Herpes simplex virus is extremely common, and for most people it shows up as occasional cold sores or genital outbreaks. Antiviral medicines work best when started early, which is exactly where telehealth helps: you can often get a prescription the same day, or keep one on hand so you can start at the first tingle.
Key Takeaways
- Prescription antivirals (acyclovir, valacyclovir, famciclovir) shorten outbreaks and can reduce how often they happen.
- Episodic therapy is taken at the first sign of an outbreak; it works best started within about a day, ideally during the tingling stage.
- Suppressive therapy is taken daily to reduce recurrences and, for genital herpes, to lower the chance of passing it to a partner.
- Telehealth handles recurrent, previously diagnosed outbreaks well; a first genital outbreak usually benefits from testing.
- Eye symptoms, outbreaks in newborns or during pregnancy, and severe or widespread sores need in-person care.
HSV basics in one minute
There are two types of herpes simplex virus. HSV-1 most often causes cold sores around the mouth, but it is also a common cause of genital herpes. HSV-2 most often causes genital herpes. After the first infection, the virus stays dormant in nerve cells and can reactivate, causing outbreaks. Many people with HSV have mild or unrecognised symptoms.
There is no cure, but antiviral medicines are effective and well tolerated. The CDC's STI treatment guidelines and the American Academy of Dermatology both describe them as the mainstay of treatment.
Episodic vs suppressive therapy
| Episodic | Suppressive | |
|---|---|---|
| How it is taken | Short course started at the first sign of an outbreak | Every day, ongoing |
| Goal | Shorter, milder outbreaks | Fewer outbreaks; for genital herpes, reduced transmission to partners |
| Good for | Infrequent outbreaks you can recognise early | Frequent or distressing outbreaks, or a partner without HSV |
| Key to success | Starting early, ideally during tingling or within about a day of sores | Taking it consistently |
The CDC notes that episodic therapy for recurrent genital herpes works best when started within a day of lesion onset or during the prodrome, the tingling, itching or burning that often comes before sores appear. Daily suppressive therapy reduces recurrences substantially in people with frequent outbreaks and lowers, but does not eliminate, the risk of transmission to partners.
Why telehealth fits herpes care
- Speed. Because timing matters, a same-day online prescription can make a real difference.
- Standing prescriptions. Many clinicians will prescribe an episodic supply to keep at home so you can start at the first tingle.
- Privacy. Many people find it easier to discuss genital symptoms in a written intake.
- Photos. For cold sores, a clear photo plus your history is often enough for a confident diagnosis.
Antivirals for HSV are not controlled substances, so standard telehealth prescribing applies. For the wider picture of online sexual health care, see telehealth for sexual health.
When testing matters
For a first genital outbreak, testing is usually recommended to confirm HSV and identify the type, because the type affects how often outbreaks are likely and how you counsel partners. The most accurate test is a swab of an active sore, typically by PCR, which generally requires a clinic or lab visit while sores are present. Some services can arrange this quickly.
Blood tests for HSV antibodies have limitations and are not recommended for routine screening of people without symptoms. They can be useful in specific situations, such as a partner of someone with genital herpes. The telehealth lab work guide explains how online clinicians order tests at local labs. If you have a new genital sore, testing for other STIs, like syphilis, is often recommended too.
Cold sores specifically
Over-the-counter docosanol cream can modestly shorten cold sores if started early. Prescription oral antivirals are generally more effective, especially for people with frequent or painful cold sores. Triggers include sun exposure, illness, stress and dental work; lip balm with sunscreen helps some people. If you get cold sores after certain procedures, a clinician may prescribe antivirals to take beforehand.
Avoid kissing and sharing utensils or lip products while a sore is active, and avoid oral sex during an outbreak, since HSV-1 can be passed to the genitals.
Safety notes
- Antivirals are generally well tolerated; headache and nausea are among the more common side effects.
- Doses are adjusted for kidney problems, so mention any kidney disease.
- Stay well hydrated, especially with higher doses.
- Pregnancy requires specific management. Tell your prenatal clinician if you or a partner have HSV.
When to be seen in person
Also book an in-person visit for a first genital outbreak if you can, for any sore that does not look like your usual outbreaks, and for outbreaks that do not respond to treatment. Our guide to telehealth vs urgent care vs ER helps you choose.
What an online herpes visit looks like
Most services use a questionnaire, sometimes followed by a video call. Expect questions about:
- Where the sores are, when they started, and whether you felt tingling first.
- Whether you have had a confirmed HSV diagnosis before, and how often outbreaks happen.
- Kidney disease, pregnancy and other medicines.
- Eye symptoms, fever or other signs that need in-person care.
- Whether you want episodic treatment, a standing supply, or daily suppression.
For cold sores, a clear, well-lit photo helps. For genital symptoms, some services accept photos and others prefer a description; use whatever makes you comfortable within the service's process. If something about your outbreak is new or unusual, a good clinician will recommend a swab test or in-person visit rather than guessing. That is what you want from them.
Living with HSV
A herpes diagnosis can feel heavier than the medical reality. It is common, manageable, and for many people outbreaks become less frequent over time. Disclosing to partners, using condoms, avoiding sex during outbreaks and considering suppressive therapy all reduce transmission. If the diagnosis is affecting your mood or relationships, talking with a counsellor can help; signs it's time to talk to a therapist may be useful.
Frequently Asked Questions
Can I get valacyclovir online?
Yes. Many telehealth services prescribe valacyclovir and other antivirals for cold sores and recurrent genital herpes after reviewing your history and sometimes a photo.
How fast do I need to start treatment?
As early as possible. For recurrent genital herpes, the CDC notes episodic therapy works best started within about a day of sores appearing or during the tingling stage.
Does suppressive therapy stop me from passing herpes on?
It lowers the risk but does not eliminate it. Combining suppressive therapy with condoms and avoiding sex during outbreaks reduces risk further.
Do I need a test for a cold sore?
Usually not, if it looks typical and you have had them before. A first genital outbreak usually benefits from a swab test to confirm the diagnosis and virus type.
When is herpes an emergency?
Sores near the eye or eye symptoms, sores in a newborn, severe headache or confusion, widespread sores, or outbreaks in someone with a weakened immune system need urgent in-person care.
Sources
- CDC STI Treatment Guidelines: Genital Herpes (Adolescents and Adults)
- American Academy of Dermatology: Cold Sores — Diagnosis and Treatment
Medical guidance and labeling change. We link primary sources so you can check the current version yourself.