One of the encouraging things about genital herpes (HSV-2) is that it’s still possible to have a rich and fulfilling sex life. Sex with herpes can be intimate, romantic, loving, and fun. Research has even given us data that shows how likely (or really, “unlikely”) you are to transmit herpes during sex when you take precautions and understand the specific circumstances you might have. So you can educate yourself about sex with herpes, including what precautions you can take, what your chances are of getting herpes, and types of sexual encounters as they relate to herpes.
For some this may be stating the obvious, but let me first say that you should always tell your partner if you have herpes, even if you have no symptoms. (How to tell your partner you have herpes). And for sex with herpes to be its most fulfilling and safe, I recommend that you have it in the context of a mutually monogamous relationship, as does the CDC.
Herpes, Sex, and Outbreaks
The likelihood of passing genital herpes to a partner is highest during an outbreak (times when a sore is present). When a person is not experiencing an outbreak, there is a 4-10% chance of transmitting it. (Depending mostly on genders.)
Men vs. Women with Herpes
Because of the nature of male and female genitalia, it is easier for herpes to be transmitted to a woman by a man than vice-versa. This is because female genitals have more exposed soft tissue. This also accounts for the slight gender gap in women vs. women with herpes. Approximately one in four American women has it, while approximately one in five American men does. (Statistics, depending on populations used, vary slightly.)
Condoms and Herpes
Condoms don’t prevent herpes transmission, but they help, cutting down the rate of transmission by about 30%. Condoms are not totally effective because genital herpes only require skin-to-skin contact to spread, so the areas that the condom does not cover are still susceptible. Some people get herpes even though they’ve always used condoms! Nonetheless, using a condom is a great idea and reducing the chancing by almost a third is nothing to sneeze at. For example, if you’re a man who is not having an outbreak, you would have an 8% chance of giving it to your partner. But using a condom, you’d bring that number down. (Add in antivirals, and you’ve brought it down to 2%). For more information, read: Do condoms prevent herpes?
Monogamous couples who know their status may want to forgo the use of condoms for whatever reason (i.e. in order to get pregnant, or because condoms are just not preferred and they are monogamous and use birth control). This is still possible as long as other precautions are taken and both parties are informed and aware of the risks. Read: When is herpes not contagious?
Suppressive therapy is the use of prescription Valtrex on a daily basis, whether an outbreak is present or not. Whereas Valtrex is commonly used to stop an outbreak as it is happening, it can also be used daily to prevent outbreaks to begin with. Valtrex is an antiviral medication that reduces the occurrence of herpes outbreaks. Using Valtrex daily also reduces the time and likelihood of the virus to “shed”, i.e. be contagious. Studies show that it can reduce the viral shedding periods so much that transmission rates drop by 50%.
Valtrex is the brand name for Valocyclovir. Other common antivirals for herpes are acyclovir (also spelled aciclovir) and Zovirax. Acyclovir is cheaper, but requires you to take more capsules at a time. With Valtrex, you only need to take one pill a day for the purpose of suppressive therapy.
Cons: Side effects of Valtrex can include dehydration and extreme thirst, and for a few individuals, disorientation. Be sure to know what effect it has on you at home before you plan to take it daily and drive a car. Some people also critique Valtrex for causing liver damage over time. Read more about Valtrex side effects here. If you don’t want to take Valtrex, there are natural herpes remedies that can somewhat suppress herpes, too.
Oral Sex and Herpes
HSV-1 is usually associated with oral herpes, but it can also spread to the genitals through oral sex. Most people know not to kiss or share a drink while a cold sore is present. The same goes for not performing oral sex while a cold sore is present. You might also wish to use a condom or dental dam.
HSV-2, which is usually genital herpes, can also spread to the oral region, but it’s not as likely. It is possible, but rare, since HSV-2 doesn’t like the oral environment. In fact, only 3% of oral herpes outbreaks are from HSV-2.
Herpes Transmission Rates
- The likelihood of passing genital herpes to a partner is highest during an outbreak (times when a sore is present).
- When a person is not experiencing an outbreak, there is a 4-10% chance of transmitting it. (Depending on sex of infected person)
According to studies done by Valtrex, these are the rates of transmission per year of regular sex:
- If partners avoid sex during outbreaks: 4% chance transmission from female to male; 8% male to female
- If partners also use condoms or antiviral medication: 2% female to male; 4% per year male to female
- If partners also use condoms and antiviral medications: 1% female to male; 2% male to female
When Both Partners Have Herpes
Congratulations — you can skip having the talk! If you and your partner have the same type of herpes, you have more freedom than a couple not trying to infect one partner. If you both have HSV-2, for example, you both already have the antibodies built up and cannot be re-infected. Your outbreaks and symptoms will instead be affected by the strength of your immune system, so keep it strong.
You will also not necessarily have the same need to avoid sex during and around times of outbreaks, but you will probably want to, for the sake of avoiding discomfort or prolonging the outbreak by irritating it.
If you have different strains of herpes; i.e. one of you has HSV-1 and one has HSV-2, read on. You are already well-protected by your antibodies. If you have HSV-2, you can still get, but might not be as likely to get, genital HSV-1. If you have HSV-1, however, you are still as susceptible to get HSV-2.
The encouraging transmission rates show that you can have fulfilling sex with herpes without passing it along if you take basic precautions. Remember that you must always tell potential partners if you have herpes, even even you have no symptoms. (How to tell them about your herpes). I also recommend the wisdom of having sex in the context of a mutually monogamous relationship, as does the CDC.