Is There Any Benefit to Treating Herpes When Someone Has No Symptoms?

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You may wonder if there's any benefit to treating your herpes if you rarely or never have symptoms. Is suppressive therapy worth it if you're not using it to prevent outbreaks?

Why Suppressive Therapy May Be Beneficial

Even if you don't ever have herpes outbreaks, there may be some benefit to using daily suppressive therapy. This is because even if you've never had a recognizable outbreak, you can still transmit the virus to your partner.

Some people think they can only transmit herpes to their partner if they have an outbreak, or in the prodromal periods immediately before an outbreak. They're wrong. Genital herpes can be transmitted at any time. This is why some individuals who have multiple sexual partners may decide to use suppressive therapy against the herpes simplex virus (HSV). People whose partners are not infected with the herpes virus may choose to do so as well, even though they don't have any symptoms.

Herpes Can Be Spread Any Time

Remember, herpes can be transmitted at any time. However, people with herpes are not equally infectious at all times. In general, you're most infectious during an outbreak. You're also highly infectious in the periods immediately before and after an outbreak. Finally, you're most infectious in the first year after you're infected. However, you can still transmit the virus at other times, even if you haven't had an outbreak in years.

It's not just about being infectious when outbreaks aren't present. Some people don't even know they're having an outbreak because the symptoms are so minor or asymptomatic (no symptoms). And again, you can be shedding the virus even when you have absolutely no signs of herpes.

Suppressive Therapy Can Help Prevent Asymptomatic Transmission

Unfortunately, many patients and many physicians are unaware of the risk of asymptomatic transmission of herpes.

Fortunately, suppressive treatment can be very effective in preventing it. You may just need to update your doctor on that news. 

If you're living with herpes and have one or more uninfected sexual partners, consider discussing the possible advantages of daily suppressive therapy with your doctor. Condoms aren't 100 percent effective at preventing the spread of herpes since it's transmitted from skin to skin. If needed, remind your doctor that many new herpes infections are acquired from people who have no symptoms at the time of transmission. Then let your doctor know that suppressive therapy has been shown to reduce the likelihood of transmission by half or more. If you have frequent outbreaks, suppressive therapy lessens them by 70 to 80 percent. In other words, for many people, it's a very good idea.

A Word From Verywell

Suppressive therapy isn't 100 percent effective at eliminating asymptomatic shedding. This is particularly true for people with frequent outbreaks. As such, suppressive therapy is no substitute for condom use. However, using medication and safe sex together may be the best way to protect your partner from your genital herpes infection.

Sources:

Centers for Disease Control and Prevention (CDC). Genital HSV Infections. Updated June 8, 2015.

Johnston C, Corey L. Current Concepts for Genital Herpes Simplex Virus Infection: Diagnostics and Pathogenesis of Genital Tract Shedding. Clinical Microbiology Reviews. January 2016;29(1):149-161. doi:10.1128/CMR.00043-15.

Johnston C, Saracino M, Kuntz S, et al. Ineffectiveness of daily standard and high-dose antiviral therapy in preventing short episodes of genital HSV-2 reactivation: three randomized, open-label cross-over trialsLancet. 2012;379(9816):641-647. doi:10.1016/S0140-6736(11)61750-9.

Romanowski B, Zdanowicz YM, Owens ST. In search of optimal genital herpes management and standard of care (INSIGHTS): doctors' and patients' perceptions of genital herpes. Sex Transm Infect. 2008 Feb;84(1):51-6.

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