When it comes to sexually transmitted infections, the best way to deal with them is to prevent them. However, it is not always possible to prevent herpes. And herpes is incurable.
Here we summarize what studies have shown about the chance of getting herpes during protected sex—meaning sex when a condom or other barrier is used.
Several factors are considered, including the following:
- Type of sex
- Genital and anal
- Oral
- Masturbation
- Gender
- Sexual orientation
We also discuss other ways to help prevent herpes transmission besides condoms or other barriers.
YouTube video by expert STD doctor (Dr.Slava Fuzayloff)
Getting herpes with protection
Is it possible to get Herpes during protected sex?
Yes! According to a 2010 study conducted by Emily T. Martin and others, there is a high risk of herpes transmission during protected sex when one of the partners is herpes-positive.1 The probability reaches 50% to 70%.1, 2 This is explained by the fact that Herpes is transmitted skin-to-skin or skin-to-mucosa.1 Therefore, the parts of the genitals that are not covered by the condom are open to herpes infection.1
Factors affecting the probability of transmission
The probability of herpes transmission among couples if one of the partners has the infection depends on various factors, such as the clinical manifestation of the disease (symptomatic/asymptomatic), frequency of sexual intercourse, and time since the herpes-positive partner was infected. In general, it is more common to get herpes from someone newly infected. Also, a person with other sexually transmitted infections is at higher risk of contracting herpes through sexual intercourse with a herpes-positive partner.3
The risk for males and females is different
It has been proven that males are more susceptible to protected herpes transmission. This is because heterosexual females primarily get infected by the herpes simplex virus through penile skin, which is covered by a condom during protected sexual intercourse.2
“….proven that males are more susceptible to protected herpes transmission”
On the other hand, heterosexual males may get this infection from contact with a wider surface area, including the vulva and perineum.4
The effectiveness of condom protection in heterosexual contact
Genital and anal sex
A 2015 study conducted by Amalia S. Magaret and others in eastern and southern Africa clearly demonstrated the per-act effectiveness of condom use. It showed that proper condom use prevents infection in 96% of infected-male/herpes-free-female and 65% of infected-female/herpes-free-male sexual encounters.4
However, over the long term, condom use resulted in only a 30% reduction in herpes transmission.1 Some studies have shown up to 40%–50% protection, depending on other risk factors that lead to herpes transmission, including the presence of other sexually transmitted infections, gender, and the frequency of sex acts.
Oral Sex:
To reduce the risk of herpes transmission, it is essential to use a condom or other barrier while performing oral sex.5 However, no data is available that indicates even the approximate chance of herpes transmission during protected oral sex.
Hand touch:
The probability of herpes transmission through partner masturbation is almost 0%. It is only important to know that genital lesions should never be touched. Also, to prevent transmission, advance handwashing with soap is recommended.6
The estimated probability of protected Herpes transmission Type of sexual intercourse Per-act (from woman to men) Per-act (from man to woman) Multiple sex acts Genital or Anal 35% 4% 50-70% Oral - - - Hand touch 0% 0% 0%
The effectiveness of condom protection in homosexual contact.
According to a 2010 study by Emily T. Martin and her colleagues, being homosexual does not significantly alter the effectiveness of condom protection against herpes acquisition. Therefore, the probability of contracting herpes during protected sex is approximately the same for homosexual and heterosexual persons.1
Other types of protection when one partner is herpes-positive
Medical male circumcision
According to the World Health Organization (WHO), circumcised males are permanently partially protected from various sexually transmitted infections, including herpes simplex virus type 2, HIV, and HPV.7
“…genital herpes transmission is 28% lower for circumcised male”
The probability of genital herpes transmission is 28% lower among men who have undergone medical circumcision.8
No sex when genital lesions are visible
It is important to know that the symptomatic herpes simplex virus is highly contagious. That’s why if one partner is herpes-positive, abstinence is a must during times when he or she has genital ulcers.7 This is true for oral sex if the herpes-positive partner has visible symptoms near the mouth.9 However, the absence of visible ulcers or blisters does not guarantee full protection from infection and there is still some probability of genital herpes transmission.7
Antiviral medications
Antiviral medications (acyclovir, famciclovir, and Valacyclovir) are a well-known remedy for disease-associated symptoms among people who are herpes-positive. Moreover, they have been recognized as a strong preventive tool against both HSV type-1 and HSV type-2 because they reduce the probability of virus transmission by about 50%.10
However, this preventive tool does not seem to be feasible in practice because of its monetary ($1,440 per year on average with daily use) and psychological (taking medicine daily) burden. On top of that, the medication has side effects, including nausea, dizziness, and abdominal pain.11
Vaccination against HSV
An effective herpes vaccine is recognized as one of the most important global health issues. Continuous, rigorous studies are being conducted worldwide to find the most effective vaccine.12
According to a clinical trial conducted by Robert B. Belshe and others in 2013, the effectiveness of the gD-2 HSV vaccine when one of the partners is herpes-positive is approximately 82%. However, this vaccine prevents only herpes simplex virus type-1 genital infection; protection against the HSV type-2 virus appears to be insignificant.13
Effectiveness of Other Preventive Methods Preventive Method Estimated Reduction in Probability of Herpes Transmission Male circumcision 28% Antiviral therapy 50% Abstinence when genital lesions are present 100%
Conclusion
In summary, herpes simplex virus is an incurable infection that is highly contagious even during protected sex. The estimated probability of disease acquisition depends on various risk factors and types of sexual intercourse. It is important to use preventive methods to reduce the likelihood of herpes transmission. And it is essential to avoid any kind of sex if herpes lesions are visible.
YouTube video by expert STD doctor (Dr.Slava Fuzayloff)
References
1. Martin ET, Krantz E, Gottlieb SL, et al. A pooled analysis of the effect of condoms in preventing HSV-2 acquisition. Arch Intern Med.
2. Preventing Sexual Transmission of Genital Herpes. Medscape
3. Genital herpes: How can you prevent the spread of herpes in sexual relationships? - InformedHealth.org - NCBI Bookshelf.
4. Magaret AS, Mujugira A, Hughes JP, et al. Effect of Condom Use on Per-act HSV-2 Transmission Risk in HIV-1, HSV-2-discordant Couples.
5. STD Risk and Oral Sex | STD | CDC.
6. How to Have a Fulfilling Sex Life When You Have Genital Herpes. WebMD
7. Herpes simplex virus. WHO
8. Male Circumcision Reduces Risk of Genital Herpes and HPV Infection, but Not Syphilis | National Institutes of Health (NIH).
9. Patient education: Genital herpes (Beyond the Basics) - UpToDate.
10. Schiffer JT, Corey L. New concepts in understanding genital herpes.
11. Bonnar PE. Suppressive valacyclovir therapy to reduce genital herpes transmission: good public health policy? Mcgill J Med. 2009;12(1):39-46.
12. Johnston C, Corey L. Current concepts for genital herpes simplex virus infection: Diagnostics and pathogenesis of genital tract shedding. Clin Microbiol Rev.
13. Belshe RB, Heineman TC, Bernstein DI, et al. Correlate of immune protection against HSV-1 genital disease in vaccinated women.
