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We all come across things in new sexual relationships throughout life that raise questions or concerns — and we need to normalize talking about them.
One of the most important topics of conversation is how to protect ourselves from sexually transmitted infections (STIs) like herpes.
When we say “herpes,” we’re referring to the herpes simplex virus types HSV-1 and HSV-2. They both cause herpes, a common STI that often manifests without major symptoms, and sometimes without any symptoms at all.
Neither type of herpes is curable. This means that once you contract herpes, you have it for life.
And that’s okay. In fact, it’s common. Both HSV-1 and HSV-2 are highly manageable conditions, but if your partner has herpes, it might trigger a pause before you take the next step in your relationship.
You might be asking how you can protect yourself from herpes exposure. Can you still have an intimate relationship when herpes is a factor or is the risk of transmission too high?
We’re diving into the facts about having sex with herpes, including how it can be passed between people and how to reduce your risk of transmission.
Understanding the modes of HSV transmission is essential to preventing the spread of oral and genital herpes and maintaining your sexual health.
The herpes virus can be transmitted through several pathways, including exposure to:
Herpes sores or lesions in the genital or oral regions
Saliva containing the virus
Genital or oral secretions
Surfaces or objects contaminated with the virus
Sex toys shared with someone who carries the virus
HSV-1 is highly contagious and can manifest as both genital and oral herpes. It’s most often acquired during childhood through non-sexual contact.
HSV-2 primarily spreads through genital contact and is the primary cause of genital herpes. It can be spread through either genital or oral sexual contact.
An infected person can experience viral shedding — when an infected person releases copies of the virus from their body as it’s replicating and reproducing in them — of both HSV-1 and HSV-2 even if they don’t have symptoms.
Before we go any further, let’s make something super clear: just because your partner has herpes doesn’t mean they’re unclean, unsafe or irresponsible. Herpes is a very common STI and many people don’t even know that they have it.
The most important first step to take in reducing your risk of contracting herpes is to foster open and honest conversations with your partner. This is a key component to any healthy relationship when it comes to any topic — especially ones related to your sexual health and safety.
Next, it’s helpful to confirm the type of herpes virus that’s on the table.
If either of you have oral or genital herpes symptoms, a healthcare provider can take a sample of the lesion to test. They can also do a herpes blood test, which checks for antibodies in the blood.
However, the Centers for Disease Control and Prevention (CDC) doesn’t recommend herpes testing for most people without symptoms, due to the potential for inaccurate test results.
If your partner has a clear diagnosis of either HSV-1 or HSV-2, the next step is understanding what the likelihood of transmission is for that virus type.
Current statistics show that an estimated 50 percent of Americans are infected with HSV-1. In other words, it’s very common and contagious.
According to estimates from the CDC, 572,000 new genital herpes infections were diagnosed in the United States in 2018 alone.
It has a higher transmission rate than HS-2 because most of the adults who have it obtained it much earlier in life from non-sexual contact with someone else’s infected saliva.
The most common symptom of HSV-1 is cold sores around the lips and mouth. However, it can also present as lesions near the genitals when it’s spread through oral sex. When you have an HSV-1 outbreak, you’ll have one or more blisters around the rectum, genitals or mouth.
Between outbreaks, HSV-1 goes dormant in a group of nerve cells located near the ear called the ganglia neurons.
Still, many people who have HSV-1 don’t experience any symptoms at all. This often means that it can spread more easily between people due to the fact that it’s not obvious that someone has it.
Some keep their breakouts at bay with a once daily pill. Connect with a healthcare provider and discover your treatment options.
Approximately 11.9 percent of the United States population between the ages of 14 and 49 years old currently have an HSV-2 infection. But it’s important to know that the prevalence of genital herpes is actually higher than that, because of genital infections caused by HSV-1.
The most common symptoms of HSV-2 are lesions that appear around the genital area or anus. Between outbreaks, HSV-2 goes dormant in a group of nerve cells in your lower spine called the sacral ganglion.
While it’s possible to spread HSV-2 from mother to child during birth, it’s much more common to transmit it through sexual contact. It’s also very contagious.
Similarly to HSV-1, many people who have HSV-2 don’t have symptoms and, according to data from the World Health Organization, most people who have HSV-2 don’t know it.
This is again why it’s so important for anyone to undergo an STI screening prior to having sex with a new partner.
Furthermore, studies have found that transmission rates of herpes remain high during asymptomatic periods. In other words, you’re not in the clear just because there are no noticeable symptoms.
After an official diagnosis of herpes, obtaining the appropriate medical prescription is crucial. There are currently three antiviral drugs approved by the Food and Drug Administration (FDA) for this purpose: acyclovir, valacyclovir and famciclovir.
The most commonly prescribed is valacyclovir, which is sold under the brand name Valtrex®. It’s well-absorbed, which means it requires less frequent dosing for most people.
For more on the differences between valacyclovir vs. acyclovir vs. famciclovir, check out our blog.
Valacyclovir is very effective for managing symptoms and can help speed up the healing process during an outbreak.
For the first outbreak of genital herpes, the typical valacyclovir dosage is 1,000 mg taken twice per day. This generally continues for 10 days as the lesions heal. For recurrent genital herpes outbreaks, the typical prescription is 500 mg taken twice per day for three days.
If your partner is taking valacyclovir for cold sores, this is usually prescribed in two large doses of 2,000 mg taken 12 hours apart.
For more information, see our blog post on how valacyclovir works.
Your partner is probably also wondering about their chances of spreading herpes while on valacyclovir.
While data show that proper Valtrex adherence can reduce herpes transmission between partners, it does not offer a 100 percent protection rate.
Specifically, research suggests that people who take valacyclovir as prescribed and have symptomatic herpes are nearly 50 percent less likely to spread the virus to others than non-medicated people with herpes.
For example, one 2004 study found that proper use of valacyclovir reduced the transmission rate of HSV-2 from 3.6 percent to 1.9 percent.
In other words, while it’s a necessary management tool, valacyclovir should not be viewed as a full-on safety net — there are still plenty of cases where herpes was sexually transmitted even when the infected person was using antiviral medication.
As for how fast valacyclovir works, this can depend on factors like the prescribed dosage and how quickly it’s started after noticing symptoms.
Valacyclovir works best when taken as soon as possible, ideally within 48 hours. It begins to work as soon as it hits your system, but you may not notice changes for a few days.
That’s why it continues to be important to refrain from sexual contact until an outbreak is fully healed, and to practice safer sex even after lesions are gone.
Using antiviral medication as a preventive treatment could also be an option if your partner has genital herpes outbreaks frequently.
The bottom line? Using a drug like valacyclovir preventively inhibits HSV activity, which helps lower the risk of transmission. While proper use of valacyclovir for herpes management doesn’t offer complete protection against transmission, it does reduce the risk of catching herpes from a sexual partner.
Your partner should speak with their healthcare provider for personalized guidance.
In addition to your partner using their prescribed antiviral medication properly, they should implement other practices to prevent the spread of genital herpes and maintain your sexual health.
First, avoid skin-to-skin contact, particularly having sex, during a herpes outbreak, since that’s when the risk of transmission from exposure to herpes lesions is highest.
Next, use condoms even when your partner is asymptomatic — and remember that condom use for sexual activity is always a good idea. It can place a barrier between you and any herpes sores and lesions, especially if they’ve had a recent outbreak.
A large 2009 review of six studies involving nearly 5,400 people examined how effective consistent condom usage was at preventing HSV-2 transmission. The individuals were HSV-2 negative at baseline and data was collected via 2,040,894 follow-up days.
HSV-2 diagnoses were made among 415 individuals at follow-up. The researchers determined there was a 30 percent lower risk of HSV-2 acquisition among those who used condoms 100 percent of the time, compared to those who never used condoms (yikes).
While 30 percent better protection isn’t as high as you might hope for as far as STI transmission rates go, it’s still better than zero.
Finally, if you’re sharing sex toys, make sure they’re thoroughly cleaned before and after use. Washing with warm soapy water is adequate for most toys.
Glass, stainless steel and non-motorized silicone toys can also be cleaned by boiling them in water for eight to 10 minutes and then allowing them to cool. (Side note: We really hope cleaning your sex toys is a standard practice already, regardless of whether one partner has herpes.)
Continue to have an open line of communication with your partner about the disease. This is a way for you to express mutual respect, make informed decisions and even grow closer together. Allow it to be a factor in strengthening your intimacy rather than a cock block.
There’s a lot to consider when embarking on a new sexual relationship, let alone when one partner has herpes. While the presence of an STI in your relationship can feel overwhelming, the proper prevention methods can help reduce your risk of contracting it.
If your partner has herpes, keep these things in mind as you move forward together:
Herpes is very common. Data show that billions of people around the world are infected with HSV-1 or HSV-2. Many people don’t even know they have it. While it has a high prevalence and risk for transmission, herpes is also a very manageable infection once it’s properly diagnosed.
Communication is key. Herpes can feel like an elephant in the room. As awkward as it may be at first, open and honest conversations are imperative to a healthy and fulfilling sexual relationship. Communication with your healthcare provider can also be helpful, especially if you’re not sure how else to protect yourself.
Treatment does not mean cure. Herpes can be managed effectively with antiviral medications such as valacyclovir. While proper adherence can help reduce the risk of transmission, antiviral drugs do not offer 100 percent protection against the spread. Other methods of safer sex, and avoiding sex during outbreaks, are highly recommended.
Consult with a medical professional via telehealth primary care if you or your partner are in need of advice. We want to help you prioritize your sexual health so you can take the next steps in your relationship and sex life with confidence.
Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.