How can I counsel patients on the risk of transmission of genital herpes to their partners?

When counseling patients about the risk of transmitting genital herpes to their sexual partners, it is important to advise them on measures to minimise infection transmission ¹.

Patients should be counselled to abstain from all sexual activity, including non-penetrative and oro-genital sex, if they have visible lesions or experience prodromal symptoms, until the lesions have completely cleared ¹. It is crucial to explain that transmission can occur even when there are no symptoms, a process known as 'asymptomatic shedding', although the risk is higher when a person is symptomatic ¹.

Regarding barrier methods, advise that when used consistently and correctly, male condoms may reduce the risk of future transmission, but they cannot prevent it completely ¹. Transmission is still possible through close skin contact or contact with infected secretions during foreplay ¹.

Patients can be reassured that a first episode of genital herpes does not necessarily indicate a recent infection, as transmission can occur from an asymptomatic partner years into a monogamous relationship ¹. Additionally, herpes simplex virus type 1 (HSV-1) infection may have spread from other body areas, such as the lips or fingers ¹. Educational interventions are important for the prevention of herpes simplex virus transmission (Patel, 2004).

Partner notification is a key aspect of counselling. Patients diagnosed with a sexually transmitted infection (STI) should be advised about the importance and benefits of partner notification, understanding that sex partners may be infected even if asymptomatic, and the risk of reinfection ². Encourage them to engage in partner notification and discuss various methods to help them decide how to inform their partners ². If a patient feels unable to tell their sex partners or is struggling with their diagnosis, they should be referred to specialist sexual health services for more support with partner notification ². Professionals with expertise in contact tracing and counselling should carry out partner notification on behalf of a person with an STI ².

For patients with genital herpes who have a new or not knowingly infected sexual partner, HSV screening (for example, using HSV type-specific serology) may be appropriate to assess the risk of HSV acquisition, depending on specialist advice ¹.

Special consideration is needed for pregnant partners: there is a risk of neonatal transmission if a pregnant woman has a first episode of genital herpes, particularly in the third trimester ¹. Consistent use of condoms is advised for any sexual partner who is pregnant and seronegative, especially in the third trimester, to reduce the risk of transmission ¹. While the risk of neonatal transmission is low with recurrent episodes, even if lesions are present at delivery, pregnant women should inform a healthcare professional immediately if they are or become pregnant ¹.