Partner Management in Symptomatic Genital HSV-2 Infection
The sexual partner does not require treatment unless they develop their own symptomatic lesions, but they should be offered type-specific HSV-2 serologic testing and comprehensive counseling about transmission risk. 1, 2
Partner Testing and Counseling
HSV-2-seronegative partners should undergo type-specific serologic testing before continuing sexual activity, as disclosure and testing in HSV-2-discordant couples reduces transmission risk. 1 This testing distinguishes between:
- Seronegative partners (at risk for acquisition) who need intensive prevention counseling 1, 2
- Seropositive partners (already infected) who may have unrecognized infection and benefit from education about recognizing their own symptoms 3
Approximately 50% of HSV-2 seropositive individuals initially deny symptoms but can identify lesions after proper education about what to look for. 3
Transmission Prevention Strategy for the Infected Partner
The symptomatic male patient should receive:
First-episode treatment: Valacyclovir 1 g orally twice daily for 7-10 days 2, 4
After initial treatment, daily suppressive therapy with valacyclovir 500 mg once daily, which reduces transmission to susceptible heterosexual partners by approximately 48-50%. 2, 5 This also reduces asymptomatic viral shedding from 10.8% of days to 2.9% of days. 5
Critical Counseling Points for Both Partners
Sexual transmission occurs primarily during asymptomatic periods when no lesions are visible—this is the most common mode of HSV-2 spread. 5 Key behavioral modifications include:
- Abstain from all sexual contact when visible lesions or prodromal symptoms are present 1, 2, 4
- Recognize that transmission can occur even without visible lesions due to asymptomatic viral shedding 5, 4
- Consistent latex condom use reduces transmission by approximately 50% from both men to women and women to men 1, 5
- Combining daily suppressive therapy with consistent condom use provides additive protection, though neither eliminates transmission risk entirely 5
Common Pitfalls to Avoid
Do not assume episodic treatment reduces transmission risk—only daily suppressive therapy has been shown to reduce transmission to partners. 5
Do not rely solely on avoiding sex during visible outbreaks, as the majority of transmission occurs during asymptomatic periods when patients believe they are not infectious. 5, 6
Do not forget to counsel about oral-genital transmission, as HSV can be transmitted from oral lesions to genital sites through fellatio, and most persons with oral HSV are unaware they have it. 5
When Partners DO Need Treatment
Partners require their own treatment only if they develop:
- Symptomatic genital lesions confirmed by viral culture, HSV DNA PCR, or HSV antigen detection 1, 4
- First-episode symptoms warranting valacyclovir 1 g orally twice daily for 7-10 days 2, 4
Special Considerations
For HIV-infected individuals, routine type-specific serologic testing for HSV-2 should be performed, as HSV-2 increases HIV acquisition risk 3-fold. 1, 5 HIV-infected patients require higher antiviral doses. 1, 4
Women of childbearing age must inform obstetric providers about HSV-2 status during any pregnancy due to neonatal infection risk. 5