FAQ About Genital Herpes

Transmission and Prevention

Herpes can be spread through skin-to-skin contact at any time the virus is in its active phase: Viral shedding deposits HSV on the skin or a mucous membrane. Contact with another individual's skin allows virus to spread and begin the job of situating itself in the nervous system of a new host.

How Many People Have Genital Herpes?

At least half of the population is infected with oral herpes, an illness often passed during childhood. And approximately one-quarter of Americans over the age of 15 are infected with genital herpes -- an estimated 40 to 50 million.

These numbers may seem hard to believe. To put them in proper perspective, remember: HSV is usually a very subtle infection. In research studies, less than a third of those infected could easily recognize herpes symptoms The remainder -- the vast majority -- could not. Most people simply don't know they are carriers. ( In some cases, this is because they have failed to identify some of the milder symptoms of herpes. In others, it's because they apparently have suffered from no symptoms at all.)

How Can I Find Out If I Have Herpes?

If you have genital symptoms now, it's important to see a medical professional as soon as possible to be examined and tested.

If you've had genital symptoms in the past or believe you were exposed to genital herpes and want to know whether you now have it now, there are new blood tests available that detect can herpes even without symptoms present.

How Did I Get Herpes?

Herpes can be so subtle that even the active phases are sometimes hard to identify. As a result, herpes is often spread during periods when people simply don't recognize the virus has become active. In addition, a person can acquire herpes without recognizing the "first episode."

For these reasons, it's often difficult to trace the source of infection or know exactly when transmission occurred.

How Does Transmission Occur During Symptomatic Recurrences?

If a person has a herpes sore on the lips, for example, he or she can spread herpes to the lips of another person through kissing. Infection can also be spread from the lips to the genitals during oral sex. This is why so many cases of genital herpes are caused today by herpes type 1.

If one has a herpes sore on the genitals, coitus or other unprotected sexual activity gives the virus a chance to spread.

How Does Transmission Occur During Sub clinical Shedding?

The same principles and same scenarios hold. Unrecognized or "sub clinical" shedding has been documented in or around the mouth as well as in various genital sites such as the vagina, penis, and anus. Thus, if HSV is active, oral, anal or vaginal intercourse can cause transmission -- even when one has no visible sores or other signs and symptoms.

How Can I Reduce The Risk Of Giving This To My Partner?

Because it's hard to pinpoint herpes' active phases, preventing transmission is not a simple matter. But there are a number of measures you can take to lower the risk of transmitting herpes:

Refrain from sexual contact when symptoms are present - including prodrome. Following outbreaks, it's best to wait for a day or two after the skin heals up, since sub clinical viral shedding is more likely at this time.

Consider using condoms: Because of the risk of transmission from sub clinical shedding, it may be helpful to use condoms for penetrative sex in between outbreaks. Condoms restrict contact between the penis and the mucosal surfaces of the vagina, mouth or anus, where sub clinical shedding is known to occur. Be advised: Condoms may not cover all sites of viral shedding, and they don't provide a 100% guarantee against herpes transmission. For example, herpes sores may be present on the scrotum or upper thigh, or virus may be shed into vaginal secretions that would reach places not covered.

On the other hand, condoms are the best all-around form of protection against HIV and other sexually transmitted diseases (STDs).

Consider medication: Some research shows that the use of daily antiviral therapy dramatically lessens the rate of asymptomatic viral shedding as well as reducing the frequency of outbreaks. The effect of daily therapy on transmission rates is still under study.

Consider outercourse: Touching, cuddling, kissing, sensual massage and many other ways of giving sexual pleasure carry less risk than penetrative intercourse. Contact with a herpes lesion, however, is never risk-free.

Which Combination Of These Precautions Is Right For You?

It's best to talk these over and make decisions with your partner. In doing so, note that your partner's medical history may be an important consideration. If he or she has already acquired herpes, for example, it may be important to know the type and discuss which precautions you still want to take. The best way to find this out is to get a type-specific blood test. For more information about these tests, including the new rapid, finger prick test for herpes, search google.com for 'herpes tests.'

What Are the Odds of Infecting a Partner?

Unfortunately, no single precaution listed above can guarantee protection for a sexual partner. And because it's difficult to organize scientific studies of sexual behavior, there's no easy way to rate the effectiveness of each risk reduction strategy. Your sexual partner's risk of acquiring herpes will vary according to a number of factors. For couples in whom one partner has genital herpes and the other does not, it appears the average rate of transmission is about 10% per year when the couples simply refrain from intercourse during outbreaks. But this average obscures two important factors:

1) The risk to uninfected women is roughly three times greater than the risk to men.

2) the risk of acquiring herpes type 2 is higher in those who have not previously been infected with herpes type 1.

A potentially important variable in risk may be the use of suppressive antiviral therapy. One study showed a 95% reduction in sub clinical shedding in people taking daily antiviral therapy, a result that could indicate lowered risk of transmission as well. Follow-up studies are addressing this question.