My husband has herpes. He's trying really hard not to give it to me. Will he always know in advance when he's going to get an outbreak? If yes, then we will avoid having intercourse when he's having it. Is there anything else we can do to prevent him passing the disease to me? Is there any hope for a permanent cure?

L.

Herpes is an infection caused by one of two viruses, herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). Generally, HSV-1 causes sores in the mouth, and HSV-2 causes genital disease, but the reverse is sometimes true as well.

Genital herpes causes two types of illness, primary infection and recurrent disease. Primary infection occurs soon after exposure and can have severe symptoms. Itchy, painful blisters (vesicles) appear on the genital area and break open to form ulcers. Some people also have fever, headache, general discomfort and other signs of illness. This stage of illness goes away on its own, usually within about two weeks.

Unfortunately, the herpes virus stays in the body forever. It hides out in the nerves, where it evades destruction by the body's infection-fighting immune system. The virus can reactivate in the future, causing symptoms that are similar to the initial infection but milder. Some people can tell when a recurrence is coming, because they feel tingling and burning a day or two before the lesions appear.

Genital herpes is usually acquired by intercourse, but any direct contact can allow spread. For example, performing oral sex on someone with genital herpes can result in oral herpes in the partner. Spread is most common when there are active lesions, but it can occur at other times. The virus can be shed from the skin for quite a while, weeks even, after the lesions are all healed. Virus can sometimes be detected with lab tests even when there have never been any lesions. Because of that, some people can carry the virus and pass it to others without even knowing they were ever infected.

How can you avoid catching herpes? Unfortunately, your husband will not always know when an outbreak is coming and he is contagious. Using condoms should help minimize the risk of spread, but they are not 100 percent effective. Since abstinence is probably not an option, you may choose to use condoms and hope for the best.

I am sure that is not the answer you were looking for, but there is one other option. People who get frequent recurrences may benefit from an antiviral medicine such as acyclovir (Zovirax), famciclovir, or valacyclovir. These drugs are not 100 percent effective at stopping recurrences, but they are pretty good. They also decrease shedding of the virus, which we presume will decrease the risk of spread. Your husband should talk to his doctor to see if one of these medicines is an option for him. Currently there is no cure for herpes, but there are some companies working on vaccines that may help prevent the disease.