Does having sex with someone who has herpes increase the frequency of herpes breakouts or flare-ups in a person already diagnosed with herpes?

Sexual Activity Between Two People with Herpes Does Not Increase Flare-up Frequency

Having sex with another person who has herpes does not increase the frequency of herpes breakouts or flare-ups in a person already diagnosed with herpes. The frequency of recurrences is determined by individual factors rather than exposure to a partner who also has herpes.

Understanding Herpes Transmission and Recurrence

Herpes simplex virus (HSV) establishes lifelong latent infection in the sacral ganglia after initial infection 1. Recurrences occur when the virus reactivates, which can happen due to various triggers:

• Stress
• Illness
• Hormonal changes
• Weakened immune system
• Exposure to UV light

The Centers for Disease Control and Prevention (CDC) guidelines clarify that once a person is infected with herpes, they already have the virus in their system 2. Having sexual contact with another infected person does not "re-infect" them or increase their outbreak frequency.

Important distinctions:

• HSV-1 and HSV-2 are different strains that cause genital herpes, with HSV-2 typically causing more frequent recurrences 2
• 5-30% of first-episode genital herpes cases are caused by HSV-1, but clinical recurrences are much less frequent for HSV-1 than HSV-2 genital infection 2
• Identification of the infecting strain has prognostic importance for counseling purposes 2

Factors That Actually Influence Herpes Recurrence

The frequency of herpes outbreaks is primarily determined by:

1. Virus type: HSV-2 causes more frequent recurrences than HSV-1 2
2. Time since infection: Recurrences are most frequent during the first year after infection 3
3. Individual immune response: Varies from person to person
4. Presence of triggers: Stress, illness, etc.

Asymptomatic Viral Shedding

Both partners with herpes can experience asymptomatic viral shedding, which:

• Occurs in the majority of patients with genital HSV-2 infection 3
• Accounts for approximately one-third of the days of viral shedding 3
• Is most frequent during the first year after infection 3
• Occurs regardless of recurrence frequency (patients with no recurrences shed virus at similar rates to those with 1-12 annual recurrences) 3

Management Recommendations

For individuals with herpes who are sexually active with other herpes-positive partners:

1. Antiviral therapy options:

   • For episodic treatment (treating outbreaks when they occur):
     • Acyclovir 400 mg orally three times daily for 7-10 days 2
     • Acyclovir 200 mg orally five times daily for 7-10 days 2
     • Famciclovir 250 mg orally three times daily for 7-10 days 2
     • Valacyclovir 1 g orally twice daily for 7-10 days 2

2. Suppressive therapy (to reduce frequency of outbreaks):

   • Daily suppressive therapy reduces herpes recurrences by ≥75% among patients with frequent recurrences (six or more per year) 2
   • Options include:
     • Acyclovir (safety documented for up to 6 years of use)
     • Valacyclovir or famciclovir (safety documented for 1 year of use) 2

3. Safe sex practices:

   • Abstain from sexual activity when lesions or prodromal symptoms are present 2
   • Consider consistent condom use, which can reduce transmission risk 3

Key Takeaways

1. Having sex with another person who has herpes does not increase outbreak frequency
2. Both partners should be aware of asymptomatic viral shedding
3. Antiviral therapy can help manage symptoms and reduce recurrences
4. After one year of suppressive therapy, consider discussing discontinuation to reassess recurrence frequency 2

Common Pitfalls to Avoid

• Misconception: Thinking that sexual contact with another herpes-positive person will worsen your condition
• Confusion: Mistaking normal recurrence patterns for "reinfection" from a partner
• Neglecting treatment options: Not considering suppressive therapy for those with frequent recurrences (≥6 per year)

Remember that while having sex with another person with herpes won't increase outbreak frequency, both partners should still practice safer sex during outbreaks to minimize discomfort and potential complications.