Genital herpes guide: Prevention and control
Prevention and control of the genital herpes.
Note: This guide provides minimal information about neonatal herpes. For more information, refer to the Canadian Paediatric Society Position Statement about the prevention and management of neonatal herpes simplex virus infections.
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 sheddingFootnote 1
- HSV-2 infection is characterized by more recurrences and more frequent subclinical viral shedding than HSV-1 infectionFootnote 2
- HSV-2 transmission is mostly genital-genitalFootnote 3
- Potential transmission to partner(s)
- Signs and symptoms
- The importance of early recognition of the signs and symptoms to prevent transmissionFootnote 4
- Abstaining from sexual activity during symptomatic periods (from prodrome to re-epithelialization) can reduce the risk of herpes transmission and acquisition over timeFootnote 5
- Consistent and correct use of barrier protection
- Condoms can reduce, but not eliminate the risk of HSV transmission or acquisitionFootnote 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 lesionsFootnote 5
- Suppressive antiviral therapy
- Daily suppressive antiviral therapy can significantly reduce the risk of sexual transmission of HSV when taken consistentlyFootnote 7
- In those with HIV, daily suppressive therapy for HSV may not reduce the risk of HSV transmissionFootnote 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 damsFootnote 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 36th 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
- Footnote 1
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Mertz GJ, Benedetti J, Ashley R, Selke SA, Corey L. Risk factors for the sexual transmission of genital herpes. Ann Intern Med. 1992;116(3):197-202.
- Footnote 2
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Engelberg R, Carrell D, Krantz E, Corey L, Wald A. Natural history of genital herpes simplex virus type 1 infection. Sex Transm Dis. 2003;30(2):174-177.
- Footnote 3
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Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015 Aug 28;64(33):924]. MMWR Recomm Rep. 2015;64(RR-03):1-137.
- Footnote 4
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Corey L, Handsfield HH. Genital herpes and public health: addressing a global problem. JAMA. 2000;283(6):791-794.
- Footnote 5
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Wald A, Langenberg AG, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA. 2001;285(24):3100-3106.
- Footnote 6
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Martin ET, Krantz E, Gottlieb SL, et al. A pooled analysis of the effect of condoms in preventing HSV-2 acquisition [published correction appears in Arch Intern Med. 2010 Jun 14;170(11):929]. Arch Intern Med. 2009;169(13):1233-1240.
- Footnote 7
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Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med. 2004;350(1):11-20.
- Footnote 8
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Smith CR, Pogany L, Auguste U, Steben M, Lau TTY. Does suppressive antiviral therapy for herpes simplex virus prevent transmission in an HIV-positive population? A systematic review. Can Commun Dis Rep. 2016;42(2):37-44.
- Footnote 9
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Wald A, Langenberg AG, Krantz E, Douglas JM, Handsfield HH, DiCarlo RP, et al. The relationship between condom use and herpes simplex virus acquisition. Ann Intern Med 2005;143(10):707-713.
- Footnote 10
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Sheffield JS, Hill JB, Hollier LM, et al. Valacyclovir prophylaxis to prevent recurrent herpes at delivery: a randomized clinical trial [published correction appears in Obstet Gynecol. 2006 Sep;108(3 Pt 1):695]. Obstet Gynecol. 2006;108(1):141-147.
- Footnote 11
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Sheffield JS, Hollier LM, Hill JB, Stuart GS, Wendel GD. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. Obstet Gynecol. 2003;102(6):1396-1403.
- Footnote 12
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Watts DH, Brown ZA, Money D, et al. A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery. Am J Obstet Gynecol. 2003;188(3):836-843.
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