How can I prevent Herpes Simplex Virus (HSV)?

Preventing Herpes Simplex Virus (HSV) Infection

To prevent HSV infection, consistently using latex condoms during every sexual encounter and avoiding sexual contact when herpetic lesions are visible are the most effective preventive measures. 1

Primary Prevention Strategies

Sexual Transmission Prevention

• Use latex condoms during every sexual encounter to reduce risk of HSV exposure 1
• Completely avoid sexual contact when herpetic lesions (genital or orolabial) are visible 1
• Be aware that transmission can occur even when no visible lesions are present due to asymptomatic viral shedding 2, 3

Condom Effectiveness

Condoms serve as mechanical barriers to genital infection. In vitro studies show condoms are nearly impermeable to viruses, reducing viral exposure by several orders of magnitude 3. While not 100% effective due to potential condom failure and the fact that HSV can infect areas not covered by condoms, consistent and correct use significantly reduces transmission risk.

For Partners of HSV-Infected Individuals

• If your partner has HSV, they should consider daily suppressive antiviral therapy, which reduces the risk of transmission to susceptible partners 2
• Valacyclovir 500 mg once daily has been shown to reduce the risk of HSV-2 transmission by 48% in heterosexual couples 2

Secondary Prevention (For Those Already Infected)

Preventing Recurrences

• Prophylaxis of initial episodes is not recommended 1
• For those with frequent or severe recurrences, daily suppressive therapy options include:
  • Acyclovir (oral) 1
  • Famciclovir 1
  • Valacyclovir 1

Reducing Asymptomatic Viral Shedding

• Daily suppressive therapy significantly reduces asymptomatic viral shedding 2, 4
• In one study, HSV DNA was detected in genital secretions on 2.9% of days with valacyclovir versus 10.8% of days with placebo 2

Special Populations

Pregnant Women

• Recommendations for preventing HSV exposure are the same as for non-pregnant individuals 1
• Oral acyclovir prophylaxis during late pregnancy is controversial and not routinely recommended 1
• For pregnant women with frequent, severe recurrences of genital HSV, acyclovir prophylaxis might be indicated 1

HIV-Infected Individuals

• All prevention recommendations apply with even greater importance 1
• HIV-infected individuals should be particularly vigilant about using condoms and avoiding sexual contact during outbreaks 1

Children

• Prevention recommendations for adults apply to children as well 1

Common Pitfalls to Avoid

1. Relying solely on visible symptoms: Many HSV transmissions occur during asymptomatic viral shedding when no lesions are visible 2, 4

2. Inconsistent condom use: Only consistent and correct condom use provides protection 3

3. Assuming oral sex is safe: HSV-1 can be transmitted through oral-genital contact, causing genital herpes 5

4. Stopping precautions after lesions heal: The virus remains dormant in nerve cells and can reactivate, so preventive measures should be ongoing 4

5. Ignoring prodromal symptoms: Early symptoms like tingling or burning can indicate an imminent outbreak, and sexual contact should be avoided during this time as well 4

Remember that while these preventive measures significantly reduce the risk of HSV transmission, they cannot completely eliminate it due to the nature of the virus and its ability to cause asymptomatic shedding.