Superiority of propolis and honey over topical acyclovir for herpes simplex: A meta-analysis

Background Topical antiviral agents, particularly acyclovir, are standard over-the-counter treatments for minor herpes simplex infections. However, natural products such as propolis and honey have drawn attention for their potential antiviral and wound healing-promoting properties. This meta-analysis aimed to systematically evaluate and compare the efficacy and safety profiles of propolis and/or honey with 5% topical acyclovir in the management of labial and genital herpes. Methods A systematic search of PubMed, Scopus, Europe PMC, and the Cochrane Library was performed to identify studies comparing topical propolis and/or honey with 5% acyclovir for herpes simplex lesions. Clinical outcomes were synthesized using random-effects models, with outcomes reported as mean difference (MD) and odds ratio (OR). Results Seven studies were included in the analysis. Treatment with propolis and/or honey was associated with quicker lesion resolution (MD: −1.87 days; 95% CI: −2.73 to −1.01; p < 0.0001) and higher healing rates by day 7 (OR: 4.71; 95% CI: 2.70–8.25; p < 0.00001). No significant difference was observed in the number of aborted attacks ( p = 0.66). Propolis and/or honey also reported reduced pain duration (MD: −0.96 days; p = 0.03) and pain intensity (MD: −6.53; p = 0.0002), with more patients reporting being symptom-free by day 3. No significant difference was observed in adverse events (AEs) rates between the natural therapy and acyclovir groups. Conclusions Propolis and/or honey demonstrated superior lesion healing and pain relief compared to 5% acyclovir, with comparable safety, supporting their potential as safe and effective alternatives to conventional antiviral therapy.