Prevention Strategies for Herpes Simplex Virus Acquisition
Consistent use of latex condoms during every act of sexual intercourse is the cornerstone of HSV prevention, reducing HSV-2 acquisition from both men to women and women to men. 1
Behavioral Prevention Strategies
Condom Use and Sexual Practices
- Latex condoms should be used during every sexual encounter to reduce exposure risk to HSV and other sexually transmitted pathogens 1
- Sexual contact must be avoided when partners have visible herpetic lesions (genital or orolabial) 1
- However, recognize that sexual transmission can occur during asymptomatic viral shedding when no lesions are present, making consistent barrier protection critical 1
Partner Testing and Disclosure
- HSV-2-seronegative persons should request that partners undergo type-specific serologic testing before initiating sexual activity, as disclosure of HSV-2 status in heterosexual discordant couples was associated with reduced transmission risk 1
- Type-specific serologic testing can identify asymptomatic partners who may be infected despite having no symptoms 2
Pharmacologic Prevention Strategies
Suppressive Antiviral Therapy in Source Partners
- Suppressive valacyclovir therapy (500 mg once daily) in persons with genital herpes reduced HSV-2 transmission to susceptible heterosexual partners by 50% 1
- This approach has not been evaluated specifically for reducing transmission from or to HIV-seropositive persons 1
- The FDA-approved indication shows valacyclovir 500 mg once daily reduced symptomatic HSV-2 acquisition by 75% in discordant couples when combined with safer sex counseling 3
Pre-Exposure Prophylaxis (PrEP) Considerations
- There are no data supporting the use of antiherpesvirus medications (acyclovir, famciclovir, or valacyclovir) as pre-exposure prophylaxis to prevent HSV-2 acquisition 1
- Daily oral tenofovir disoproxil fumarate (TDF) when used for HIV prevention was associated with 30% reduced risk of HSV-2 seroconversion in heterosexual discordant partnerships in Africa 1
- However, TDF/FTC should not be used solely for HSV-2 prevention in persons not at risk for HIV acquisition due to insufficient evidence 1
Post-Exposure Prophylaxis
- The dose, duration, and efficacy of antiviral prophylaxis after exposure to HSV have not been evaluated, and therefore prophylaxis of initial HSV episodes is not recommended 1
Special Population Considerations
Pregnancy Prevention Strategies
- Seronegative pregnant women should avoid acquiring herpes infection in late pregnancy by refraining from genital intercourse with partners known or suspected to have genital herpes 1
- Pregnant women should avoid direct orogenital contact with partners known or suspected of having orolabial herpes 1
- Type-specific serologic screening of asymptomatic partners can determine whether risk for HSV-2 acquisition exists 3
HIV-Infected Populations
- The same behavioral prevention strategies apply, with emphasis on consistent condom use and avoidance of contact during visible lesions 1
- Medical male circumcision shows inconsistent results for HSV-2 prevention efficacy 1
Patient Education and Counseling
Critical Information to Convey
- Patients must understand that genital herpes is frequently transmitted through asymptomatic viral shedding, even when no lesions or symptoms are present 3, 2
- Counseling should address the natural history of infection, variability in recurrence patterns, and specific risk reduction strategies 4
- Partners of infected persons should be advised they might be infected even without symptoms 3
Common Pitfalls to Avoid
- Do not rely solely on symptom recognition, as most transmission occurs during asymptomatic periods 1
- Avoid assuming condoms provide complete protection—they reduce but do not eliminate transmission risk 1
- Do not recommend antiviral prophylaxis for uninfected persons, as this is not evidence-based 1