Primary prevention
To reduce the risk of spreading HSV infection to others, it is important to avoid sexual contact when lesions are present.
Consistent condom use decreases the risk of HSV-2 acquisition compared with no condom use, with 96% reduction in per-act-risk of transmission from men to women.[28][29][30] Because HSV is spread by skin or genital contact, all potential areas of viral shedding are not covered by condoms. This is thought to explain why condoms are not more effective in preventing HSV transmission. Although the chance of spreading disease is greatest when lesions are present, the virus can become active and be transmitted to a sexual partner even when the skin appears completely normal. For this reason, preventive measures (e.g., sex with a condom, regular medical checks for STIs, limiting the number of sexual partners, and cleaning sex toys between use) should be used between disease outbreaks to lessen the chance of spreading disease to a sexual partner. Circumcision may reduce the risk of HSV infection in men who have sex with men.[31] Circumcision of adolescent and adult males was associated with a 25% reduction in incident HSV-2 infection in one randomized trial.[32] Male circumcision does not appear to affect transmission of HSV-2 to female partners.[33]
Mothers with HSV may continue to breast-feed if no lesions are present on the breasts and if lesions elsewhere on the body are fully covered. If active lesions are present on the breast, the mother should temporarily stop breast-feeding from the affected breast and should not feed expressed milk from the affected breast. Appropriate hand hygiene should be followed before holding the infant.[34]
Secondary prevention
Antiviral medications are effective at shortening the duration and decreasing the severity of outbreaks and are most effective when given at the first symptom of an outbreak. Suppressive doses of antiviral medication can be taken to prevent episodic disease and improve quality of life. In addition, suppressive antiviral therapy is associated with a 48% decrease in transmission to susceptible partners in monogamous, heterosexual relationships.[24] Suppressive doses of antiviral medications can be taken to prevent episodic disease, prevent transmission, and improve quality of life. Because herpes is incurable, prevention is key.
Herpes labialis also has a variable clinical course, and outbreaks can be treated and suppressed by antiviral medications.[89][90] During an outbreak or prodrome, patients should avoid oral contact with others, including kissing, oral sex, and sharing food and utensils. Oral HSV-1 can also be transmitted during asymptomatic shedding.
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