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Has your partner, or potential partner, recently informed you that he or she has been diagnosed with genital herpes? After thinking about it, did you decide to continue with the relationship, despite not being infected with the virus that causes genital herpes yourself? Congratulations — the two of you are now a “discordant couple,” which means that one of you has genital herpes and the other doesn’t. While you might have come to the conclusion that acquiring a herpes simplex virus (HSV) infection below the belt won’t be the end of the world, you still might want to stay discordant — and do everything you can to minimize chances of virus transmission.

Condoms, medication, and abstinence during outbreaks can reduce risk for herpes transmission.

You can read all about herpes elsewhere on this blog, but here’s a quick rundown: Genital herpes can be caused by one of two strains of the herpes simplex virus: HSV-1 or HSV-2. While HSV-1 is more commonly associated with cold sores and HSV-2 is more commonly associated with genital herpes, either virus can infect the genital area. One estimate states that 1 out of 6 Americans between 14 to 49 years of age has a genital HSV-2 infection. Since genital herpes infections can also be caused by HSV-1, the number of people with genital herpes is actually higher.

Barring total abstinence from all sexual activity, you won’t be able to protect yourself completely from acquiring HSV — but there are many steps that you and your partner can take to decrease risk. Studies on discordant couples show that viral transmission can be reduced with condoms, antiviral herpes medications, practicing abstinence when symptoms are present, and patient education.

Condoms

Latex condoms protect against most STDs, especially fluid-borne infections like HIV and gonorrhea. But condoms also provide some protection against STDs that are transmitted by skin-to-skin contact, including genital herpes. One large study found that condom usage was associated with lower rates of HSV-2 acquisition — the more frequently someone used condoms, the lower the risk. Unsurprisingly, risk was also associated with frequency of sex acts: People having vaginal or anal intercourse more than twice weekly were 77 percent more likely to acquire HSV-2 than people having less sex.

Other studies have reached similar conclusions, such as this study of monogamous, discordant couples, which found that HSV-2-positive men who used condoms were much less likely to transmit the virus to their female partners. Overall, for every 10,000 acts of vaginal or anal intercourse, 8.9 women acquired HSV-2 from their male partners, while 1.5 men acquired HSV-2 from their female partners. HSV-2 transmission also declined over the course of the study, possibly due to a decline in sexual activity between partners as well as counseling to use condoms and avoid sex during outbreaks.

It is difficult to perform good studies on the effect of condoms on disease transmission, because it’s unethical to ask one group of test subjects not to use condoms, and possibly not realistic to expect another group to use condoms consistently and correctly. Therefore, researchers must rely on self-reported data from their subjects and trust that the information they are providing is reliable and that they were using condoms correctly. However, researchers believe that these types of flaws lead to an underestimation of condoms’ effectiveness — so use ’em!

Herpes Medications (Suppressive Therapy)

A partner with genital herpes can consider daily herpes medications, such as acyclovir, which has been found to reduce viral shedding by as much as 94 percent. These medications, which are called “suppressive therapy” when taken daily, have not only been shown to reduce recurring outbreaks in symptomatic sufferers, but also to reduce asymptomatic shedding, offering another avenue for someone with genital herpes to protect his or her partner.

Other herpes medications include valacyclovir, whose efficacy was studied by a team that found a daily 500 mg. dose offered a 48 percent reduction in risk. Not only did this drug reduce the number of herpes outbreaks experienced by the partners with HSV infections, but it reduced risk for their HSV-negative partners, who were more than twice as likely to acquire HSV-2 from partners who were not taking suppressive therapy. For every 1,000 sex acts there were 0.60 cases of male-to-female herpes transmission and 0.23 female-to-male herpes transmissions. Transmission rates were even lower among couples who used condoms.

There are many alternative remedies, such as plant-based preparations or dietary supplements, touted as prevention against herpes outbreaks or transmission, but in general they are not supported by reliable evidence.

Abstinence During Outbreaks

When someone is experiencing symptoms of a genital herpes outbreak — blisters, itching, open or swollen sores, pain in the infected area — he or she is also “shedding virus,” meaning that HSV can be transmitted to others. Someone also might be able to recognize warning signs of an impending outbreak, such as burning, itching, or tingling sensations. When these types of symptoms are present, it is imperative to practice total abstinence until seven days after the sores heal. Because condoms do not cover the entire genital area, they do not provide adequate protection from the virus (condoms should always be used between outbreaks).

A partner with herpes should also avoid touching the sores, as he or she could transfer the virus to another place on the body (such as the facial area), to a contact lens, or to another person. If you have touched a herpes sore, be sure to wash your hands with soap and water immediately afterward.

Unfortunately, most HSV transmissions occur during periods of asymptomatic shedding — when there are no outbreaks.

Patient Education

In the 1980s, before the common use of herpes medications like acyclovir, one group of researchers conducted a study on HSV-2-discordant couples. This represented a “best-case scenario” in that the couples were educated on recognizing mild or atypical herpes outbreaks, were counseled to practice abstinence until four days after sores had healed, were taught about condom use, and were highly motivated to avoid HSV-2 transmission. They concluded that the risk of genital HSV transmission was:

  • 10 percent per year, overall
  • 20 percent per year if the partner without genital herpes had not been previously infected with HSV-1 (the virus most commonly associated with cold sores)
  • 16 percent per year in women who already carried HSV-1
  • 32 percent per year in women who did not carry HSV-1

Presumably, HSV transmission rates are higher in the absence of this education, safer sex practice, and desire to mitigate risk. In this study, the factors that made the biggest difference in whether or not someone caught a genital HSV-2 infection from her partner was the consistent use of condoms and spermicide, even during asymptomatic periods.

If you have a genital HSV infection, you can ask a sexual health expert, such as a provider at Planned Parenthood, to educate you on how to be more aware of any cues that the virus is flaring up. Although truly asymptomatic shedding does occur, patients can be made more aware of how to recognize mild or nonspecific symptoms that might signal an infectious period.

Other Strategies

A healthy immune system can help keep viral infections in check. While there are a lot of dietary supplements out there that claim to “boost” immunity, there actually aren’t any magic bullets to ensure a strong immune system. The best things you can do to boost your immunity are to quit smoking, eat a healthy diet, get enough sleep, and avoid stress.

Some conditions, like an HIV infection or receiving chemotherapy for cancer, can compromise the immune system, which can make it more difficult for your body to control a herpes infection.

Planned Parenthood health centers have condoms, can diagnose and treat herpes, offer patient education on herpes symptoms and transmission, and can help you decide if herpes medications are right for you.

Tags: safer sex, abstinence, herpes, condom, cold sores, sexually transmitted infections, genital herpes, STI, sexual health, STD Awareness, HSV, HSV-2, drug, antiviral

About Anna C. 

Anna first volunteered for Planned Parenthood as a high school student in the 1990s. Since then, she has received a bachelor’s degree from UC Berkeley and a master's degree in epidemiology from the University of Arizona. As an ode to her fascination with microbes, she writes the monthly STD Awareness series, as well as other pieces focusing on health and medicine.