Herpes simplex virus (HSV) is a common infection causing painful blisters or ulcers, primarily spreading through skin-to-skin contact. It is treatable but not curable. Two main types exist: HSV-1, often associated with oral herpes or cold sores, and HSV-2, which typically causes genital herpes. Both types are common; globally, an estimated 64% of people under 50 have HSV-1, while approximately 13% of individuals aged 15-49 worldwide have HSV-2, the main cause of genital herpes. Many people who carry the virus may experience no symptoms, or only mild ones, and might be unaware they are infected.
Understanding Herpes Transmission Between Partners
Herpes transmits through direct skin-to-skin contact, even without visible sores. This is known as asymptomatic viral shedding, where the virus can leave the skin and potentially infect another person. Transmission risk is highest during an active outbreak with visible lesions. However, the virus can pass from the first tingling sensation before an outbreak, and also when the skin appears entirely normal.
When both partners have the same type of herpes, such as HSV-2, “reinfection” or “superinfection” is not a concern. Once infected with a specific HSV type, the immune system produces antibodies. These antibodies provide protection, making a significant new infection or worsening of the condition from a partner with the same strain highly unlikely. While viral shedding can still occur, the immune system’s existing response manages the virus.
Managing Shared Herpes
Managing herpes involves addressing outbreaks and minimizing their frequency and severity. Antiviral medications like acyclovir, valacyclovir, and famciclovir are available for episodic treatment and daily suppressive therapy. Episodic treatment is taken at the first sign of an outbreak to shorten its duration and reduce symptom severity. Daily suppressive therapy can reduce outbreak frequency by 70% to 80% and decrease viral shedding likelihood.
Outbreaks can be triggered by factors including stress, fever, hormonal changes like menstruation, and a weakened immune system. Physical friction from sexual activity or sun exposure can also be triggers.
Open communication about symptoms and triggers allows partners to support each other and make informed decisions about sexual activity, especially when symptoms are present. Avoiding sexual contact during active outbreaks reduces transmission, even when both partners share the same virus.
Herpes and Family Planning
For couples planning a family where one or both partners have herpes, understanding implications for pregnancy and childbirth is important. Herpes simplex virus can transmit to a newborn during delivery, leading to a serious, potentially life-threatening condition called neonatal herpes. This risk is greatest if the mother acquires herpes for the first time late in pregnancy, as her body has not developed protective antibodies to pass to the baby.
Healthcare providers should be informed of any herpes history during pregnancy. To reduce transmission risk, antiviral suppressive therapy may be recommended starting around 36 weeks of gestation. This therapy aims to prevent outbreaks and reduce viral shedding near delivery.
If a mother has active genital lesions or prodromal symptoms (like tingling or burning) at labor onset, a cesarean delivery is typically recommended to avoid exposing the baby to the virus in the birth canal. Herpes does not affect female fertility, but some evidence suggests it might reduce sperm quality in men.