For shingles the window is 72 hours. Getting seen quickly is most of the treatment.
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Antivirals for herpes viruses work best when started early — in some cases, very early. For shingles, the evidence-based window is 72 hours from the rash appearing, and the main determinant of outcome is often simply how quickly you were able to see someone.
That is a problem a remote service is unusually well placed to solve. A same-day consultation and a prescription to your own pharmacy can land comfortably inside the window.
Aciclovir — the long-established option, effective but taken five times daily, which people struggle to keep up.
Valaciclovir — better absorbed, taken two to three times daily. Usually the more practical choice.
Famciclovir — an alternative with similar convenience.
These do not eliminate the virus, which stays dormant in nerve tissue for life. What they do is shorten the episode, reduce its severity and — in shingles — reduce the chance of lasting nerve pain afterwards.
They are also used suppressively: a daily low dose to prevent frequent recurrences, which is a genuinely life-changing option for people with recurrent genital herpes or repeated cold sores and is under-offered.
Speed matters here more than in almost anything else we treat. We assess the rash or lesion by video, and by photograph where that is clearer.
Two situations change the plan entirely. Shingles involving the eye or the tip of the nose needs same-day ophthalmology, not just antivirals. Shingles in someone immunosuppressed may need hospital-level treatment.
Private prescription to your own pharmacy, usually within minutes of the consultation.
Shingles pain is neuropathic and frequently undertreated with paracetamol alone. We will discuss appropriate options, including amitriptyline or gabapentinoids where warranted — and be clear about what we can and cannot prescribe remotely.
For recurrent disease we discuss daily suppressive treatment and review it periodically.
Aciclovir and valaciclovir are well tolerated. The commonest side effects are nausea, headache and diarrhoea, and most people notice nothing.
Hydration matters. These drugs are cleared by the kidneys and can crystallise if you are dehydrated. Drink plenty, particularly at higher shingles doses.
Doses must be reduced in kidney impairment. At full dose in someone with poor kidney function, confusion and agitation can occur — more often in older people, and sometimes mistaken for delirium from the illness itself. Tell us about your kidney function.
They are considered safe in pregnancy where treatment is needed, and this is a discussion worth having rather than avoiding.
Shingles is contagious to anyone who has not had chickenpox. Avoid contact with pregnant women who have not had chickenpox, newborns, and anyone immunosuppressed until the rash has crusted over.
For shingles, the evidence-based window is 72 hours from the rash appearing, and the main determinant of outcome is often simply how quickly you were seen.
Beyond 72 hours, treatment is still worthwhile if the rash is still spreading, if you are over 50, or if you are immunosuppressed — so a late presentation is not a reason to give up.
Shingles pain is neuropathic, and paracetamol alone frequently does not touch it.
Shingles can give chickenpox to anyone who has not had it. Keep the rash covered, and avoid contact with pregnant women who have not had chickenpox, newborns, and anyone immunosuppressed until it has crusted over.
It is not spread by coughing, and you cannot catch shingles from someone else's shingles.
Suppressive treatment — a daily low dose — is standard for six or more recurrences a year, and it is under-offered. It is genuinely life-changing for people with recurrent genital herpes or repeated cold sores, and it is reviewed periodically.
Recurrent or unusually severe shingles warrants asking why, and looking at immune function.
The one that gets taken properly beats the theoretically ideal one.
Aciclovir cream is available over the counter, and it works only if applied at the tingling stage, before the blister forms. Once the blister has appeared, it does very little.
For anyone whose recurrences are frequent or predictable, having oral treatment already in hand to start at the first tingle is far more effective — and that is worth arranging in advance rather than in the middle of an outbreak.
NHS sexual health services provide diagnosis, treatment and support free of charge, and take self-referrals. They are also better placed for partner notification and for the broader conversation, and we would point you there.
Suppressive treatment for six or more recurrences a year is standard, and considerably under-offered. It reduces outbreaks substantially and reduces transmission to a partner.
Amitriptyline and gabapentinoids are the appropriate options for neuropathic pain, and the earlier pain is treated properly, the lower the chance of it persisting.
We do not prescribe opioids remotely under any circumstances — and they work poorly for neuropathic pain in any case.
The shingles vaccine is free on the NHS for eligible age groups and for people who are immunosuppressed, and it is markedly under-taken.
Check whether you are eligible — it substantially reduces both shingles and postherpetic neuralgia, which is the complication worth avoiding.
Lysine supplements, whose evidence is weak. "Immune boosting" products. And waiting to see whether shingles settles on its own, which wastes the treatment window that determines the outcome.
Aciclovir is very cheap. Valaciclovir costs somewhat more and is taken far less often, which is generally worth the difference. We earn nothing from what is prescribed.
This is one of the few things we treat where a few hours changes the outcome.
The 72-hour shingles window is often missed not because of any clinical decision but because nobody could be seen in time. A same-day consultation and a prescription to your own pharmacy lands comfortably inside it — and reduces the chance of nerve pain lasting months afterwards.
Postherpetic neuralgia — nerve pain lasting months or years after shingles — is the expensive outcome, in ongoing medication, appointments, sleep and quality of life.
Early antiviral treatment and early proper pain control reduce that risk, which is what makes acting quickly worth it.
No supplements, no lysine, no "immune support". We sell nothing.
And we will not take a fee to treat shingles affecting the eye — that needs same-day ophthalmology, and we will tell you to go and help you get there.
Within 72 hours of the rash appearing — that is the evidence-based window, and the main determinant of outcome is often simply how fast you were seen.
Beyond 72 hours it is still worth treating if the rash is spreading, if you are over 50, or if you are immunosuppressed. Do not assume you have missed the boat.
If it affects the eye, eyelid, or the tip of the nose — that needs same-day ophthalmology, not just antivirals.
The nose sign is the one to remember: a rash on the tip of the nose indicates the nerve supplying the eye is involved, and sight is at risk.
Also urgent: facial weakness, hearing change or vertigo with a rash around the ear (Ramsay Hunt syndrome); widespread shingles; or shingles in someone immunosuppressed.
You cannot give someone shingles — but you can give chickenpox to anyone who has not had it.
Keep the rash covered, and avoid contact with pregnant women who have not had chickenpox, newborns, and anyone immunosuppressed until it has crusted over. It is not spread by coughing.
No — these viruses stay dormant in nerve tissue for life, and no treatment eliminates them.
What antivirals do is shorten the episode, reduce its severity, and in shingles reduce the chance of lasting nerve pain. That last point is the main reason to treat.
Nerve pain persisting beyond a month after the rash — the commonest complication of shingles, and more likely with increasing age and with severe pain early on.
It is treatable, and it should be reported rather than endured. Early antivirals and early proper pain control both reduce the risk.
Because shingles pain is neuropathic, and simple painkillers frequently do not work for it. This is routinely undertreated.
Amitriptyline or a gabapentinoid are the appropriate options, and we will be clear about what can be prescribed remotely. We do not prescribe opioids remotely, and they work poorly here anyway.
If you are eligible, yes — and it is free on the NHS for eligible age groups and for people who are immunosuppressed.
It substantially reduces both shingles and postherpetic neuralgia, and it is markedly under-taken. Worth checking your eligibility.
Timing. Aciclovir cream works only if applied at the tingling stage, before the blister forms — once the blister has appeared it does very little.
If your recurrences are frequent or predictable, having oral treatment in hand to start at the first tingle is far more effective, and worth arranging in advance.
Yes — suppressive treatment, and it is genuinely under-offered. A daily low dose taken continuously, standard practice for six or more recurrences a year.
It reduces outbreaks substantially and, in genital herpes, reduces transmission to a partner. For people whose life is organised around recurrences, it is transformative.
They are considered safe where treatment is needed, and this is a discussion worth having rather than avoiding.
Genital herpes in pregnancy needs maternity team involvement, particularly a first episode in the third trimester, which has specific implications for delivery. Tell us.
Aciclovir and valaciclovir are well tolerated — most people notice nothing. Nausea, headache and diarrhoea are the commonest.
Two things matter: drink plenty, since these are cleared by the kidneys and can crystallise if you are dehydrated; and doses must be reduced in kidney impairment — at full dose with poor kidney function, confusion and agitation can occur, more often in older people, and it is sometimes mistaken for delirium from the illness itself.
Where you can, yes. NHS sexual health services are free, take self-referrals, and are better placed for partner notification and wider support.
What we offer is speed and privacy when an outbreak starts and you cannot get seen.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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