Having sex with herpes: how to have a healthy sex life

Poor media representation, moral panic, and insensitive jokes have shrouded genital herpes in stigma. While a genital herpes diagnosis can be burdensome, it doesn’t signify the end of your sex life. In fact, genital herpes is extremely common, and you can continue to have safe, fulfilling partnered sex following a diagnosis–sex with herpes is safe for you and your partner(s) as long as you take the proper precautions and treatments. Continue reading to learn more about having safe sex with herpes.

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Before we dive into how to have a healthy sex life with herpes, know that if you have a herpes infection, you are far from alone. 

Herpes is caused by the herpes simplex virus (HSV), which is categorized into two types: HSV-1, which typically causes cold sores outside the mouth and lips, and HSV-2, which is a sexually transmitted infection (STI) that causes genital herpes. While HSV-1 is most commonly transmitted orally, it can also be spread during sex and lead to genital herpes.

HSV is very prevalent in the United States–approximately 40 to 50 million adults in the US live with genital herpes. Seems a bit silly to stigmatize an infection experienced by that many adults, doesn’t it? An estimated 572,000 new genital herpes infections occurred in 2018 for people aged 14 to 49, and worldwide, over 491 million people are infected with HSV-2.

There is no cure for HSV, but treatments are available to reduce your symptoms (more on this to come). Sex with herpes can be safe and satisfying if you are honest with your sexual partners and take precautions to prevent the spread of infection. This means that it’s very important to understand how herpes is spread in the first place.

How is herpes spread?

Genital herpes spreads through skin-to-skin contact with someone who has a herpes infection, either by touching their herpes sores or the skin in the genital area, or by coming into contact with body fluids (saliva, semen, vaginal discharge, etc.). 

Oral herpes caused by HSV-1 can also be spread from the mouth to the genitals (from a person’s skin or their saliva during oral sex).

What happens during a herpes outbreak?

The initial herpes outbreak typically lasts about two to four weeks. Symptoms of a herpes outbreak include:

• Painful lesions or small blisters around the genitals, rectum, or mouth

• Fever

• Body aches

• Headache

• Swollen lymph nodes

Recurrence of herpes outbreaks is common and may happen several times a year. However, symptoms during a recurrence tend not to last as long or be as severe as the initial outbreak.  

You should not have sex during an active herpes outbreak because you are more contagious and likely to spread the infection to your partner. 

What if I don’t have any herpes symptoms?

Most people with a herpes infection are asymptomatic and don’t know they have it. Others might have mild symptoms that can be easily confused with other skin conditions. 

Even if you don’t have active symptoms, there is still a risk of transmission. Studies have shown that over 10% of people with an asymptomatic HSV-2 infection had genital shedding (when the virus continues to make particles that can be spread to others), compared with around 20% of those with symptoms.

This is why being transparent and communicative with your sexual partners is necessary. Just because you can’t see the virus, that doesn’t mean it’s not there and that they can’t contract it. 

Telling your sexual partner that you have herpes can be difficult. Rest assured, there is no reason to be ashamed. A herpes infection can happen to anyone and is not a result of reckless behavior or a lack of cleanliness. 

While a conversation about herpes can be awkward, being honest with your partner is the best way to maintain a healthy sexual relationship. Be prepared to share facts and explain how you manage the virus to help put your partner at ease. 

A few conversation starters can include:

• What type of herpes you have (oral herpes vs. genital herpes)

• How the virus is spread

• Ways to prevent infection (condoms and medication)

• When to abstain from sex (during active outbreaks)

When and where you disclose your herpes diagnosis should be considered as well. For example, telling your partner immediately before having sex is not a good idea–this doesn’t give your partner adequate time to make their own decisions about how they’d like to proceed, and can make them feel pressured. Creating time and space to talk about it can help both of you feel safe and supported. 

Additionally, getting tested for sexually transmitted diseases (STDs) with your sexual partner can build trust and connection. STD testing is done at a healthcare provider’s office or a community clinic, and it involves a quick blood test, urine sample, or swab culture. 

You may be surprised to learn that many standard STI/STD panels do not screen for herpes. In July 2019, the US Preventive Services Task Force (USPSTF) upheld findings from 2005 that recommended against routine screening for HSV in asymptomatic adolescents and adults, including pregnant people. Why? The task force found no evidence that routine screening of patients without symptoms improves health outcomes, symptoms, or reduces transmission of the infection. 

To understand how herpes is detected, it’s important to understand the difference between screening and testing for herpes. Screening is done when a person has no symptoms (just to see if they’ve been exposed), and testing is done when a person does have symptoms. If a person does have symptoms of herpes, the virus can be detected in two ways: in lesions (blisters) or by antibodies in the blood.

With honesty, good communication, and the knowledge to manage and prevent spreading the infection, a healthy sex life with herpes can be a reality. 

Healthcare providers and public health experts have outlined ways to have safer sex and prevent the spread of herpes with various treatment options.

1. Don’t have sex during a herpes outbreak

The number one rule for someone with an HSV infection is never to have sex while having an active herpes outbreak. The virus is highly contagious and will likely infect your sexual partner. This includes vaginal, anal, and oral sex. 

2. Try herpes medications

Taking antiviral medication, such as valacyclovir or acyclovir, may reduce the rate of herpes transmission during sex and lower the recurrence rate. While antiviral medication does not cure HSV, it does relieve pain and itching and helps sores heal faster.

Herpes medication can be used to treat an outbreak or to prevent recurrences. Suppressive therapy is herpes antiviral medication taken daily, and continuously, to prevent flare-ups. It works by stopping the virus from multiplying and spreading to healthy cells.  

Side effects of valacyclovir may include:

• Upset stomach

• Vomiting

• Headache 

• Diarrhea/ loose stools

• Constipation

3. Use protection

Condom use is a great way to prevent STIs, including herpes. While they don’t eliminate the risk of transmission, condoms and dental dams make a difference. 

A study on condom use to slow the spread of HSV-1 and HSV-2 found that condoms were 96% protective against HSV transmission from men to women and 65% effective at preventing transmission from women to men.

Having unprotected sex (without a condom), even with a dormant herpes infection, can increase your partner’s risk of infection. Wearing a condom during oral, anal, and vaginal sex promotes sexual health and safety. 

4. Get creative with sex

There are plenty of ways to have sex that don’t involve direct contact with a partner’s genitals or bodily fluids. If you’re looking to explore new and creative ways to get sexy, mutual masturbation is a great place to start. You can masturbate facing each other for a full-frontal view, lying side by side, or back to back as you describe the sensations you feel to your partner. You might also want to use vibrators or other toys on each other–just make sure you use body-safe toys with nonporous material like medical-grade silicone. Many dildos and vibrators can even be used with condoms over them for more protection! 

Sex is certainly more expansive than penetrative intercourse, so during outbreaks or with sexual partners who prefer not to make direct contact, use this opportunity to have fun. 

The herpes simplex virus is a widespread STI. You should not be ashamed if you develop an infection. It’s possible to have safe and fulfilling sex with herpes—as long as you take the proper precautions.

Remember to abstain from sex during an active outbreak, use condoms and dental dams for protection, and consider taking herpes antiviral medications to prevent the spread of infection to your sexual partner or partners. Being honest with your partner about your infection and keeping the lines of communication open can build trust and help create a healthy, active sex life.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

November 08, 2023

Written by

Amy Isler

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.