Protecting your partner: Ways to reduce herpes transmission
When people are diagnosed with herpes, one of the first things they think about is how to protect other people.
- How can I protect my current and future partners?
- How can I keep my kids and other family members from getting it?
- Can I prevent transmission or at least lower the risk?
In this section, we’ll summarize the most common and practical ways of reducing the risk of transmitting herpes to your partners and other loved ones. First, we’ll present some statistical information in tables. That will be followed by frequently asked questions with Dr. F’s answers.
If you want to know how to protect your sexual partner and your family, this chapter is for you!
Common ways herpes is transmitted
- Both herpes viruses—HSV-1 and HSV-2—are transmitted via direct skin-to-skin contact.
- Both HSV-1 and HSV-2
- Can be transmitted sexually and non-sexually and
- Can affect either the oral or genital area.
HSV-1 transmission
Nonsexual transmission
- Since HSV-1 is mainly stored in the oral area, people with HSV-1 commonly get the infection via nonsexual contact (kisses, touching blisters) during their childhood from parents or friends.
Transmission during sex
HSV-1 can be spread during sex via oro-genital contact (mouth-to-genital contact such as oral sex). Once it’s passed to a person’s genital area, it will be stored and passed genitally by that person (about half of genital herpes cases are caused by HSV-1 infection).
HSV-2 transmission
- People with HSV-2 mostly get the infection during sexual intercourse. HSV-2 is rarely transmitted via genital-to-oral contact
Other ways of getting herpes and how likely they are
As mentioned earlier, herpes is mostly transmitted via skin-to-skin contact (kissing, sexual intercourse, touching the blisters and touching other parts of your own body, etc.).
There is a small theoretical risk of herpes transmission via other routes, such as sharing utensils, friendly kisses and hugs, clothing, etc. The real-world risk of this is considered to be very low.
In the table below, we summarize the estimated likelihood that herpes will be transmitted by various routes.
| Sex | Kiss | Sharing utensils | Clothing | Hard surfaces |
|---|
Chance of transmission | Up to 20% | Unknown (but considered to be low) | Unknown (but considered to be low) | 0% | 0% |
*Please note: The risk of herpes transmission varies from person to person because various factors affect that risk:
- Race (Black people are more susceptible to infection)
- Number of sexual partners (people with multiple sexual partners are more likely to get herpes)
- Skin condition (people with damaged skin are more likely to get herpes)
- Gender (women are more susceptible to infection than men)
- Sexual orientation (homosexual men are more likely to get herpes than heterosexual men)
- Immune status (people with a compromised immune system are more likely to get herpes)
Two ways to reduce herpes transmission to a sexual partner: condoms and antiviral therapy
There are two main ways of decreasing herpes transmission rates to sexual partners:
- Condoms
- Antiviral therapy.
Condoms
Condoms work as a physical barrier, preventing contact with infected skin. A condom covers only a very small area of skin (the penis) and therefore provides only partial protection (because herpes transmission may occur from contact with the larger area surrounding the penis). However, it covers the most important area—the area that has thin, moist skin that is subject to being damaged more easily, which facilitates herpes transmission.
Antiviral therapy
Antiviral medication given in a regimen that is suppressive inhibits the activity of the virus. Sadly, no method offers 100% protection. You can see the average protection rates of the earlier mentioned methods in the table below.
| Preventative method | Risk reduction |
|---|
| Condoms | Per act
- Women to men: 65% reduction
- Men to women: 96% reduction
Per relationship
- 30%–50% reduced chance of getting herpes
|
| Antiviral medication | 50% reduction (20% to 10%) |
Frequently Asked Questions
Here we summarize real patients’ questions, grouped by topic, and Dr. Fuzayloff’s answers to them.
What should I be aware of if I want to protect my sexual partner from getting herpes? 
It’s impossible to completely eliminate the risk of transmitting herpes to your partner because all preventative methods offer only partial protection.
However, there are ways to significantly reduce the risk that involve improving your knowledge of herpes and modifying your behavior accordingly:
Avoid sex and kisses during outbreaks
People are more contagious during herpes outbreaks because the fluid-filled blisters and sores have the highest concentration of herpes virus.
Pay attention to prodrome symptoms
Prodrome herpes symptoms are usually very nonspecific symptoms of fatigue, mild skin tingling, and shooting pain where the outbreaks usually occur (the oral or genital area). Herpes virus is likely to shed during that period.
Avoid skin trauma during sexual intercourse
Damaged skin is more vulnerable to herpes infection. That’s why it’s recommended that silicon-based lubricants be used during vaginal or anal sex.
Maintain proper hand hygiene
The herpes virus may stay on your hands after you touch blisters or sores and you can easily transmit the infection by then touching your partner. Always wash your hands with soap after you touch your herpes lesions.
Don’t share utensils during oral herpes outbreaks
There is a theoretical risk (though the likelihood is unknown and considered to be extremely low) of herpes transmission via utensils since fluids that contain herpes virus could be on the utensils. If so, this would bring the skin around the mouth or oral mucosa into contact with the virus
Use condoms
Condoms may decrease the chance of herpes transmission (per multiple sex acts) by 50%. But the parts of the genitals not covered by a condom will still be exposed to the virus.
Take antiviral medication
Proper antiviral therapy reduces the risk of herpes transmission by 50%. It reduces the chance of both symptomatic and asymptomatic transmission.
How, when, and why does asymptomatic herpes transmission (“silent virus shedding”) happen?
Asymptomatic herpes transmission complicates trying to protect your partner from herpes. People want to be ethical and protect their partner, but it’s not always possible.
Research to date leaves a lot of questions about asymptomatic herpes transmission unanswered. We still must make a lot of assumptions.
Here we tell you what is known about asymptomatic herpes transmission:
How silent herpes virus shedding happens
Silent herpes transmission is believed to happen when activated herpes virus from the local nerve ganglion travels to the skin’s surface. Transmission occurs with skin-to-skin contact where the virus is active. It is still unclear how high the concentration of virus on the skin must be for asymptomatic transmission to occur.
When asymptomatic transmission happens
It’s not completely clear when asymptomatic transmission happens. It’s believed that the same factors that cause flare-ups (stress, exhaustion, disease) make asymptomatic transmission of herpes more likely. And it’s believed that an immune system that’s strong enough will suppress the virus fast enough to prevent a visible skin flare-up, but transmission can still occur.
When asymptomatic transmission is most likely
- The chance of transmission is greatest during the first year after a patient acquires the disease.
- The chance of transmission is usually greatest from a few days before an outbreak to a few days after an outbreak.
I was diagnosed with genital herpes (HSV-2) during routine STD testing. Am I contagious if I use protection?
Let’s discuss the two possible scenarios:
When you’re having an outbreak
You are most contagious during an outbreak. Therefore, during herpes outbreaks (meaning when you have symptoms and signs of herpes infection) it’s highly recommended that you avoid any kind of sexual intercourse regardless of whether you use protection. And it’s important to wash your hands with soap after touching the area of the outbreak.
When you’re not having an outbreak
- You are contagious even when you’re not having an outbreak. Because of “silent” shedding of the virus, your partner’s skin can still come in contact with the infected area (broadly, the oral or genital area, not the exact spot where you had an outbreak in the past).
- A condom significantly (by 50%) reduces the chance of herpes transmission. But the protection given by a condom is only partial because it covers only a small portion of the skin that comes into contact with your partner during sex (the penis), and virus may be shedding from the broader genital area that isn’t covered. Using a condom is always encouraged because of the partial protection it offers.
Can I pass herpes by sharing a bed with someone
According to the CDC, you can’t pass the herpes virus through bed sharing. Here’s why:
- Herpes doesn’t survive in the dry air for very long.
- The concentration of the virus needs to be high for herpes to be transmitted, which is why transmission normally requires direct skin-to-skin contact
- Herpes more easily penetrates the skin in thin, moist, damaged areas (usually penile skin and the vagina and vulva during sex).
Yes, you can pass herpes via skin-to-skin contact while sleeping by touching your partner’s skin with your blister and sores. You should avoid skin-to-skin contact during an outbreak.
Can I herpes through toilet seats?
That’s extremely unlikely! According to the CDC, you can’t pass the infection via toilet seats, clothes, or towels.
Let’s look at the sequence of events, and their probability, that would have to happen for herpes to be transmitted via a toilet seat.
1. The herpes-positive person uses a toilet seat and their herpes sore touches the seat.
2. Very soon (probably within 15 minutes), another person sits on that seat, and their skin comes into contact with exactly the same spot the first person’s sore touched.
3. The area of the second person’s skin that touches that exact spot of the toilet seat is thin and moist so herpes can invade it. (But it’s typically not—usually it’s the thigh, which has very thick skin, that comes into contact with a toilet seat.)
Can I pass herpes through common utensils?
This is extremely unlikely, but let’s separate it into the two possible scenarios:
During an outbreak
There’s a very low chance of passing herpes through home utensils even during outbreaks (meaning when there are visible crusted and oozing sores and blisters).
Nevertheless, to be as safe as possible, avoid sharing towels, underwear, toothbrushes, razors, and other objects during an outbreak.
Not during an outbreak
There is no risk of passing the herpes infection by sharing utensils when you’re not having an outbreak because the utensils won’t contain contaminated fluids
Can I pass herpes by touching people with my hands?
It is possible that during an outbreak (the sores and blisters phase), you could pass herpes by touching someone after touching your sores or blisters. Washing your hands with soap after touching that area should prevent transmission.
You might find this Herpes study interesting:
A study was conducted in which herpes-containing fluid droplets were put on the palm of each subject’s hand and the subject was required to touch the droplets after 15, 30, 60, and 120 minutes. It was found that at the moment of placing the droplet in the hand, it was 100% contagious, and then its contagiousness gradually decreased. After 15 minutes it was about 40% contagious. However, even after 120 minutes, when the droplets had completely dried, that part of the palm still contained virus particles, which were easily recovered after contact with saliva or other body fluids.
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