When do you know if you need to take medication everyday to control outbreaks?

This is a good question. I'm curious as well because my doctor put me on suppressive therapy immediately. Idk if it was because of how bad my first outbreak was.

If you are in a relationship with a seronegative partner who wants to lower their risk of acquiring genital HSV (or, I suppose, if you intend to be sexually active without a relationship), then you should go on daily suppressive therapy, otherwise the advice is to see how your body naturally manages HSV in the first year, with antiviral meds only used to pre-empt/treat recurrent outbreaks (episodic therapy).

If outbreaks are frequent, like 6-10 per year, then low dosage suppressive therapy is indicated (e.g., 500mg valacyclovir daily). If over 10 outbreaks per year, high dosage suppressive therapy may be necessary (e.g., 1000mg valacyclovir daily). That's what I've read at least!

I had my primary outbreak and was treated with valacyclovir 2x a day for 10 days. I went back for a follow up appointment with my gyno before the 10 day course was over. She then told me she wanted to put me on valacyclovir once a day for a year for suppressive treatment.. She said she wanted to because of the severity of my primary outbreak. She said after the year I could choose to continue on the medication once a day of of course 2x a day for 5 days in the event of another outbreak. I think it really just depends on your doctor and how they go about treating it. If suppressive therapy is something you want or feel you need I would discuss it with your doctor and make sure she knows that is what you want if you haven't already. Many people I've read have managed without suppressive therapy but making sure to have a good diet and a high intake of lysine.