Valacyclovir for genital and oral herpes
Valacyclovir treats genital and oral herpes (HSV-1 and HSV-2). You take it daily to suppress outbreaks or as a short course when one starts. A licensed clinician reviews your intake and prescribes generic valacyclovir. A pharmacy ships it.
The numbers: daily suppression reduces outbreak frequency by roughly 70 to 80 percent, and once-daily valacyclovir cuts the risk of passing genital HSV-2 to a susceptible partner by roughly half. It does not cut transmission to zero, and it is not a cure.
What you get
Generic valacyclovir, 500 mg and 1000 mg tablets. No compounding. Dosing assumes normal kidney function; we adjust for impairment.
- Genital HSV, suppressiondaily
- 500 mg once daily for fewer than ten recurrences a year. 1000 mg once daily for ten or more a year, where 500 mg can be less effective.
- Genital HSV, episodicas needed
- Start within 24 hours of the prodrome or lesion: 1000 mg once daily for 5 days, or 500 mg twice daily for 3 days.
- Cold sores, episodicas needed
- 2000 mg twice daily for one day, two doses 12 hours apart, at the first warning sign.
- Cold sores, suppressiondaily
- 500 mg once daily, for frequent or disabling recurrences by clinician judgment.
Suppression reduces recurrence frequency by roughly 70 to 80 percent. It is not a cure. There is no cure.
What the evidence says
- [1]
Transmission. Corey et al. (NEJM 2004) showed once-daily valacyclovir 500 mg cut acquisition of genital HSV-2 by susceptible partners by 48 percent, roughly half. It reduced transmission; it did not abolish it. Transmission can still happen from skin without a visible sore, which is called asymptomatic shedding.
- [2]
Recurrence. Suppressive therapy reduces outbreak frequency by roughly 70 to 80 percent.
- [3]
Guidelines. The CDC STI Treatment Guidelines (2021, current) list valacyclovir as first-line for both suppressive and episodic therapy.
- [4]
Serology limits. Type-specific IgG assays carry meaningful false-positive and false-negative rates; the USPSTF recommends against routine serologic screening of asymptomatic adults.
Who qualifies
- Age 18 or older.
- Genital or oral HSV that is lab-confirmed, previously diagnosed by a clinician or worked up through our testing pathway.
- None of the conditions listed in the risks section below.
If you only suspect HSV and were never diagnosed, we route you to testing before suppression: a swab of an active lesion (PCR is best, within 48 hours of a new lesion, and it tells you the type), or type-specific IgG blood testing when there is no lesion. The blood tests are imperfect. A low-positive HSV-2 IgG can be a false positive and should be confirmed, and IgG misses 12 to 30 percent of people with PCR-proven recurrent genital herpes. We do not screen people without symptoms; the CDC and USPSTF advise against it.
Known risks and who should not use the online path
Valacyclovir's main risk is to the kidneys. It clears through the kidneys, and at high doses or with dehydration it can cause kidney injury. If your kidney function is impaired, it can build up and cause confusion, hallucinations or tremor. In people with severe immune compromise, high-dose use has been linked to TTP/HUS, a rare and serious blood disorder.
Each condition below routes you out of the online flow and to the right care instead.
- An allergy to valacyclovir, acyclovir or famciclovir. We will not prescribe it. A clinician reviews alternatives.
- Advanced HIV or AIDS, or a CD4 count under 200. High-dose suppression in severe immunocompromise has been linked to TTP/HUS. This needs HIV care or a video visit, not an automatic prescription.
- A bone marrow, stem cell or solid organ transplant. Same TTP/HUS concern. Routes to your transplant team or a clinician.
- Significant kidney disease, an eGFR under 30, or dialysis. Valacyclovir can build up to harmful levels when the kidneys cannot clear it. A clinician doses it for you instead of the online flow.
- Pregnancy. Valacyclovir is used in pregnancy under clinician supervision, including late-pregnancy suppression. That decision belongs to a treating clinician, so pregnancy routes to a video visit, not a block from care.
- Warning signs of serious disease right now: stiff neck, confusion, severe headache, eye pain or vision change with the outbreak, or a widespread blistering rash. Go to urgent or emergency care today. These can signal disease in the brain, the eye or the whole body.
If you are 60 or older, have diabetes or high blood pressure, or take regular NSAIDs or other kidney-stressing drugs, we ask for a recent creatinine or eGFR before prescribing. That is a safety check, not a no.
How it works here
You answer an intake. You tell us how often you get outbreaks, where, whether a clinician has diagnosed you, and your kidney and immune history. About five minutes.
A licensed clinician reviews it. A clinician licensed in your state reviews it and prescribes. If a clinician never confirmed your diagnosis, we route you through a short testing pathway first. We do not start daily suppression on a self-diagnosis.
The pharmacy ships. Your tablets ship to your door. Suppression ships as an ongoing supply. Episodic treatment ships as per-episode courses you keep on hand and start at the first tingle.
Price
| Clinical visit and prescription | $29 |
|---|---|
| Suppression, valacyclovir 500 mg daily (90-day supply) | $30 |
| Suppression, valacyclovir 1000 mg daily (90-day supply) | $48 |
| Episodic genital course (per course) | $15 |
| Cold sore one-day course (per course) | $12 |
| Confirmatory testing, if needed | $79 (swab) / $89 (type-specific IgG) |
Generic valacyclovir is inexpensive. If your pharmacy copay beats our cash price, we will say so.
FAQ
Does daily valacyclovir stop me from passing herpes to my partner?
It lowers the risk by roughly half. It does not remove it. Condoms and not having sex during prodrome or an outbreak add protection. Transmission can also happen from skin with no visible sore, so suppression is one layer, not a guarantee.
Should I take it every day or only during outbreaks?
That depends on how often you get them and what you want. Suppression suits frequent recurrences (a common threshold is six or more a year), bothersome outbreaks or a wish to lower transmission to a partner. Episodic suits infrequent recurrences you would rather treat one at a time.
500 mg or 1000 mg for suppression?
500 mg once daily works for most. We move to 1000 mg once daily at ten or more recurrences a year, because 500 mg can be less effective in that group.
Can you prescribe if I have never been formally diagnosed?
Not for daily suppression. We route you to a swab or a blood test first. A swab during an active lesion is best and also tells you the HSV type.
I have HSV-1 genitally, not HSV-2. Do I still need daily suppression?
Often not. Genital HSV-1 tends to recur and shed less than HSV-2, so many people with it have infrequent outbreaks and do well with episodic treatment. We tailor it to your recurrence pattern.
Is valacyclovir hard on the kidneys?
It clears through the kidneys. At high doses or with dehydration it can cause kidney injury, and in kidney impairment it can cause confusion, hallucinations or tremor. That is why we gate dosing on kidney function and tell you to stay hydrated. Report confusion or new tremor right away.
Can I take it while pregnant?
Under a clinician's supervision, yes. It is used late in pregnancy to lower the chance of an outbreak at delivery. We route pregnancy to a video visit so a clinician makes that call directly.
How fast should I start an episodic course?
At the first sign: tingling, itching, burning or a new sore. Earlier is more effective. Finish the full course even if the sore heals.
Will suppression stop working over time?
Recurrence rates tend to fall over the years on their own. We reassess at least annually, and we will offer a trial off therapy when it makes sense.
Do you treat shingles or eye herpes here?
No. This protocol covers genital and cold sore HSV. Herpes zoster, HSV keratitis and severe primary infections route to video or in-person care.
The rest of the catalog
The same rules apply to every medication we carry: a structured intake, a licensed clinician on every review, flat prices and FDA-approved generics only.
From the catalog · Sexual health
Start your intake
Answer the intake and get a clinician's decision, usually the same day.
Clinical content reviewed by [Reviewer name], MD. Last clinically reviewed 2026-06-10.