Genital herpes guide:  Prevention and control

On this page

• General STBBI prevention and control
• Prevention and control of genital herpes
• Prevention and control during pregnancy
• References

General STBBI prevention and control

Case finding, education, counselling, partner notification and treatment are critical to control STBBIs.

Healthcare providers should offer screening for STBBIs as part of routine prevention and control strategies. Since many STBBIs are frequently asymptomatic and may lead to serious complications if left undiagnosed and untreated, offer STBBI screening during routine medical care, with special attention towards those with risk factors. Normalizing screening in this way can reduce barriers to testing and the stigma associated with STBBIs.

Integrate STBBI prevention strategies such as counselling, vaccination and education on preventive practices into care. Motivational interviewing may be used to identify barriers to prevention practices and the means to overcome them.

Offer vaccination for hepatitis B (HBV), hepatitis A (HAV) and human papillomavirus (HPV) to people at risk of these infections as per the Canadian Immunization Guide . For many STBBIs, partner notification has public health benefits (e.g. disease surveillance and control) and reduces the risk of reinfection for the index case.

Prevention and control of genital herpes

Measures to prevent and control the transmission of HSV include counselling, prompt diagnosis, use of barrier protection and suppressive therapy. For more information, refer to the Genital Herpes Counselling Tool .

Counsel people with suspected or confirmed herpes about:

• The natural history of the disease with emphasis on the potential for recurrences and asymptomatic shedding^{Footnote 1}
  • HSV-2 infection is characterized by more recurrences and more frequent subclinical viral shedding than HSV-1 infection^{Footnote 2}
  • HSV-2 transmission is mostly genital-genital^{Footnote 3}
• Potential transmission to partner(s)
• Signs and symptoms
• The importance of early recognition of the signs and symptoms to prevent transmission^{Footnote 4}
  • Abstaining from sexual activity during symptomatic periods (from prodrome to re-epithelialization) can reduce the risk of herpes transmission and acquisition over time^{Footnote 5}
• Consistent and correct use of barrier protection
  • Condoms can reduce, but not eliminate the risk of HSV transmission or acquisition^{Footnote 5Footnote 6}
• Indications for testing of sexual partners
  • Although partner testing is not routinely recommended, the identification of HSV-2 serodifferent or serodiscordant couples has implications for prevention and management measures for genital herpes. For example, testing may be appropriate if a serosusceptible pregnant person has a partner with a history of genital lesions^{Footnote 5}
• Suppressive antiviral therapy
  • Daily suppressive antiviral therapy can significantly reduce the risk of sexual transmission of HSV when taken consistently^{Footnote 7}
  • In those with HIV, daily suppressive therapy for HSV may not reduce the risk of HSV transmission^{Footnote 8}

Prevention and control during pregnancy

It is important to counsel pregnant persons on the signs and symptoms of HSV, as well as risk reduction strategies.

No evidence currently exists to support screening for HSV when neither the pregnant person nor their partner have a history of genital lesions.

Pregnant persons who are proven seronegative for HSV-1 or HSV-2 are at risk of acquiring HSV. If a seronegative pregnant person has a partner with oral or genital herpes, advise abstinence from oral or genital sexual contact and suppressive therapy for the partner during pregnancy. If abstinence is ruled out, suggest the use of condoms and dental dams^{Footnote 5Footnote 6Footnote 9}.

A first episode of genital herpes in pregnancy warrants oral antiviral treatment. Caesarean delivery should be considered if the first episode occurs in the third trimester of pregnancy. These measures reduce — but do not eliminate — the risk of vertical transmission.

When a history of HSV exists, suppressive therapy from the 36^th week of gestation may help prevent recurrence and asymptomatic shedding and may thus reduce the need for caesarean section. Suppressive therapy using acyclovir or valacyclovir from 36 weeks gestation until delivery is recommended for anyone who has had a recurrence within the previous year [A-1]^{Footnote 10Footnote 11Footnote 12}.

References