Living with herpes

Transmission of Herpes Simplex 2

The herpes simplex 2 virus can be spread by direct skin-to-skin contact, especially during intimate sexual contact. This includes kissing, oral sex and contact with the genitals or anus. The herpes simplex 2 virus may sometimes be transmitted through a cut to the skin.

The herpes simplex 2 virus can be spread during an outbreak of symptoms as the virus is contained in the blisters and sores on the skin. However, even when there are no symptoms, the herpes simplex 2 virus can still be present on the skin and be transmitted to other people who come into close contact.

The medical terminology for the herpes simplex 2 virus being released from the surface of the skin is called viral shedding. Viral shedding can occur with symptoms (symptomatic herpes) and without symptoms (asymptomatic herpes). You may or may not be aware that viral shedding is happening. The virus cannot be spread when it is inactive (in the nerve cell). There is no simple way to know if the herpes virus is active when there are no symptoms.

Protecting yourself and your partners

• Discuss genital herpes with your partner and decide together on the precautions that suit you best. When you have symptoms of genital herpes, avoid skin-to-skin contact with the affected area until all of the sores have healed.
• Use condoms. Condoms provide good all-round protection from STD's. They also offer useful protection against asymptomatic shedding, by covering and protecting the parts of the body that are the most likely sites of transmission. It is essential to slide a condom on as soon as a complete erection occurs, not just at penetration. If someone has cold sores around the mouth (oral herpes), avoid oral sex until the sores have healed. The virus is also present in the saliva of people with oral herpes.
• Use dental dams to reduce your exposure when giving oral sex to a woman with genital herpes.
• Stay informed about the antiviral medications available. Taking daily antiviral medication reduces the frequency of episodes of viral shedding. This may be particularly helpful when you first get the herpes virus, as viral shedding is more frequent in the earlier days. You may wish to discuss this matter with your doctor.

Discussing herpes with sexual partners

It's important to discuss genital herpes with potential partners before having sex. That way you can work together to reduce the chance of transmission. Talking about herpes may be difficult at first, but remember that open discussion is the best way to help you decide how to best minimise the risks for you and your partner. Let them know that you have a history of genital herpes and that there may be times when you cannot have sex. Discuss the place of condoms in your relationship. And don't forget to ask them about their sexual health.

Case study

My friend Jenny is 38 years old, and lives the "high life" of an international flight attendant. I'm one of the few friends whom she's told that she's been living with herpes for around 20 years. Jen thinks she got the virus from her first boyfriend who wasn't aware that he had it. Her first attack was extremely painful and caused her a lot of shock and concern. But she didn't seek help immediately. It took her a while to consult her doctor. Jen hasn't let herpes rule her life. Although it proves to be a bit inconvenient at times, particularly when she's tired and sore, Jen says, "You just get through it and move on". She always tells people that she has herpes before they sleep together for the first time. Although she finds this to be a little uncomfortable at times, it's never got in the way of a relationship.

HIV and herpes infection

Most people with recurrent genital herpes infection in Australia do not have HIV infection. Some doctors think that HIV may be more easily acquired in the presence of an open sore or ulcer in the genital area, although the evidence is not clear on whether this applies to genital herpes. Many doctors think that treating sexually transmitted diseases that cause ulcers may help to prevent the spread of HIV infection.

Herpes may recur in a person who also has human immunodeficiency virus (HIV) infection because of lowered immunity. If you have herpes and think that you may have been exposed to HIV infection, you may wish to talk to your doctor about the possibility of having an HIV test. Treating HIV infection as well as herpes often helps the body to control episodes of genital herpes in people with HIV infection.

Pregnancy and childbirth

When first diagnosed with herpes, many women are concerned about passing the virus on to their unborn child during pregnancy. However, the vast majority of women with genital herpes have normal pregnancies and deliver healthy babies.

Women who have genital herpes before falling pregnant have a lower risk of passing the virus to their babies. Women who develop genital herpes during their third trimester of pregnancy have a higher chance of passing the virus on to their baby because their body has not built up antibodies to the virus. This can be a problem if a woman has an active episode of genital herpes during childbirth, causing the baby to come into direct contact with the virus. If sores are present at the time of delivery, babies can usually be delivered safely by a caesarean section.

Although recurrent outbreaks of genital herpes in pregnancy present a smaller risk of transmission, many obstetricians still recommend a caesarean section to women with recurrent genital herpes at delivery.

If you are pregnant and your partner has genital herpes, it is important to avoid contracting the virus during pregnancy. Avoid skin-to-skin contact when herpes sores are present and remember to use condoms even when there are no obvious genital herpes lesions to reduce the risk of possible transmission through asymptomatic viral shedding.