[ICYMI] ASK DR. HISAM: Dealing with Genital Herpes

July 11, 2019

by Dr. Hisam Goueli

Dr. Hisam,

I'm a 57-year-old gay man in an open relationship. I'm HIV negative. But I have genital herpes. How do I not transmit anal warts during anal intercourse? —Unsure

Dear Unsure,

I am happy to hear from you! All right, to your question. To start, I am assuming that you are confident about the diagnosis and it was made by a medical professional. Herpes is just one of many things that can cause painful ulcerations, and I would hate to give you the wrong information.

In general, when discussing transmission to partners, we tell patients to limit the number of sexual partners and use a condom with each sexual encounter. This is probably stuff you have already heard.

Although condoms are effective in decreasing transmission, infection can still be spread from skin-to-skin contact in areas not protected by a condom. This eventually led the Europeans to develop full-body latex underwear to limit the transmission. A good kink but not super practical.

Interestingly, avoiding sexual intercourse during outbreaks does not prevent herpes transmission. Yeah, I found that crazy too! The majority—about 70%—of herpes simplexvirus (HSV) transmissions happen when people are not symptomatic.

You can reduce asymptomatic viral shedding by 90% with medications. There are several options, which all end in "-cyclovir." The one that I typically prescribe—provided you have fewer than 10 outbreaks per year—is valacyclovir 500mg daily by mouth. If you have more than 10 outbreaks per year, acyclovir 400mg twice per day is a reasonable choice.

To summarize, good sexual health practices include condom use and regular STI visits, as well as open communication. Using a medication to suppress shedding is also super reasonable and common.

I hope you find this helpful, and thanks for writing!

 

Got a Question for Dr. Hisam? Please email him drhisamg@gmail.com