What precautions can be used to minimize the transmission of herpes?

Precautions to Minimize Herpes Transmission

The most effective precautions to minimize herpes transmission include consistent condom use, abstaining from sexual activity during outbreaks, antiviral suppressive therapy for infected individuals, and open communication with partners about infection status. 1

Sexual Contact Precautions

• Patients should completely abstain from sexual activity when lesions or prodromal symptoms (tingling, burning, itching) are present 1
• Consistent latex condom use during all sexual exposures significantly reduces transmission risk:
  • Reduces per-act transmission risk from men to women by 96% 2
  • Reduces per-act transmission risk from women to men by 65% 2
• Patients should be informed that sexual transmission of HSV can occur during asymptomatic periods without visible lesions 1
• Asymptomatic viral shedding occurs more frequently in HSV-2 infections and during the first 12 months after initial infection 3

Antiviral Suppressive Therapy

• Daily suppressive therapy with antiviral medications significantly reduces the risk of transmission to uninfected partners 4
• Valacyclovir once daily reduces the risk of HSV-2 transmission in heterosexual couples by 48% overall and symptomatic infections by 75% 4
• Suppressive therapy reduces viral shedding by approximately 80% (from 10.8% to 2.9% of days) 4
• Recommended suppressive regimens include:
  • Acyclovir 400 mg orally twice daily 1
  • Valacyclovir 500 mg orally once daily 5, 4
  • Famciclovir as prescribed by healthcare provider 6

Patient Education and Communication

• Infected individuals should inform their sexual partners about their HSV status 1
• Partners should be educated about:
  • The natural history of genital herpes 1
  • Potential for recurrent episodes 1
  • Asymptomatic viral shedding 1
  • Risk reduction strategies 7
• Childbearing-aged women with genital herpes should inform healthcare providers during pregnancy due to risk of neonatal infection 1

Additional Precautions

• Limit the number of sexual partners to reduce exposure risk 7
• For oral herpes (cold sores), avoid oral contact with others during outbreaks 8
• Avoid sharing personal items that may contact lesions (towels, razors, lip balm) 9
• For HIV-infected individuals, consistent condom use is particularly important as they may have more frequent and severe HSV outbreaks 1

Important Caveats

• No prevention method completely eliminates transmission risk; combining multiple strategies provides the best protection 3
• Even with suppressive therapy, asymptomatic viral shedding can still occur, so condom use remains important 1, 4
• The highest transmission risk is from men to women (28.5 transmissions per 1000 unprotected sex acts) 2
• Patients should understand that herpes is a lifelong infection with variable recurrence patterns 9