Australian Herpes Management Forum

Herpes: What does it mean for partners?

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Dr Chris Miller

It’s common for one person in a couple to have genital herpes, and the other to have no symptoms. Some of the questions that come up in this situation are:

• How can the couple reduce the chance of passing the herpes virus from one partner to another?
• Does the person with no symptoms of herpes actually carry the virus without knowing it?

When one partner carries the herpes virus and the other partner doesn’t, the couple is said to be serodiscordant.

HSV serology: the herpes blood test

A blood test for signs of the herpes virus can help couples decide what to do next if one partner has genital herpes and the other doesn’t. This blood test is known as type-specific herpes serology.

It detects antibodies—proteins made by your immune system. If you have ever been infected with either of the herpes simplex viruses (the cause of genital herpes and cold sores) you will always have the antibodies in your blood. Even if you have never had an outbreak of genital herpes or cold sores, the antibodies will be present.

HSV-1 and HSV-2

Herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2) are the viruses that cause genital herpes and cold sores.

• HSV-2 is the most common cause of genital herpes. About 12 per cent of Australians carry this virus.
• HSV-1 is the most common cause of cold sores, but about 35 per cent of cases of genital herpes are caused by this virus. Usually, genital herpes caused by HSV-1 is less severe with fewer outbreaks than with HSV-2. About 76 per cent of Australians carry HSV-1.

What the test can tell you

Herpes serology can tell whether you are carrying the HSV-1 or HSV-2 antibodies.

If the result is positive, it means that antibodies to HSV-1 and/or HSV-2 were detected. In other words, it confirms that the person is carrying the HSV-1 and/or HSV-2 virus and could therefore develop genital or cold sores. It also means that the person might be able to pass on the virus (or viruses) to others.

If the result is negative for both HSV-1 and HSV-2, it means that the person has never been infected with either of these viruses. If their partner has genital herpes or cold sores, or has positive HSV-1 or HSV-2 serology, then they are potentially at risk of getting the virus.

What the test can’t tell you

If the result of HSV serology is positive, it only means that you are carrying the herpes virus.

Because the virus often causes no symptoms, the test can’t tell you if you will get outbreaks of genital herpes or cold sores. If you have a sore, blister or rash which you think might be due to genital herpes, the best test is for a health professional to take a swab from the sore.

Positive herpes serology can’t tell you exactly when you caught the virus, unless it was very recent. It can’t tell you who passed the virus on to you, or how high the risk that you will pass it to someone else.

Discordant results

You are a serodiscordant couple if:

• One partner has a positive result for HSV-1 and/or HSV-2 antibodies, and
• The other partner has a negative result for the antibodies carried by the first partner

This means there is a risk of one partner passing on the infection to the other.

If the second partner is negative for both HSV-1 and HSV-2, there is a higher risk that they will develop more serious symptoms (of genital herpes or cold sores) if either HSV-1 or HSV-2 is transmitted. This is because if they already have one type of HSV antibody, it provides some protection if the pick up the other strain of HSV. People with neither type of HSV antibody don’t have this protection.

What next?

If you are not serodiscordant

If you are not serodiscordant (i.e. in one of the green boxes in the table above), it means either:

• Neither of you has the virus, or
• Both of you have the virus

In both cases, there’s no risk of passing it from one to the other. As a couple, you will not have to take any special action to prevent HSV transmission.

If you are serodiscordant

If your results are in one of the red boxes in the table, you are a serodiscordant couple and the negative partner is at risk of getting herpes from the positive partner.

There are several possible courses of action. You should discuss which will work best for you. It can be helpful to involve a health professional such as a GP, sexual health nurse or counsellor in this discussion, although the final decision is up to you.

Possible strategies include:

• Reduce the transmission risk only when the partner with the virus is most likely to be infectious, i.e. during outbreaks of genital herpes or cold sores
• Reduce the transmission risk only when the partner without herpes is at risk of serious problems, for example if the partner without herpes is pregnant or has immune system problems such as HIV/AIDS
• Reduce the transmission risk at all times.

Different strategies may be suitable at different times. You may need to discuss this from time to time to make sure that you are both satisfied that you are doing the right thing.

Techniques

Some of the possible ways of reducing the risk of transmitting the infection include:

• Avoid intercourse, oral sex or kissing during outbreaks of herpes or cold sores
• The partner with herpes can take antiviral medication such as valaciclovir at all times to reduce the risk of shedding the virus
• Use condoms to reduce skin-to-skin contact. This method will work to prevent herpes transmission to or from the area covered by the condom. It will not prevent transmission caused by skin-to-skin contact with other areas.

The Australian Herpes Management Forum

The Australian Herpes Management Forum is a group of medical experts that provides resources and information about the herpes group of viruses and the conditions they cause. These include genital herpes, shingles, chickenpox, glandular fever and cold sores. If you are concerned about herpes or think that you may have come into contact with someone that has herpes, please see a doctor.

  

More information about herpes

Genital Herpes Essential Facts Herpes Myths... Debunked Herpes Transmission and Safe Sex Herpes Treatments Testing for Herpes Non-sexual transmission of herpes What does it mean for partners? Herpes & Pregnancy Herpetic Dermatitis & Whitlow

 

Where can I go for help?

To find a public sexual health clinic near you, see the Register of Public Sexual Health Clinics (published by the Australasian Chapter of Sexual Health Medicine)