This week in clinic I saw several cases of genital herpes. Not only were these patients suffering because they had genital sores, their hearts were broken. Sometimes herpes transmission comes from sex that wasn’t wanted. Sometimes it brings up questions of infidelity in the relationship. Amidst the sea of emotion, I wanted to put some simple facts out there and some resources about talking with your partner.

If you are reading this blog and have herpes, you are not alone. Herpes is super common. 8/10 adults have HSV 1 which is usually oral herpes but can be found in the genital location. About 15.7% of adults have HSV 2 or genital herpes which is less likely to infect oral tissues. (1) Almost 90% of patients who tested positive for HSV 2 by blood tests have never had a breakout. So many folks who are spreading herpes have no idea that they have it.

Herpes is transmitted through skin to skin contact, oral or genital secretions and oral, vaginal and anal sex. So you could have been super careful and used a condom correctly and still get herpes via unprotected oral sex or through skin contact that wasn’t covered by the condom.

Herpes can be transmitted when there is no lesion. Someone who is carrying the HSV-2 and has never had an outbreak is shedding virus about 10% of the time. Folks who have HSV -2 and have had an outbreak shed virus about 20% of the time when they have no lesion present. (2)

What about HSV -1 in the genital location? If you have HSV 1 in the genital location typically the initial outbreak can last 2 weeks. Whereas genital HSV -2 can recur usually the HSV 1 infection in the genital area does not recur and is less likely to have asymptomatic viral shedding.

How do I explain this to my partner?
Many patients struggle with starting the conversation about herpes with their current or prospective sexual partner(s). It’s important to understand how to start the conversation.
One resource can be found here.

How can I prevent transmission to my partner?

Antiviral medication is available to decrease asymptomatic viral shedding but before you start on a medication for the rest of your life, there are several factors to consider:

    1.  Duration of infection. If a patient was newly diagnosed with herpes, they are much more likely to be shedding virus, than if they have had the infection for several years. So antiviral suppression may make sense right after diagnosis but may not be appropriate for years on end. 
    2. Type of infection. HSV 2 is more likely to have viral shedding when there is no lesion than HSV 1 in the genital location.
    3. Status of you and your partners immune system. If you have autoimmune disease and are on immunosuppressants, or your partner is, you might be prudent to consider antiviral medication as compared to someone who is not immunocompromised.

Condoms are helpful just not perfect.

Communicate with your partner. Think about how you felt with your first outbreak. You may have felt betrayed, like someone knew they had a virus and they didn’t give you the choice to be exposed or not. You have an opportunity to give your next partner a choice.

Don’t have sexual contact when you have prodromal symptoms or a lesion. Some folks have burning or tingling in the area where they usually have an outbreak right before a lesion shows up. This is a time of viral shedding. Avoid sexual contact at this time.

Here is the take home point:
Herpes doesn’t shorten or end your life. It doesn’t cause cancer. It is a bothersome viral infection, that is manageable. It doesn’t need to end your relationship or sex life. You are a whole person who has lots of fantastic talents. You are not defined by a virus. Be honest. Practice the golden rule. Seek out those who support your genuine authentic self.

References
(1.). Bradley H, Markowitz L, Gibson T, et al. Seroprevalence of herpes simplex virus types 1 and 2—United States, 1999–2010. J Infect Dis, 2014. 209(3):325-33.
(2.) Tronstein E, Johnston C, Huang M, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA, 2011. 305(14): 1441–9.

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