If a man and woman who both have herpes (Herpes Simplex Virus) engage in sexual activity without visible symptoms, will it exacerbate their herpes infection?

Sexual Activity Between Partners with Herpes: Impact on Infection Status

Sexual activity between two individuals who both have herpes but are currently without symptoms will not exacerbate their infections or cause new outbreaks. 1

Understanding Herpes Transmission and Reactivation

Herpes simplex virus (HSV) infection is a chronic condition that remains in the body even when no symptoms are present. When both partners already have the infection, sexual contact does not lead to a "new" infection or automatically trigger outbreaks. Key points to understand:

• HSV remains dormant in nerve cells and can periodically reactivate
• Asymptomatic viral shedding can occur even without visible lesions
• Having sex with another HSV-positive partner doesn't increase disease severity

Factors That Actually Trigger Herpes Outbreaks

Instead of sexual contact with another infected person, herpes outbreaks are typically triggered by:

• Stress
• Hormonal changes
• Immune system weakening
• Friction or trauma to the genital area
• Illness or fever

Management Recommendations for Couples with Herpes

Even though both partners have herpes, proper management is still important for quality of life:

1. Consider suppressive therapy - Daily valacyclovir 500 mg is recommended by the CDC to reduce asymptomatic viral shedding and minimize outbreak frequency 1

   • Alternative options: Acyclovir 400 mg twice daily or Famciclovir 250 mg twice daily

2. Recognize prodromal symptoms - Both partners should be aware of early warning signs (tingling, burning, itching) that may precede outbreaks 1

3. Abstain during outbreaks - Even between two infected partners, sexual contact during active outbreaks can potentially:

   • Cause additional irritation to lesions
   • Delay healing
   • Introduce bacteria leading to secondary infections

4. Be aware of different HSV types - If one partner has HSV-1 and the other HSV-2, transmission of the other type is still possible 2

Special Considerations

HIV Status

• If either partner is HIV-positive, more aggressive HSV management is recommended as HSV-2 can increase HIV viral shedding 1
• Suppressive therapy is not effective at decreasing transmission risk among persons with HIV/HSV-2 coinfection 2

Renal Function

• Patients with renal impairment require dose adjustments of antiviral medications 1

Common Pitfalls to Avoid

1. Assuming all herpes infections are identical - Partners may have different viral types (HSV-1 vs HSV-2) or strains

2. Neglecting protection during asymptomatic periods - Even without symptoms, viral shedding can occur

3. Discontinuing treatment without medical advice - Suppressive therapy benefits should be evaluated periodically, but don't stop without consulting a healthcare provider 1

4. Ignoring psychological aspects - The diagnosis of herpes can affect psychosexual development and relationships 3

While sexual activity between two partners with herpes won't cause new infections or automatically trigger outbreaks, maintaining appropriate treatment and precautions during symptomatic periods will help minimize discomfort and optimize quality of life.