Partner Treatment for Genital Herpes
Partners of patients with genital herpes should NOT receive antiviral treatment unless they develop their own symptomatic infection; instead, they should receive evaluation, counseling, and consideration for type-specific HSV-2 serologic testing. 1
Management Approach for Partners
Evaluation and Counseling (Not Treatment)
Partners should be evaluated and counseled, but routine antiviral treatment is not indicated for asymptomatic partners. 1
Symptomatic partners should be managed as any patient with genital lesions would be managed, with appropriate diagnostic testing and treatment if HSV infection is confirmed. 1
The majority of persons with genital HSV infection do not have a history of typical genital lesions, so asymptomatic partners benefit from evaluation and counseling about recognizing future lesions through self-examination. 1
Type-Specific Serologic Testing Considerations
Partners at increased epidemiologic risk (such as those with sexual activity with an HSV-2 infected partner) could be considered for HSV-2 serologic screening to identify undiagnosed symptomatic infection. 1
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 reduces transmission risk. 2
However, routine serologic screening is not recommended in asymptomatic individuals with low pretest probability of infection. 1, 2
Transmission Prevention Strategies (For the Infected Partner, Not Treatment of Uninfected Partner)
Suppressive Antiviral Therapy in the Source Partner
The infected partner (not the uninfected partner) should be offered daily valacyclovir 500 mg once daily to reduce transmission risk. 2, 3
Suppressive antiviral therapy in the source partner reduces HSV-2 acquisition by 48-50% and reduces symptomatic genital herpes by 75%. 2, 4
This is FDA-approved specifically for reduction of transmission in immunocompetent adults with genital herpes. 3
Additional Prevention Measures
Consistent use of latex condoms reduces HSV-2 acquisition and should be encouraged for all sexual exposures. 2, 5
Avoiding sexual contact when the infected partner has overt genital or orolabial herpetic lesions is essential. 2, 1
Partners should understand that sexual transmission occurs during asymptomatic periods, as asymptomatic viral shedding is common. 1, 6
Common Pitfalls to Avoid
Do not prescribe antiviral therapy to uninfected partners as prophylaxis - there is no indication for treating partners who do not have HSV infection themselves. 1
Do not rely solely on episodic treatment in the infected partner for transmission prevention, as episodic therapy does not reduce transmission risk to sex partners. 2
Do not assume condoms provide complete protection - they reduce but do not eliminate transmission risk. 2
Note that suppressive therapy does NOT reduce HSV-2 transmission from or to HIV-seropositive persons. 2
Special Populations
Women partners of childbearing age should be counseled that if they acquire HSV infection, they must inform healthcare providers during any future pregnancy about HSV infection. 1, 6
HIV-infected partners require special consideration, as suppressive therapy effectiveness differs in this population. 2