How can males with genital herpes start a family safely?

In my clinical practice, I have come across quite a number of patients who become extremely worried and anxious after being diagnosed with herpes infection. Oftentimes, the anxiety is fuelled by misinformation.

Genital herpes is caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2)

The CDC reports that about 776,000 Americans contract genital herpes each year. The virus is more easily passed from men to women than women to men. The infection is transmitted through lesions (wounds or ulcers in the skin) on surfaces lined with mucus or genital or oral secretions. Transmission often occurs when an infected person who is asymptomatic unknowingly passes the virus. In fact, almost 90% of people who are infected have either no symptoms or such mild symptoms that they do not know they are carriers.

Diagnosing and treating herpes

Genital herpes is diagnosed through various types of tests that vary in accuracy; it is best to consult with a physician knowledgeable with sexually transmitted infections. It is possible to have a false negative, which is yet another reason why protection is always important when engaging in sex; a person can also pass along the infection even if there is no visible evidence that it is active.

There is no cure nor vaccine for herpes, but it can usually be managed with the use of antiviral medications. Partners can also agree to get tested for infection before they begin having sex. The herpes blisters can be uncomfortable. They can be treated with topical ointments or oral medication and usually clear up completely in five to seven days.

It is important to avoid sexual contact until a week after the lesions disappear. Asymptomatic shedding of the virus may occur and hence there is a subsequent risk of transmission. Asymptomatic shedding tends to occur during the first year, the risks are much lesser over time. Although chronic psychological morbidity may have an adverse effect, acute anxiety situations and everyday stresses do not increase recurrences.

Symptoms of herpes

When symptoms do appear, it is usually in the form of a painful ulcer or sore on or around the genitals or mouth. Initially, the ulcers are often accompanied by body aches, headaches, fever, and swollen lymph nodes. After the ulcers open, they usually take 2 to 4 weeks to heal. Each time the ulcers appear, it is called an “episode”; episodes are generally more frequent in the first year after being infected and gradually taper off. Many people have prodromal symptoms before an episode that may include shooting pain in the buttocks or legs or tingling at the ulcer site. Herpes can lie dormant for long periods of time, only to break out in blister-like lesions on the penis, especially during periods of stress, exhaustion, or illness. Symptoms might also include:

• fever,
• headache,
• a burning sensation while urinating,
• and discharge.

When the blisters appear, the infection is highly contagious.

Having genital herpes puts a person at a two-to four-fold increase of risk for contracting HIV. Genital herpes is particularly dangerous in pregnant women, as it can be passed as a potentially fatal infection to the newborn at any time during gestation or delivery.

I presume your concern is the spread of herpes to the newborn - a condition called neonatal herpes. This is a rare but serious, and potentially fatal, condition.

It occurs when the genital herpes virus (HSV-2) is present in the birth canal when the baby is passing through it during delivery. Neonatal herpes can cause permanent damage to the baby’s central nervous system, mental retardation and death from overwhelming infection.

It is important to note that while genital herpes is common in men and women - (25-30% of pregnant women in the USA have genital herpes), that the incidence of neonatal herpes is only 0.1% - meaning most women with herpes give birth to healthy babies. This is because the women have antibodies to the virus, and pass this natural immunity to their babies.

The danger is when women are newly infected with herpes late in pregnancy. They do not have time to acquire the antibodies against the virus and pass on this temporary natural immunity to the baby. Furthermore, new infections tend to be more active with a higher chance of being active in the birth canal during delivery.

The steps for a man with genital herpes to start a family safely is:

• Ask your partner to be tested for genital herpes - this can be done by a blood test. If your partner does not have herpes - then you can reduce the risk of transmission of herpes to your partner by avoiding sex when you have active sores, and discuss with your doctor using suppressive therapy to reduce your viral load when having sex to conceive.
• If your partner has genital herpes - the risk of transmission to the baby is low. Her obstetrician should be informed. The doctor will then monitor your partner for active herpes during labour. If there are signs of active herpes in the birth canal, the doctor will then recommend Caesarian section to prevent contact of the baby with active herpes sores in the birth canal.

In summary, genital herpes is a common condition. There should be no shame or stigma of having it. Open discussion with your partner and your doctors will help with starting your family safely.