I searched your Archives, but found nothing. Do you have up-to-date information on the recurrence rates of Herpes Type I on the genitals? And since this is what has happened to me, and given that the virus can be passed asymptomically, am I doomed to sex with condoms for the rest of my life? What if I have children one day?

Scared and Hopeless

Dear Scared and Hopeless,

With genital Herpes Type I (milder than Type II, but typically the same), there is usually one major episode (the first outbreak), then few to many recurrent episodes, or none at all. This may be due to the site preference of the virus, and also a person's immune system. However, how this has been, or will be, affecting you may be another story, since each of us is unique and the virus affects everyone differently.

No, you are not doomed to use condoms for the rest of your life. Often we find that the number of herpes episodes diminishes over time. As for transmitting the virus when you have no symptoms, it is possible (read archived Alice Testing for Asymptomatic Herpes and Herpes from a tanning bed? for more information). Clearly, additional research is needed in this area. In the meantime, protecting yourself and your partner with condoms and good judgment (because herpes sores and viral shedding can have more sites than the penis or vagina) when you do have a herpes outbreak, is important.

Alice can sense your anxiety regarding how herpes may impact your future parenthood, and your concern is not without reason. Neonatal infection with herpes can be serious, but neonatal infection is a rare problem in and of itself. Questions about herpes and pregnancy are in flux, so the answers may be different when you are ready to conceive. Within a few years, the risk for infection will be better understood after being re-evaluated.

For now, at least you've got one thing on your side -- you already know that you have herpes. This is important because with this in mind, you can prepare for a pregnancy, following the necessary precautions, in order to reduce the risk of neonatal infection. Health care providers carefully monitor pregnant women with herpes throughout their pregnancy, especially during the last 3 - 4 weeks. If the mother has a primary outbreak during pregnancy, which is quite unlikely, the baby has a fairly high chance of becoming infected. A more likely situation is if the mother experiences an active recurrent outbreak at or near the time of labor and delivery. In this case, there is still a chance of neonatal infection, but it does not carry as high of a risk. Medical providers would perform a Caesarean section to help protect the baby (although babies can still be infected via C-section delivery). A C-section may also be advised in the event a woman has had any outbreaks in the month preceding labor.

Family planning can be tricky if the man has herpes and the woman doesn't. It's best to try to conceive when the man does not have an outbreak. However, a risk for transmission to the woman remains a possibility, particularly because of asymptomatic shedding.

This information may seem intimidating and discouraging, but it doesn't mean that you will never be able to have satisfying intimate relations with other people, or even have healthy pregnancies. Couples come to different kinds of peace with this and rarely feel this way later on. Alice knows several women and men with herpes who have had several partners, have gotten married, and/or have had healthy children, some by C-section and some by vaginal delivery.

For more information, Alice highly recommends Charles Ebel's book, Managing Herpes: How to Live and Love with a Chronic STD, from the Herpes Resource Center of the American Social Health Association. You can also try the following hotlines and websites:

National Herpes Hotline
Herpes Resource Center
American Social Health Association

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