Adult Genital Herpes Treatment (Genital Herpes (HSV-2 Infection))
Discreet, MD-only care for genital herpes outbreaks and suppressive treatment, all by secure video. $49 flat-fee visits, no insurance required, available in 25+ states.
TeleDirectMD is physician-led. You will always see a board-certified MD, not a mid-level provider.
What Is Genital Herpes (HSV-2 Infection)?
Genital herpes is a sexually transmitted infection caused most often by herpes simplex virus type 2 (HSV-2), and less commonly by HSV-1. The virus establishes lifelong infection in the body and can cause painful blisters or sores in the genital and anal area, along with burning, itching, or tingling.
Many adults with genital herpes have mild symptoms or no symptoms at all but can still shed virus and transmit infection to partners. When symptoms do occur, they may appear as grouped painful blisters or shallow ulcers, sometimes with swollen lymph nodes, flu-like symptoms, or burning with urination.
Antiviral medications cannot eliminate HSV from the body, but they can shorten outbreaks, decrease pain, and reduce the risk of transmission. TeleDirectMD focuses on safe, guideline-based antiviral use, clear counseling, and appropriate triage to in-person testing when needed.
Genital Herpes Symptoms and Red Flags
Common symptoms can often be assessed safely by video, but certain features require in-person or emergency evaluation. Use the table below as a general guide and not as a substitute for medical judgment.
| Symptom | What it suggests | Telehealth appropriate? | Red flag requiring in-person / ER care |
|---|---|---|---|
| Painful blisters or sores on genitals or anus | Typical genital herpes outbreak, especially if recurrent in same area | Often yes for adults without severe systemic symptoms | Rapidly spreading skin infection, black or very deep lesions, or severe uncontrolled pain |
| Burning, tingling, or itching before lesions appear | Prodrome of recurrent herpes outbreak | Yes, good fit for episodic antiviral treatment | New numbness, weakness, or loss of bladder or bowel control |
| Painful urination with vulvar or penile sores | Genital herpes affecting urethral opening or surrounding skin | Yes if able to urinate, afebrile, and otherwise stable | Inability to pass urine, severe pelvic pain, or fever and chills |
| Fever, body aches, swollen lymph nodes | Possible primary genital herpes outbreak or another infection | Sometimes; MD will determine if in-person labs are needed | High fever, severe headache, stiff neck, confusion, or difficulty breathing |
| No symptoms but known exposure to partner with genital herpes | Asymptomatic infection or non-infected but at risk partner | Yes for counseling and discussion of testing options | None specific, but in-person testing may be preferred in some cases |
| Severe headache, light sensitivity, neck stiffness | Concern for meningitis or encephalitis, which can rarely be caused by HSV | No | Requires emergency department evaluation immediately |
| Genital sores in pregnancy | Genital herpes during pregnancy, which has delivery and neonatal implications | Limited role; telehealth can advise but not replace obstetric care | Third-trimester primary outbreak, ruptured membranes, or labor with active lesions require urgent obstetric evaluation |
| Genital sores in immunocompromised adult | Genital herpes with higher risk of severe or disseminated infection | Sometimes; MD may recommend prompt in-person care depending on severity | Extensive lesions, difficulty swallowing, eye involvement, or systemic illness require urgent in-person care |
Conditions That Can Mimic Genital Herpes
Several other infections and skin conditions can cause genital sores, ulcers, or irritation. A careful history and exam help distinguish genital herpes from these conditions and determine whether lab testing or in-person evaluation is needed.
Syphilis (Treponema pallidum)
Early syphilis can cause a painless ulcer (chancre) on the genitals, anus, or mouth rather than multiple painful blisters. Syphilis always requires in-person lab testing and penicillin-based treatment; undiagnosed syphilis can lead to serious long-term complications.
Chancroid and Other Ulcerative STIs
Chancroid (uncommon in many regions) and a few other infections can also cause painful genital ulcers. These conditions usually require in-person evaluation, specialized testing, and injectable or oral antibiotics, not antiviral medication.
Genital Warts (HPV)
Human papillomavirus (HPV) causes fleshy, cauliflower-like growths rather than fluid-filled blisters. Genital warts are typically painless and do not respond to antiviral medicines used for herpes. Treatment often involves topical agents, freezing, or minor procedures.
Friction, Dermatitis, and Irritant Rashes
Shaving, new hygiene products, latex, or friction can cause redness, small bumps, or superficial skin breakdown that may be mistaken for herpes. These usually improve with time, gentle skin care, and avoiding the irritant rather than with antivirals.
Folliculitis or Infected Hair Follicles
Ingrown hairs or infected follicles can appear as tender bumps with a central hair, sometimes with a small amount of pus. They are usually localized and may respond to warm compresses and hygiene, occasionally requiring antibiotics rather than antiviral therapy.
Aphthous or Noninfectious Ulcers
Inflammatory conditions, autoimmune disease, or certain medications can cause genital ulcers that are not due to HSV or other infections. These often need in-person evaluation, targeted testing, and individualized treatment beyond standard antiviral regimens.
When Genital Herpes Can Be Treated by Telehealth
TeleDirectMD focuses on safe, guideline-based use of telehealth. Some genital herpes concerns are well suited to MD-only video visits, while others need urgent in-person testing, procedures, or hospital care.
When a TeleDirectMD Video Visit Is Appropriate
- Adult with known history of genital herpes and a typical recurrent outbreak.
- Burning, tingling, or localized pain in the same area as prior lesions.
- Mild to moderate discomfort, able to eat, drink, and urinate normally.
- Questions about episodic versus daily suppressive antiviral therapy.
- Counseling on transmission risk, partner notification, and condom use.
- Stable adult with possible first outbreak but no severe systemic illness, open to in-person STI testing when advised.
Red Flags Requiring In-Person or ER Care
- Inability to urinate, severe pelvic or rectal pain, or urinary retention.
- High fever, severe headache, stiff neck, confusion, or light sensitivity.
- Extensive or rapidly spreading genital, anal, or body rash.
- Eye redness, eye pain, or vision changes suggesting ocular herpes.
- Genital sores in late pregnancy, especially with first-ever outbreak.
- Severe illness or widespread lesions in immunocompromised adults.
- Any concern for sexual assault or abuse, which requires immediate in-person care.
How TeleDirectMD Treats Genital Herpes in Adults
Treatment focuses on decreasing pain, shortening outbreaks, reducing transmission risk, and supporting your long-term health and relationships. TeleDirectMD uses evidence-based antiviral regimens and clear counseling while avoiding unnecessary or unsafe medications.
Supportive Care
- Cool compresses or brief sitz baths for comfort and to keep the area clean.
- Loose, breathable clothing and cotton underwear to decrease friction.
- Over-the-counter pain relievers such as acetaminophen or ibuprofen when appropriate.
- Adequate hydration and rest during outbreaks, especially with systemic symptoms.
- Avoiding sexual contact and oral-genital contact while lesions or prodromal symptoms are present.
First-Line Antiviral Treatment
For adults with a first recognized genital herpes episode or bothersome recurrent outbreaks, TeleDirectMD physicians may prescribe oral antiviral medications such as acyclovir, valacyclovir, or famciclovir when clinically appropriate.
- First episode: multi-day antiviral course to reduce symptom duration and viral shedding.
- Episodic therapy: short courses started at the first sign of tingling, burning, or new lesions.
- Suppressive therapy: daily preventive antiviral treatment for patients with frequent or very distressing outbreaks.
Exact dosing and duration are individualized based on your history, kidney function, other medications, and overall health.
Stewardship and Safety Principles
- No controlled substances are prescribed for genital herpes visits.
- We avoid unnecessary long-term antivirals when outbreak frequency is low and symptoms are mild.
- We screen for potential drug interactions and adjust dosing in kidney disease when appropriate.
- We emphasize partner notification, safer-sex practices, and recommended STI testing through local clinics or labs.
- We triage to in-person care when visual limitations or red flags make telehealth unsafe.
Common Medications Used for Genital Herpes in Adults
The table below shows example adult dosing patterns used in guidelines for genital herpes. Your TeleDirectMD physician will tailor any prescription to your specific situation. Doses may differ in kidney disease, drug interactions, or other special circumstances.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Acyclovir | 400 mg orally 3 times daily | 7–10 days | Typical first-recognized genital herpes episode in otherwise healthy adult, continued until lesions have crusted and healed. |
| Valacyclovir | 1,000 mg orally 2 times daily | 7–10 days | Alternative first-episode regimen; often preferred for twice-daily dosing convenience. |
| Famciclovir | 250 mg orally 3 times daily | 7–10 days | Another first-episode option when valacyclovir or acyclovir are not ideal or available. |
| Valacyclovir (episodic therapy) | 500 mg orally 2 times daily | 3 days | Episodic treatment for recurrent outbreaks started at the first sign of burning, tingling, or new lesions. |
| Acyclovir (episodic therapy) | 800 mg orally 3 times daily | 2 days | Short-course episodic regimen for recurrent outbreaks in adults with predictable prodrome or early recognition of symptoms. |
| Valacyclovir (suppressive therapy) | 500–1,000 mg orally once daily | Ongoing, with periodic reassessment | Daily suppression for adults with frequent or severe outbreaks or for couples seeking to reduce transmission risk. |
| Acyclovir (suppressive therapy) | 400 mg orally 2 times daily | Ongoing, with periodic reassessment | Daily suppression when valacyclovir is not preferred, taking into account adherence and kidney function. |
These regimens reflect common adult dosing patterns. TeleDirectMD physicians do not prescribe controlled substances for genital herpes and will individualize antiviral therapy based on your health profile and goals.
Home Care, Intimacy, and Return to Work
Most adults with genital herpes can safely recover at home and return to work or school once they feel well, as long as they follow basic precautions to prevent transmission to partners.
Home Care and Symptom Relief
- Keep the area clean and dry; consider brief lukewarm sitz baths for comfort.
- Pat dry gently instead of rubbing, and wear loose cotton underwear and clothing.
- Use over-the-counter pain relievers if appropriate and not contraindicated for you.
- Avoid topical steroids or over-the-counter antibiotic creams on open lesions unless specifically directed by a clinician.
- Do not pick at blisters or sores; allow them to crust and heal naturally.
Sexual Activity and Partner Safety
- Avoid sexual contact and oral-genital contact while lesions or prodromal symptoms are present.
- Use condoms consistently when sexually active; they reduce but do not eliminate transmission risk.
- Discuss your diagnosis with current and future partners and encourage appropriate STI testing.
- Daily suppressive antiviral therapy may reduce the risk of transmission in some couples.
Return to Work or School
- Most adults can work or attend school as soon as they feel well enough and do not have severe systemic symptoms.
- Genital herpes is not spread by casual contact, shared toilets, or typical workplace interactions.
- Jobs requiring heavy physical exertion may be more uncomfortable during severe outbreaks; your MD can provide guidance if needed.
TeleDirectMD Genital Herpes Care: What to Expect
TeleDirectMD provides MD-only virtual urgent care for adults, with $49 flat-fee video visits available in 25+ states. Our physicians evaluate your symptoms, review your history, and prescribe evidence-based antiviral treatment when appropriate. We do not prescribe controlled substances, and we clearly explain when in-person testing, procedures, or emergency care is safer than telehealth.
Genital Herpes FAQs for Adults
These common questions can help you understand how genital herpes is diagnosed, treated, and monitored through TeleDirectMD video visits, and when in-person care is recommended.
Genital herpes is a sexually transmitted infection caused most often by herpes simplex virus type 2 (HSV-2) and sometimes by HSV-1. After the first infection, the virus remains in the body and can reactivate, causing recurrent outbreaks of genital or anal sores, burning, or tingling.
HSV spreads through direct skin-to-skin contact, most often during vaginal, anal, or oral sex with an infected partner. Transmission can occur when visible sores are present and sometimes even when the skin looks normal due to asymptomatic viral shedding. It is not spread by casual contact, toilets, or typical workplace interactions.
Typical symptoms include painful blisters or open sores on the genitals, perineum, or anus, along with burning, tingling, or itching. Some people also have swollen lymph nodes, fever, fatigue, or headache, especially during a first outbreak. Others have very mild symptoms or none at all.
Diagnosis is based on your symptoms, exam findings, and sometimes laboratory tests such as a swab PCR from a fresh lesion or type-specific blood tests. In a TeleDirectMD visit, an MD will review your history, visually assess the area over video when appropriate, and advise whether in-person testing at a clinic or lab is recommended.
In many adults with a typical history and exam, an experienced MD can make a working diagnosis and start antiviral treatment via video. However, if the appearance is atypical, if another STI is suspected, or if red flags are present, we may recommend in-person testing or referral to a local clinic to ensure you receive the safest and most accurate care.
Antivirals are commonly prescribed for a first episode of genital herpes, for episodic treatment of recurrent outbreaks, and for daily suppressive therapy in adults with frequent or very distressing recurrences. Your TeleDirectMD physician will decide whether an antiviral is appropriate, which regimen fits you best, and how long to continue treatment.
Episodic therapy means taking antivirals for a short period at the first sign of an outbreak to shorten symptoms. Suppressive therapy means taking antiviral medication every day to reduce how often outbreaks occur and to help lower the risk of transmission. Your MD will help you decide which option aligns with your outbreak pattern, lifestyle, and goals.
Many adults notice improvement in pain and discomfort within a few days of starting antiviral medication, especially if treatment is started early in the outbreak. Sores may take one to two weeks to fully crust and heal in a first episode and often clear more quickly in recurrent outbreaks.
There is currently no cure that removes HSV from the body. However, antiviral medications, safer-sex practices, and good communication with partners allow most adults to live full lives, with fewer and milder outbreaks and lower risk of transmission over time. TeleDirectMD focuses on long-term management and support rather than a one-time visit.
You should avoid sexual contact and oral-genital contact whenever you have active sores or feel prodromal symptoms such as tingling or burning. Even outside of outbreaks, using condoms and considering suppressive antiviral therapy can help reduce, but not eliminate, the chance of transmitting HSV to a partner.
You should seek in-person or emergency care for high fever with severe headache or stiff neck, inability to urinate, rapidly spreading rash, eye symptoms, severe weakness, or genital sores in late pregnancy. TeleDirectMD MDs will clearly tell you when telehealth is not enough and help direct you to the right setting of care.