir. Some studies have also noted that patients report greater satisfaction with honey in terms of tolerability.

While honey is generally safe, some individuals may have a sensitivity or allergy to bee pollen within the honey, which can cause minor skin irritation. Acyclovir cream can also cause local itching in some cases.

Combining treatments should be done under the guidance of a healthcare professional. While one study showed benefits of combining honey with acyclovir for herpetic gingivostomatitis in children, it's not a standard recommendation. Your doctor can advise on the best course of action.

While topical honey can treat an active outbreak, its effectiveness in preventing future recurrences has not been conclusively established. For frequent outbreaks, a doctor might recommend daily suppressive therapy with oral antivirals.

Medical-grade honey can sometimes be more expensive than over-the-counter acyclovir cream or generic prescription options. The cost depends on the specific product and treatment plan.