HSV Transmission Counselling — SCE Infectious Diseases MCQ

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EasySTIsHSV Transmission CounsellingSCE Infectious Diseases

A 35-year-old man with HIV (CD4 520, VL <50 on ART) develops a first episode of genital herpes (HSV-2 confirmed). He asks about the risk of transmitting HSV to his HIV-negative partner. What counselling should be provided?

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Correct answer: A — HSV shedding occurs even between outbreaks (asymptomatic shedding); condoms reduce but do not eliminate transmission; daily suppressive Valaciclovir reduces transmission by ~50%; disclosure to partners is essential

Genital HSV-2 is shed asymptomatically on ~10–20% of days, accounting for the majority of transmission events. Suppressive antiviral therapy (Valaciclovir 500 mg daily) reduces both symptomatic recurrences (by 70–80%) and asymptomatic shedding/transmission (by ~50%). Condoms provide ~30% additional reduction. The combination of suppressive therapy plus condoms provides the best protection but does not eliminate risk. Disclosure to sexual partners, education about prodromal symptoms (tingling, itching before outbreak), and counselling about the high prevalence of HSV-2 (15–25% of UK adults) are important.

Reference: BASHH 2014 – Genital herpes; NICE CKS 2024 – Genital herpes counselling