Herpes and sex

This information is not provided for the purpose of diagnosis or medical treatment and should not be considered a substitute for medical advice from a doctor.

Genital herpes is one of the most common sexually transmitted diseases (STDs) in the world. It is a viral infection that is spread by close contact with somebody who has been infected with the herpes simplex virus (HSV). Anyone who is sexually active can become infected with genital herpes. It is not life-threatening but unlike most other STDs, it is a lifelong condition.

This section of the website discusses the potential impact that herpes can have on sexual relationships.

How is genital herpes transmitted?

Genital herpes is passed from person to person through direct skin-to-skin, genital-to-genital or mouth-to genital contact. It is most commonly transmitted during intimate sexual contact. The virus is more likely to be transmitted if sexual contact takes place during an active episode of herpes, ie when symptoms such as sores or blisters are present. Since many people cannot recognise the signs and symptoms of genital herpes, it is not always possible to know when you or your partner are having an active outbreak. Unfortunately, it is also possible to transmit the virus even in the absence of symptoms - this is known as asymptomatic shedding, when the virus becomes active and can be shed from the skin, but does not cause any visible signs or symptoms.

Does having genital herpes mean my sex life is over?

Not at all! It is natural to feel concerned about the risk of transmitting the virus to your partner but there are ways of minimising this risk and there is no reason why you cannot continue to enjoy a full and active sex life. If you are already in a relationship, it is always best to be honest with your partner. In most cases, they will be supportive and understanding. The section Herpes and relationships provides useful information on the best ways of telling your partner you have genital herpes.

If you are not in a relationship, it is responsible to raise the topic of genital herpes (and indeed other STDs) with potential sexual partners so that you can take appropriate precautions and protect your own and your partner's health.

How can I reduce the risk of being infected or of transmitting genital herpes to my partner?

The most important precaution is to avoid sexual contact during an active outbreak of genital herpes (ie if symptoms such as sores or blisters are present). However, as explained above, it is still possible to transmit the virus in the absence of genital symptoms (asymptomatic viral shedding).

Using latex condoms can help to reduce the risk of transmitting genital herpes between symptom recurrences, although this does not provide 100% protection. Female condoms can be used if male partners are not willing to use a condom.

If one partner in a couple has been infected with the genital herpes virus and the other has not, the partner with genital herpes may wish to consider suppressive antiviral therapy (preventive treatment that is taken on a daily basis to reduce the number of outbreaks). Recent research has shown that the use of suppressive antiviral therapy with valaciclovir can substantially reduce the risk of passing genital herpes on to a partner.(1) The section Reducing your risk provides more detailed information on the use of suppressive therapy to reduce transmission.

Can genital herpes be passed on through oral sex?

Yes. Genital herpes is usually caused by herpes simplex virus type 2 (HSV-2), but many people do not realise that 'cold sores' are also a type of herpes, usually caused by infection with the other type of virus, HSV-1. This means that during oral sex, the virus can be spread from the mouth to the genital area. It is more common for oral HSV-1 to be transmitted to the genitals through oral sex, than it is for HSV-2 to be transmitted to the mouth.

Like genital herpes, facial herpes is most infectious when there is an active outbreak, with blistering or cracks causing a 'cold sore'. You should avoid oral sex when such symptoms are present, since there is a high likelihood of passing the virus on to your partner. Alternatively, dental dams or latex sheets are available to provide protection during oral sex and can be purchased from pharmacies in some countries or via the internet.

Can genital herpes be transmitted during homosexual or lesbian sexual activity?

Yes. Genital herpes can be transmitted during any type of intimate sexual contact (vaginal, oral or anal), even if full sexual intercourse does not take place. Genital and facial herpes can be transmitted to any other part of the body's surface through direct skin to skin contact.

Reference
1. Corey LC, Wald A, Patel R et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med 2004;350:11-20.