Prevention of Herpes

Since genital herpes (HSV-2) is sexually transmitted, safer sex practices can go a long way in preventing both infection and transmission. Cold sores, or oral herpes (HSV-1), can be harder to prevent, as they are usually spread by casual contact, though there are strategies that can help. If you are already infected with a herpes simplex virus, you can also reduce the frequency of symptomatic recurrences.

While no one wants herpes, it is especially important to prevent oral or genital HSV infections if you have an immune deficiency. These conditions can be more severe if your immune system is not functioning as it should. If you are pregnant or thinking about becoming pregnant, you should be vigilant about preventing genital HSV infection because it can be transmitted to your baby during vaginal delivery, potentially causing serious problems. 

There are several approaches for preventing transmission of HSV types 1 and 2. There are also some ways that you can reduce your chances of having a recurrence if you already have the infection. 

Genital Herpes

While the prevention of genital herpes may be on your mind if you or a partner have already been diagnosed, anyone who is sexually active should be mindful of the risk of transmission, especially since many people with HSV-2 have no symptoms at all.

Barrier method: Unlike many other sexually transmitted diseases, herpes spreads by skin-to-skin contact instead of through bodily fluids. Since condoms don't cover all areas of potentially infectious skin, they cannot completely stop the spread of herpes. That said, consistent condom use reduces the risk of herpes transmission from men to women by 96 percent and from women to men by 65 percent.

If you or your partner has herpes, or if you are unsure of a partner's status, you need to use condoms correctly every time you have sex, even when no symptoms are present. Every unprotected sexual exposure increases the risk of herpes transmission, so the intermittent use of condoms is not effective at prevention. Even if you use condoms, it is best to abstain from sexual contact when you have prodromal symptoms and when you have an outbreak. 

Barriers should also be used for oral sex since genital herpes can be spread to the mouth and cold sores can also infect the genitals. 

Abstaining from sex before an outbreak: One of the most important ways to reduce the risk of herpes transmission is to avoid having sex right before an outbreak when prodromal symptoms are present. Prodromal symptoms include numbness, pain, or tingling in the genital area, and they occur a few days before recurrent lesions appear. You are most contagious during this time because the virus is reproducing, increasing in quantity, leaving its dormant (resting) location, and entering into other areas of the body (a process known as viral shedding). 

Abstaining from sex when you have lesions: If you or your partner has sores, it is best to abstain from sexual contact during this time, even with a condom, because the virus is present in open sores and blisters. While you need to use condoms to prevent the spread of infection, even during asymptomatic intervals, it is recommended to abstain from sex when lesions are present. 

Cold Sores

It's very easy to pass along the virus that causes cold sores—and to become infected yourself. Knowing this, though, may remind you to think twice about some common practices that can put you (or others) at risk.

Kissing: Kissing can spread cold sores, even when lesions are not present. 

Infection: One of the ways to avoid becoming infected with HSV-1 is to avoid sharing cups, lipstick, toothbrushes, mouthguards, and other items that go in or on your mouth and lips.

Cold sores can also be caused by HSV type 2 as a result of oral sex. If you or your partner get cold sores or genital herpes, it's important to know that oral sex can spread a genital herpes infection to the mouth and oral herpes to the genital areas. Spreading the infection can occur whether sores are visible or not, so you should take precautions even when you do not have symptoms. 

Recurrence: Cold sores are likely to recur if you have already been infected. Some preventative methods include avoiding mouth trauma, avoiding sunburns (use sunscreen and lip balm when you are out in the sun), and avoiding excessive stress, as these can all make it more likely for a cold sore to recur. 

Prescription medication can be used to prevent genital herpes outbreaks. While the use of these drugs to prevent oral herpes recurrence is rare, your doctor may write you a prescription if your infections tend to be severe, frequent, or excessively painful.

There are three antiviral medications that help prevent outbreaks, Valtrex (valacyclovir), Zovirax (acyclovir), and Famvir (famciclovir). 

People who have recurrent herpes may use the same medications that are recommended for symptomatic outbreaks when characteristic tingling and pain develops. In these situations, the medication course is started immediately to stave off or reduce the severity of an episode.

Suppressive therapy, which is when a daily medication is used to prevent an infection or an outbreak, can reduce one's symptoms and the amount of viral shedding. This can be quite helpful, particularly in combination with reliable condom use.

In some cases, uninfected partners are given a prescription for antiviral medication prior to sexual exposure, because this may reduce the known risk of infection. This is described as pre-exposure prophylaxis (PrEP).

If you are an adult, the symptoms of herpes are usually pretty manageable and only rarely cause complications. However, herpes can be very dangerous if it is transmitted to a growing baby during pregnancy. If you have genital herpes and are pregnant, or if you are sexually involved with someone who is pregnant or planning to get pregnant, talk to your doctor about managing the risks.