[ICYMI] ASK DR. HISAM: Dealing with Genital Herpes

July 11, 2019

by Dr. Hisam Goueli

Dr. Hisam,

I'm a 57-year-old gay man in an open relationship. I'm HIV negative. But I have genital herpes. How do I not transmit anal warts during anal intercourse? —Unsure

Dear Unsure,

I am happy to hear from you! All right, to your question. To start, I am assuming that you are confident about the diagnosis and it was made by a medical professional. Herpes is just one of many things that can cause painful ulcerations, and I would hate to give you the wrong information.

In general, when discussing transmission to partners, we tell patients to limit the number of sexual partners and use a condom with each sexual encounter. This is probably stuff you have already heard.

Although condoms are effective in decreasing transmission, infection can still be spread from skin-to-skin contact in areas not protected by a condom. This eventually led the Europeans to develop full-body latex underwear to limit the transmission. A good kink but not super practical.

Interestingly, avoiding sexual intercourse during outbreaks does not prevent herpes transmission. Yeah, I found that crazy too! The majority—about 70%—of herpes simplexvirus (HSV) transmissions happen when people are not symptomatic.

You can reduce asymptomatic viral shedding by 90% with medications. There are several options, which all end in "-cyclovir." The one that I typically prescribe—provided you have fewer than 10 outbreaks per year—is valacyclovir 500mg daily by mouth. If you have more than 10 outbreaks per year, acyclovir 400mg twice per day is a reasonable choice.

To summarize, good sexual health practices include condom use and regular STI visits, as well as open communication. Using a medication to suppress shedding is also super reasonable and common.

I hope you find this helpful, and thanks for writing!


Got a Question for Dr. Hisam? Please email him drhisamg@gmail.com 

Dr. Hisam Goueli is a Seattle based, board certified, psychiatrist and is  affiliated with multiple hospitals in the area, He received his medical degree from University of Wisconsin School of Medicine and Public Health. Dr. Hisam, born in Minneapolis to Egyptian immigrants, married his Peruvian partner, Roberto in 2012.

As a disclaimer, the information on this site is for informational purposes only and is not intended to serve as a substitute for consultation with your own doctor. Dr. Hisam does not have a legal duty to you.