Prevention of Herpes

Preventing herpes can be challenging given that so many people have the disease and don't even know it. According to the Centers for Disease Control and Prevention (CDC), no less than 87% of people with genital herpes in the United States are undiagnosed.

Genital herpes is a sexually transmitted infection (STI) caused mainly by herpes simplex virus type 2 (HSV-2) but also increasingly by herpes simplex virus type 1 (HSV-1), the type commonly associated with cold sores. Both can cause painful and often recurrent outbreaks of tiny blisters and sores on the genitals or rectum.

Safer sex practices can help prevent the spread of herpes, while antiviral drugs may reduce the risk of flareups—and possibly the risk of transmission—in people living with herpes.

Learn more about the different strategies to protect yourself and others from an STI that affects over 18 million people in the United States today.

Preventing Genital Herpes

Short of sexual abstinence, there is no 100% surefire way to prevent herpes. Each year, over a half-million new HSV-2 infections are estimated to take place in the United States, the majority of which are asymptomatic (without symptoms).

Even if there are no symptoms, herpes can still be passed during periodic flareups when the virus is silently shed from the site of the infection (referred to as genital shedding).

With no vaccine to prevent either genital herpes or oral herpes, it's largely up to you to make informed choices to better evade this common, incurable STI.

Condoms and Other Barrier Methods

Herpes is most efficiently passed through direct contact with a herpes sore. However, unlike many STIs, herpes can also be spread by skin-to-skin contact.

While condoms can reduce the risk of herpes, they aren't perfect as they don't cover all of the areas where a genital infection can occur (such as the testicles or groin). Moreover, they tend to work better for women than men.

Even if condoms are not 100% perfect, they still offer the best protection if you are sexually active. These not only include external (male) condoms but also internal (female) condoms.

Herpes can also be passed through oral sex. To this end, dental dams (pre-cut squares of latex or polyurethane) can provide a protective barrier when engaging in oral-anal sex ("rimming") or oral-vagina sex (cunnilingus).

If a dental dam is not available, a condom can be cut open as an alternative.

Abstinence

There are times when abstinence is a reasonable option for preventing herpes. This is especially true if you are in a relationship where either you or your partner has herpes.

Even before a herpes outbreak occurs, it will often be preceded by so-called prodromal symptoms. These are "pre-event" symptoms that hint that an outbreak is about to occur. With genital herpes, these can develop anywhere from hours to days in advance.

Prodromal symptoms are an indication that the virus has reactivated and is already "shedding" viruses from the site where the infection initially occurred. Even if there are no blisters or sores, transmission can still occur.

As such, a person with genital herpes should refrain from sex if they experience prodromal symptoms like:

• Localized genital or rectal pain
• Burning, itchiness, or tingling at the site of the initial infection
• Tingling or shooting pains in the legs, hips, or buttocks

Prodromal symptoms should also signal you to start taking antiviral drugs to either avert an outbreak or reduce the severity of one.

Preventing Oral Herpes

It's very easy to pass oral herpes from one person to the next. As with HSV-2, HSV-1 is most easily transmitted by direct contact with a sore but can also be passed during the prodromal phase just before an outbreak.

Even if an outbreak is averted with antivirals, there can still be asymptomatic shedding of the virus.

Cold sores can be spread either by direct or indirect contact with HSV-1, such as:

• Kissing
• Touching a sore and then another part of the body
• Sharing lipstick, lip balm, or toothbrushes
• Sharing cigarettes, pipes, hookahs, and cigarettes
• Drinking from the same cup or sharing the same utensils

As a rule of thumb, one of the best ways to avoid oral herpes is to avoid sharing anything that goes into the mouth and touches the lips of someone else.

If you are prone to frequent cold sores, there are several things you can do to reduce your risk of recurrence:

• Avoid mouth trauma of any sort.
• Use UV-protective lip balm to prevent sunburn.
• Manage your stress (a common cause of herpes outbreaks).
  

Can Antivirals Reduce Herpes Risk? 

Genital herpes is treated with antiviral drugs that quickly block the replication of the virus and bring the infection under control. Three are approved for the treatment of genital herpes:

• Famvir (famciclovir)
• Valtrex (valacyclovir)
• Zovirax (acyclovir)

The drugs can be used "on demand" for episodic outbreaks.

If you have frequent outbreaks, they can be taken in low doses on a daily basis as a form of suppressive therapy to lower the risk of recurrence.

At one time, suppressive therapy was thought to reduce the risk of HSV transmission given that it keeps the viral load (the amount of virus in the body) low. This, in turn, was thought to reduce the risk of asymptomatic shedding.

As reasonable as these assumptions seem, the theory has yet to be proven. According to a 2012 study in the Lancet, even with fully suppressive therapy, a person can still experience short episodes of asymptomatic shedding (generally between seven to 10 hours) during which transmission can occur.

While suppressive therapy may reduce the risk of HSV transmission, it doesn't erase it.

Preventing Herpes During Pregnancy

If you are an adult, the symptoms of herpes are usually manageable and rarely cause complications. However, if herpes is transmitted to a baby before, during, or after childbirth, it can be dangerous.

Even with aggressive treatment, newborns who get herpes often die because they don't have the immune defenses to fight off the infection, allowing it to spread to the liver, lungs, brain, and other parts of the body.

Neonatal herpes mainly occurs during childbirth as the baby comes into contact with lesions in the birth canal. Less commonly, the virus is passed while the baby is still in the womb or after birth when the newborn comes into contact with a herpes sore. (Herpes is not passed through breastmilk.)

Since 85% of these infections occur during childbirth, the American College of Obstetricians and Gynecologists (ACOG) recommends that women with active recurrent genital herpes be given suppressive therapy starting at 36 weeks of pregnancy. Doing so can greatly reduce, but not entirely eliminate, the risk of infection.

After childbirth, mothers may need to limit contact with a newborn if an outbreak occurs. They also need to take extra care to wash their hands and any touched objects thoroughly and frequently.

Summary

Herpes is often difficult to prevent because many of the people who have the disease have no idea they've been infected. This includes herpes simplex virus type 2 (HSV-2), the primary cause of genital herpes, and herpes simplex virus type 1 (HSV-1), the type commonly associated with cold sores that can also be passed to the genitals.

The risk of herpes can be reduced by avoiding sex during an outbreak as well as the prodromal stage when you first start sensing symptoms. The consistent use of condoms can also help.

During an outbreak, an effort must be made to avoid contact with sores. Suppressive antiviral therapy can be used to prevent recurrence in people with frequent outbreaks as well as to avoid passing the virus to a baby during childbirth.

A Word From Verywell

If you have symptoms of genital herpes, you should get checked out immediately. A physical exam with a swab of an open sore is all that is typically needed to confirm the diagnosis. The treatment of an initial infection tends to reduce the severity of future outbreaks.

If you suspect you've been exposed to herpes but have no symptoms, you can request a herpes blood test from your healthcare provider.

With that said, routine screening for herpes without symptoms is not recommended as it has not been shown to change sexual risk behaviors, particularly in people who are asymptomatic.