Why does a first-ever outbreak have to be seen in person?
A first episode needs swab (PCR) testing to confirm the diagnosis, usually along with STI and HIV screening — several conditions, including syphilis, can look like herpes and are treated completely differently. First episodes also carry the highest counseling stakes, so this lane always refers them to in-person or STI-clinic care rather than guessing.
How is this different from the cold-sores option?
The Cold sores lane treats a single active orolabial flare — a typical cold sore on the lip. This lane owns ongoing care: daily suppression (for oral or genital herpes) and short courses for genital recurrences in someone already diagnosed. If you just have a cold sore starting on your lip today, start from the Cold sores guide at /conditions/cold-sore-treatment-online-virginia instead.
Does daily suppression stop me from spreading herpes?
It helps a lot but is not absolute: daily valacyclovir roughly halves the risk of transmitting genital herpes to a partner. Disclosure to partners, condoms, and avoiding sex during outbreaks or warning symptoms (tingling, burning) remain part of the plan, and the physician includes a written STI/HIV screening recommendation with every approval.
Which medications are prescribed, and for how long?
Valacyclovir is the default — 500 mg daily for suppression, moving to 1 g daily only when outbreaks number ten or more per year — and acyclovir 400 mg twice daily is the lower-cost alternative. Episodic genital courses are valacyclovir 500 mg twice daily for 3 days or acyclovir 800 mg twice daily for 5 days. Suppression fills cover 90 days with no automatic refills: a short secure-message check-in gates every refill, and a full re-evaluation at least every 12 months includes discussing a trial off suppression.
Why do the questions ask about my kidneys?
Valacyclovir and acyclovir are cleared by the kidneys, and wrong dosing can injure them or cause confusion. Known kidney disease or dialysis means in-person dosing instead, and patients 65 and older need a creatinine or eGFR blood-test result from the last 12 months before this lane can prescribe. Every fill also comes with hydration counseling.
Can I get a standby course to keep on hand?
Yes — one episodic course per approved request, with no automatic refills. Starting treatment within 24 hours of the first tingling or sore is what makes episodic therapy work, so having one course ready is reasonable. The next request re-asks about your outbreak frequency and how the last course was used, and frequent outbreaks usually mean suppression is the better plan.