STD Awareness: How Can I Protect Myself if My Partner Has Herpes?

herpes protectionHas 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.

Click here to check out other installments of our monthly STD Awareness series!

27 thoughts on “STD Awareness: How Can I Protect Myself if My Partner Has Herpes?

  1. Are these numbers for real? “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.” And that’s on valtrex? So an even less than 1 in 1,000 chance if one person is on meds? What’s the big deal then?

    • Those numbers are per sex act, so depending on how often a couple has sex, the chances per year would be much higher. The risk might be acceptable to some, unacceptable to others.

      Here’s the relevant paragraph from the New England Journal of Medicine:

      The median number of sexual contacts per couple during the study was 49 in the valacyclovir group and 46 in the placebo group (range, 0 to 482). The frequency of genital HSV-2 acquisition increased with the reported frequency of sexual activity and was 0.35 per 1000 sexual contacts among the susceptible partners of valacyclovir recipients, as compared with 0.68 per 1000 sexual contacts among the susceptible partners of placebo recipients. The respective rates of acquisition among susceptible women were 0.60 and 1.27 per 1000 sexual contacts and, among susceptible men, 0.23 and 0.35 per 1000 sexual contacts.

    • So, take this with a grain of salt, as I haven’t taken my biostats classes yet, but I believe these numbers would translate to a 3.07% chance of a female catching herpes from a male after 52 sex acts (say after a year of having sex once a week on average), while a male would have a 1.19% chance of catching herpes from his female partner after 52 sex acts, assuming the person with herpes was taking valacyclovir.

      I used this cheat sheet, where the herpes was represented by 52 lottery tickets. T=1000, W=0.6 or W=0.23, and P=52. Take it with a grain of salt as I’m not a statistician!

  2. Ann,

    I believe the cheat sheet you used for your calculations would not be the proper one to use for this example. You are also using 52 for sex acts based on once a week. If you were using this number, your number for W would be much less as .6 and .35 are based on 1000 sex acts. Based on the numbers from the report, to me at least, its saying that for every 1000 sex acts for women susceptible to HSV-2, .6 women contracted the disease when their partner was on Valtrax while 1.27 women contracted it when their partner was not on Valtrax. If you put this into a percentage, this means .6/1000 and 1.27/1000 for women and .23/1000 and .35/1000 are the only formulas you would need to use.

    If it indeed cuts down viral shedding by up to 94%, that is a major factor in the reduction in transmission. What the report doesn’t say though, is whether the couples abstained during outbreaks. Now you add condoms to the mix, and its even lower. I know people that have been on suppressive therapy for years and have not had any outbreaks during that entire time. Most people who transmit the disease do not know they have it, therefore they are not taking medication to help control it. I do believe a cure is on the way for both HSV-1 and HSV-2 as they have now determined what causes Herpes to go into latency in both versions of the disease which makes it impossible to kill. Once a drug can be created and tested that will bring all herpes cells out of hibernation, it can be killed using the same drugs used for suppressive therapy. Think of it as one massive outbreak bringing the condition to an end. Its still a ways off due to lack of funding for clinical trials, but search for Duke University and University of Florida herpes research to learn more about this discovery.

  3. I have a question my girlfriend has herpes 2 I’ve done reading got tested checked out clean…but yesterday we were making out and I noticed she had wat looked like a bit of blood on her lips although she was wearing red lipstick at the time and maybe I’m just over thinking but my question if I did ingest a bit of her blood can the virus still be passed on? I

    • Herpes is spread by skin-to-skin contact. If your girlfriend has an HSV-2 infection in her genital region, it can only be transmitted via contact with her genital region — not by kissing. The herpes virus doesn’t hang out in the blood. (According to Ask Alice, small amounts of virus might enter the bloodstream during the first herpes outbreak. So if your girlfriend has had HSV-2 for a while, you don’t have to worry about even that small possibility.)

      According to the Red Cross, people with herpes can donate blood: “Chlamydia, venereal warts (human papilloma virus), or genital herpes are not a cause for deferral if you are feeling healthy and well and meet all other eligibility requirements.”

  4. Of the 267 Women 9 got it during the study period. That suggests in active couple that woman likely have 3% chance of getting it after a sustained time period and sexual encounters. I’d also suspect the results would be in the double digits if we were talking about a couple where they both didn’t know that one of them has it. The risk is real over time but not a deal breaker if you think the person is the “one”. Does suggest not to be too casual and have repeated acts with someone that you don’t deem to have long term relationship potential.

    >>
    Participants A total of 528 monogamous couples discordant for HSV-2 infection, including an HSV-2–susceptible population of 261 men and 267 women.

  5. I am 23yrs of age and I was diagnosed with HSV 2 a few months ago . My partner complained of discomfort after sex with me and when I checked it out a week later I had the virus and a blister on my anus. I felt like my life had ended and was worried because we had broken up and I had sex with a new partner while I was on the last day of my period . After I was diagnosed I was paranoid I had passed the virus to my new partner but I had not. We have been having safe sex whilst I have no symptoms of an outbreak and everything has been gud until now. I was again on my last day of my period and we had unprotected sex in the shower with the water running and within less than 3hours of intercourse my parter started complaining about discomfort. Based on my research it says the virus cannot be passed on via the blood but I am concerned the only time my virus seems to b passing on is during my period. We are going to the doctor tomorrow and I’m praying that he hasn’t contracted the virus from me .

    • Herpes can be transmitted even when no symptoms are present, because the virus can be “shed” from your body without symptoms. However, some things can “trigger” the virus, including menstruation. To reduce risk of transmitting the virus to your partner, it’s important to use condoms each and every time, in combination with other risk-reducing strategies like medications (acyclovir).

      Good luck, and the doctor should be able to answer your questions. Make sure to write them down first, so you don’t have to worry about forgetting to ask.

  6. My question is that I the male has genital hsv2 for some years and the female has oral hsv1. We been married for 22 yrs. now and I found out 2 yrs. ago I hve genital hsv2 from a past relationship like over 20 yrs. ago. Can she get genital hsv2 from me if we continue to have unprotected sex?

    • Yes. Because HSV-2 can be transmitted by skin-to-skin contact, you can pass the virus to your wife during sex. Condoms will reduce the risk but are limited by how much skin they cover. If she has HSV-1 she has some, but not complete, protection from symptoms of an HSV-2 infection. Has your wife had a blood test for HSV-2? It’s possible she already has it, but never got symptoms. Most people with HSV-1 or HSV-2 don’t get symptoms.

        • I don’t remember seeing any studies on whether a person with a long-term asymptomatic HSV-2 infection can stop shedding the virus completely, but I’ll take another look and see if I can find one. But probably the best thing to do is to talk to a qualified health care provider for advice on whether you should start using condoms or taking suppressive medication. It also depends on how your wife feels about the possibility of getting HSV-2. Some people are willing to take the risk.

  7. I just found out that I have hsv today, Should I tell my exboyfriend? He the only one I have been with in the last two yesrs. But I’m not sure if it came from a past relationships 3 years ago.

    • Hi Tala! Unfortunately, it’s often impossible to know where an HSV infection came from. It also depends on how you found out about your HSV infection — did you have an outbreak that was confirmed as herpes, or did you have a blood test that showed you had been exposed to HSV? Most people will test positive for HSV-1 on a blood test, but if they don’t have symptoms they can’t know for sure if the infection is located in their facial area, genital area, or both. If you decide to tell your ex-boyfriend, you might find some of these tips helpful.

  8. If my wife has hsv1 in the gentials and I have hsv2 while on suppressive therapy and no visual or physical outbreak does study show that I can infect her in unprotected sex?

    • Suppressive therapy dramatically reduces risk of HSV transmission, and there is less risk of transmission when symptoms are not present, but it is still possible to transmit HSV even when you have no symptoms and are on anti-herpes medications. Someone with an HSV-1 infection in the genitals might not have as severe symptoms if later infected in the genitals with HSV-2, though it is possible to be infected with HSV-1 and HSV-2 in the same part of the body. You and your wife will have to decide what level of risk you’re OK with, and might want to talk to a knowledgeable doctor to get all of your questions answered. Good luck!

      • Ok I just found out that I had herpes 1 and 2 but from 2009 I have always got tested and everything came out find but on 03/6/16 that when the doctor told me I had it I don’t understand I had two sex partners for over for years

        • Hi Crystal! You would need to ask your health-care provider to look at your medical records to answer your specific questions, but most STD screening does not include blood tests for herpes, so it’s possible you hadn’t been tested until now. Also, since most people get HSV-1 (herpes simplex virus type 1) in childhood, most of us will test positive for it.

  9. Do you feel it’s necessary to disclose HSV to every single sex partner you have moving forward after a diagnosis?

    • Whether to disclose herpes status is a question that a lot of people have when first learning of their diagnosis, especially when they learn how common herpes is despite being stigmatized. People can reduce risk of transmitting the virus to a partner by taking FDA-approved herpes medications such as acyclovir, which decreases the amount of virus that a person can “shed” from their body. While this type of medication can be used along with other risk-reducing methods, like abstinence during outbreaks and condoms or dental dams during other sexual contact, it does not reduce the risk to zero.

      However, healthy relationships are built on trust, and talking about HIV/STD status is an important conversation for people to have when first getting together. It might be a difficult conversation, but it’s an important one for all sexually active people to learn to do, regardless of their own HIV/STD status. It is a time to talk about health, boundaries, and what activities you’re into. Disclosing your status can be one part of a larger, and very important, conversation that can help form the foundation of a healthy relationship.

  10. Hi I just found out last month I had 1 and 2 .. I’m so lost and upset I want to know how can I not give it to my guy friend that I’m with now because he doesn’t like using condoms and I want to know when am I shedding and also we had unprotected sex 2 times . I felt disgusting with my self when I first found out so I’m asking what should I do?

    • Unfortunately, you can’t know when you’re shedding, though sometimes there are signs (e.g., a tingling sensation) that people can recognize. But just because there are no symptoms doesn’t mean you’re not shedding — that can happen with no symptoms at all.

      The best way to avoid transmission is to practice abstinence during outbreaks (until a week after sores have healed), to take anti-herpes medications, and to use condoms. Communication is also important. Your guy can decide for himself what risks he is comfortable taking, and he can also get a blood test (if he hasn’t already) to find out if he is already a carrier for either type of herpes. Most people have HSV-1, and HSV-2 is also very common, though the vast majority of people who have it don’t know it, because they never have symptoms.

      Please don’t feel disgusting! You are not defined by the viruses in your cells. Everyone has viruses — they are a fact of life — but society chooses to view certain viruses as taboo. It is so unfortunate that so many of us are made to feel shame for our STD status. Shame doesn’t help anyone. Good luck!

  11. Question: I do not have herpes but let’s say there was a gal I was interested in and I did not know her HSV status. Now, I have read a lot on the internet about infected people taking Valtrex as suppressive therapy to reduce the risk of transmission to healthy individuals, but what I would like to know is, what if *I* (HSV-free) choose to take valacyclovir to prevent my chance of getting infected from *her*? I could not find anything online to address the chance of contracting HSV from a known infected person if the *healthy* person decides to take the medication to lower their risk of infection. Any information would be appreciated.

    • Hi Jeff! It’s a good question, but I’m unaware of any studies on using acyclovir to prevent HSV acquisition in people who don’t have the virus. Using Google, I found this webpage, which says that no research has been performed to answer this question (I’ve never heard of that website and don’t necessarily endorse it). Using PubMed, I wasn’t able to find any article addressing the question either. I did find an article assessing the effectiveness of a different drug (not acyclovir) in protecting HSV-negative people from acquiring the virus — while it had encouraging results, I don’t think this drug has been well-studied as pre-exposure prophylaxis either, but it’s worth a closer look.

      The thing is, you would need a doctor to prescribe the acyclovir, and if you’re negative for HSV-2 or don’t have symptoms for HSV-1 (which most people will test positive for), a doctor might not prescribe it — the drawbacks (e.g., cost and side effects) might not be worth the benefits (e.g., avoiding HSV-2 acquisition, which is not a proven benefit). A good thing for sexual partners to do before getting together is to discuss their STD status, and go in for testing together. As I said in my reply to another comment to this post, healthy relationships are built on trust, and having “the talk” about your status is an important conversation to learn how to have. It may be a difficult conversation, but it can serve as an opportunity to talk not just about health, but also about boundaries, likes, dislikes, etc. Good communication is the foundation for healthy relationships, whether they are long-term or short-term.

  12. Oh man, so many questions. My partner has hsv-1 genitalially(sp?). We had a great talk about it, where she told me and I told her I would love to keep seeing her. But I am so new to this where as I only remember education from school. Protected sex thus far. But what about when she gives me oral sex, how high are risks? And what about sleeping throughout the night with no clothes on and “spoon” as we typically do? What about foreplay like using my hands and such? And last, what about towels that have her bodily fluids on them? Reading this article and the comments and replays have helped tremendously. Sorry if any of these questions are stupid, but I feel the more educated we are the better the relationship.

  13. hi everyone, im in a committed relationship we’ve been together for around 8 months already but he tells me that he sees himself with me for the rest of his life but we are also very young (20) and i just recently had an initial outbreak where i was very sick, i didnt really know what it was at first for the longest time i thought it was something else but during the summer (we are away from eachother right now *long distance) i discovered i had gotten a coldsore (i had never had one before so im now positive that the sickness i had was the initial herpes sickness) i probably got it from sharing cups and stuff from friends idrk how i got tbh . anyways I dont know how to tell him, im thinking that when we get back to school im going to break up with him because i dont want to chance infecting him and itll be embarassing anyway. im also scared that i have it genitally but i have no lesions to prove it but im also aware that i may never know. sex is very important in a relationship so i think we should part ways seeing as though we would have to be very careful when dealing with it and he’s so young , i dont want to keep him from having other partners in life since we lost our virginity to eachother, so we haven’t experienced anyone besides eachother. he is the love of my life but i also dont want to infect him. what should i do to be less contagious, how do i combat this disease.

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