Genital herpes simplex virus type 1 (HSV-1) infection: Recurrence rates? Risk to future children?

Dear Scared and Hopeless,

Finding out that you have herpes can be a worrying experience, especially if you're unsure how this may affect your sex life and capacity to have a healthy child. Generally, for people with herpes simplex virus type I (HSV-1), there is a risk of transmission to future sexual partners through oral, vaginal, and anal sex — even if the infection is asymptomatic. However, the likelihood of transmission to newborns rare. That said, since herpes manifests in and affects people differently, it’s difficult to predict what your experience might be. While transmission rates are lower when there isn’t an active outbreak, using barrier methods (such as condoms or dental dams) and open communication can help ensure that the infection isn’t transmitted between partners.

When it comes to genital herpes, it may be nerve-wracking to anticipate when and how often you’ll have flare-ups. For many people with genital herpes, their first outbreak tends to be their sole major episode. After that, the number of episodes may diminish over time depending on the strength of their immune systems, where the herpes simplex virus resides within their body, and if they’re infected with genital HSV-1 or herpes simplex virus type 2 (HSV-2). Typically, people infected with genital HSV-1 experience fewer recurring episodes (roughly one per year), compared to people infected with HSV-2 who experience roughly four episodes per year. That being said, it can’t be determined for certain exactly how many episodes you’ll have.

It might also be worrying to consider what a herpes infection may mean if you’re considering having children. The good news is that herpes infections in newborn infants are rare. Yet, when they do occur, they can cause serious health consequences for the infant, including higher risk of preterm labor, low birth weight, greater occurrences of sickness, and a higher risk for premature death. If the partner carrying the child already has herpes, the child is at lower risk of developing herpes since the antibodies that fight against herpes will be shared with the baby. On the other hand, if the person carrying the baby contracts herpes during the pregnancy, the baby is more likely to become infected with neonatal herpes. That being said, there are steps folks can take to protect their unborn child in both instances, such as meeting with health care providers to carefully monitor herpes during the pregnancy, taking suppressive therapy if appropriate (more on this in a bit), and using safer sex practices to prevent transmission. Additionally, asking the health care provider to take special measures during birth such as performing a caesarian section (C-section) or using tools that won’t perforate the baby’s skin can help reduce the risk of the virus being transmitted.

While there is no cure for herpes, suppressive therapy may help reduce the risk of herpes transmission to partners and potential children. Some medications include acyclovir, famciclovir, or valacyclovir. The efficacy of each medication may vary depending on whether it’s the first outbreak or subsequent outbreaks, so the therapy prescribed will be dependent on the type of outbreak being experienced.

Since you know your herpes status, you can take proactive steps to prevent transmission to your partner(s) and potential future children. With these steps, you may still have satisfying and intimate relationships with other people, healthy pregnancies, and children. Rather than feeling that condoms limit pleasure, they can be incorporated to increase pleasure. By exploring different types of lubes and condoms, you can find the kinds that make sex more fun. Not only that, using barrier methods can also make sex more enjoyable as you can focus on pleasure rather than worrying as much about transmission risks. You may also find it helpful to think about how to have conversations with future partners about your herpes infections and how you can work together to reduce risks of transmission while maximizing pleasure.

For a more personalized approach on how to move forward, it might be helpful to speak with your health care provider about ways to manage your herpes and prevent transmission to others. Until then, it’s best to use barrier methods with your partners. Additionally, you can learn more about herpes in the Herpes category of the Go Ask Alice! Sexual and Reproductive Health archives.