Prevention of Genital Herpes and Cold Sores

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 there have been some promising trials of herpes vaccines, to date, no human trials have shown high enough efficacy to bring a herpes vaccine to market.

There are several approaches for preventing transmission of HSV types 1 and 2, as well as ways to reduce your chances of having a recurrence if you already have the infection.

Preventing Genital 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.

Many people with HSV-2 have no symptoms. If you are sexually active you should be aware of the risk and take steps to reduce it.

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.

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.

Consistent condom use reduces the risk of herpes transmission from men to women by 96% and from women to men by 65%.

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 oral herpes can be spread to the genitals.

Sexual Abstinence

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 the prodromal phase when 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).

The herpes virus is found in open sores and blisters, so it is best to abstain from sexual contact—even with a condom—when active lesions are present.

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.

Preventing 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 can spread cold sores, even when lesions are not present. So, too, can any object that comes into contact with a sore.

One of the best ways to avoid oral herpes is to avoid sharing cups, utensils, lipstick, lip balm, toothbrushes, pipes, hookahs, cigarettes, e-cigarettes, or any other items that go into your mouth and touches your 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.

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.

Prescriptions

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, involving the daily use of antiviral to prevent an outbreak reoccurrence, can reduce one's symptoms and the amount of viral shedding. This can be quite helpful, particularly in combination with reliable condom use.

If your partner has herpes but you don't, you may be able to reduce your risk by taking an antiviral prior to sex. The strategy, known as pre-exposure prophylaxis (PrEP), may be appropriate if your partner has frequent outbreaks or your immune system is weakened by HIV or other causes.

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.