The odds of getting herpes
"What are my odds of getting an infection?" This is the most common question we hear in our practice.
In this section, we summarize herpes statistics answering that question and many other related questions regarding herpes transmission:
- With and without protection
- While symptomatic versus while asymptomatic
- And the difference between the two types, HSV-1 and HSV-2
Statistics are one of the most important parts of medicine and doctors rely heavily on statistics for early diagnosis and treatment. They tell doctors how common a condition is in general, how easy it is to get an infection through a one-time contact or through multiple contacts, the chance of contracting the infection in different ways, and many other things.
First, we present tables statistical information. This is followed by FAQ answered by an expert STD physician.
Let's dive in.
All you need to know about herpes testing. By STD expert.
Symptomatic versus asymptomatic herpes transmission
This table summarizes the chance of transmission of herpes when a person is symptomatic (that is, when a herpes-positive individual has symptoms and signs of herpes) and when he or she is asymptomatic (does not any symptoms or signs or herpes).
The table presents information about the overall chance of getting a herpes infection over time, with multiple contacts. Please notice that infected people pass the infection regardless of whether they are symptomatic or asymptomatic.
The percentages mentioned bellow are general estimates and may vary from person to person based on immune system strength (people with low immunity are more susceptible to infection), skin condition (people with damaged skin are more likely to contract the infection), and race (black people are more susceptible to herpes infection).
| Disease manifestation | Chance of transmission |
| Symptomatic | 20.1% |
| Asymptomatic | 10.2% |
Chance of herpes transmission by gender
This table summarizes herpes transmission by gender. The percentages are the per-year chance of contracting the disease (with multiple contacts) when one person is infected:
- infected male to susceptible female
- infected female to a susceptible male
As you can see, females are at higher risk of contracting the infection.
The percentages mentioned bellow are general estimates and may vary from person to person based on immune system strength (people with low immunity are more susceptible to infection), skin condition (people with damaged skin are more likely to contract the infection), and race (black people are more susceptible to herpes infection).
| Vector of transmission | Chance of transmission (per year) |
| From an infected male to a susceptible female | 7%–31% |
| From an infected female to a susceptible male | 4% |
Chance of herpes transmission with and without protection
This table presents statistics on herpes transmission with and without protection (condoms). Please notice that using protection significantly reduces the risk.
The percentages mentioned bellow are general estimates and may vary from person to person based on immune system strength (people with low immunity are more susceptible to infection), skin condition (people with damaged skin are more likely to contract the infection), and race (black people are more susceptible to herpes infection).
| Chance of transmission |
| Asymptomatic patients | Symptomatic patients |
| Protected sex | 5.15% | 5.15% |
| Unprotected sex | 10.2 % | 20.1% |
Asymptomatic herpes shedding for oral (HSV-1) and genital (HSV-2) herpes
This table shows the chance that each of the two herpes types will shed, by anatomical lotion (oral and genital).
Herpes shedding is a silent process without symptoms or visible signs. We measure whether the virus has shed by seeing whether we can isolate it on the skin (saliva, vaginal fluid, etc.) while the patient is asymptomatic.
Please understand that these statistics are not for transmission, but rather for virus shedding. It is still unclear to researchers how much a virus needs to be shedding for transmission to occur, but it is believed that the higher the virus shedding rate, the greater the chance of transmission.
| Herpes type | Chance of oral shedding | Chance of genital shedding |
| HSV-1 | 37% | 11% |
| HSV-2 | 6.5% | 78% |
Frequently Asked Questions
Here we summarize real patients' questions, grouped by topic, and Dr. Fuzayloff's answers to them. "Dr. F" (his patients' name for him) has been an STD physician for over two decades in Midtown Manhattan, NYC.
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How does herpes transmission occur? 
Herpes is transmitted through direct skin-to-skin contact. If the skin of the person that has a herpes blister comes into contact with a partner's skin, the blister might rupture, exposing the partner's skin to fluid that contain high concentration of infection. During the herpes-positive person's first outbreak the chance of transmission is greater because the concentration of the virus in the sores is much higher.
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Why are the mouth and genital areas affected more than other areas of the body?
Herpes prefers to enter the body through areas where the skin is thinner. In addition, skin abrasions are more common in the oral and genital areas. The thicker skin of the arms and torso is less penetrable.
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I have tested positive for HSV-1 via an IgG blood test. As I understand it, knowing where the virus resides in my body could help me protect my partner. How can I tell where it is?
A blood test cannot tell us the location of the virus, only the type of herpes virus you have.
We can't say with certainty where the virus is located in patients who were diagnosed based on a blood test and have never had an outbreak. However, we can make an assumption based on statistics:
- If you are positive for type 1 (HSV-1), it is most likely that it's in the oral area (though it can be in the genital area).
- HSV-2 rarely affects the oral area.
The only way to know the location of the virus for sure is to have an outbreak and test the visible sore with a swab at that time.
You are correct that the location of the virus in the body is important to know, because it's stored locally and passed to other people through contact of the skin in that area to a partner's skin.
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What's the chance of transmitting herpes while I'm symptomatic?
The chance of passing herpes while you have signs (sores) is about 20.1%. That's twice as high as the chance of passing it when you don't have sores (10.2%).
A person is considered symptomatic from the beginning of the prodrome period (when you can have fatigue, fever, and chills) a few days before skin eruptions appear and continuing until after the skin is completely healed (a few days after the crust has healed).
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What's the chance of transmitting herpes while I'm asymptomatic?
The chance of asymptomatic shedding is about 10.2%.
Please be aware of the following statistics:
- The majority of herpes transmissions (80%) are by asymptomatic patients since people assume that they are infectious only when they have visible signs of the infection.
- About 75% of infected people have contracted herpes from a partner who was unaware of his or her herpes-positive status.
- Most people who have oral herpes get it in a nonsexual way from friends and family members during childhood
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Please tell me about silent herpes shedding. What is it? When does it occur? How common it? What areas shed the virus? What is the psychological impact of it?
What is it?
Once herpes is contracted, it stays in the body in a latent (suppressed) state.
Unlike other viruses that the body's immune system clears completely, the herpes virus is only suppressed by the immune system.
When does it occur?
Occasionally, certain triggers (sun, stress, and others) can activate the herpes virus so that it travels back to the skin, causing symptoms (blisters and sores). Sometimes the same triggers activate the herpes virus but without causing skin symptoms. This is called silent virus shedding. During those times, asymptomatic transmission might occur.
It is still unclear to researchers exactly when shedding occurs, but most likely it is caused by the same triggers that induce a flare-up (outbreak) of the virus.
How common is silent shedding?
It is believed to be more common in the first few years. As with flare-ups, the frequency of silent shedding is believed to go down over time. It is believed that silent transmission occur 4% of the time—so, on average, 14.5 days in a year.
In what areas of the body does the virus shed?
Silent shedding occurs from the same area of the skin where symptomatic flare-ups occurs:
- Females: vaginal, vulva, entire perianal area
- Males: penile shaft, the entire perianal area
- Both genders: oral area
What is the psychological impact of silent shedding?
Many people find it very troubling to know they're spreading the virus silently because it prevents them from protecting their partner from getting it.
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My blood test is positive for herpes type 1 (HSV-1). How am I passing it to others?
The herpes virus is transmitted when the area where herpes resides while asymptomatic come into contact with your partner's skin.
If herpes (HSV-1 or HSV-2) was diagnosed based on a blood test (IgG) and you've never had a herpes outbreak, it's impossible to tell where herpes is residing in your body while it's inactive.
Since both herpes types can affect both areas, the IgG test is only somewhat helpful. It doesn't tell us the most important part—where herpes is residing in your body. Knowing the virus type (based on IgG blood test), we can make an assumption about where herpes is most likely to be based on overall herpes statistics:
- HSV-1 is most often located in the oral area
- HSV-2 is most often located in the genital area
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Why are females more likely to get herpes?
The chance of herpes transmission from a herpes-positive male to his susceptible female partner is 7%–31% (10% on average). This is about two-and-a-half times higher than the chance of herpes transmission from an infected female to a susceptible male (4%).
This is explained by the fact that the herpes virus is more easily transmitted via mucosa (thin, moist skin) than "regular" skin and females have a larger exposed area of mucosa in their genital area than men do.
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If there a difference in herpes transmission rates for homosexual and heterosexual couples? Why?
It's easier for the herpes virus to enter the body through moist, thin skin areas such as the vaginal, rectal, and oral areas. The chance of transmission is greater if the exposed part of such areas is larger.
Homosexual females
It is estimated that homosexual females are at less risk of getting herpes than heterosexual females are.
Homosexual males
Homosexual males are more likely to get herpes than heterosexual males are.
A study conducted in Australia explained this difference by the fact that homosexual men more commonly engage in:
- Oral sex
- Oral sex leads to the transmission of HSV-1 infection (up to 90% of people have this type of herpes virus) from the oral area to the genital area, and vice versa.
- Anal sex
- Anal sex may damage the mucosa, which makes a person more vulnerable to herpes acquisition
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How is herpes transmitted through oral sex?
There are no statistics available on the probability of herpes transmission via oral sex (at least, we couldn't find any).
What is known (estimated) is that the chance of getting herpes through receptive oral sex (that is, receiving oral sex from one's herpes-positive partner) is about 1.5 times higher than through vaginal sex. In vaginal sex, the chance of herpes transmission per act is 2.3%. So, multiplying 1.5 by 2.3, we assume that the probability of per-act transmission for herpes infection via oral sex will be about 3.5%.
Again, this is an estimate; reality may be different.
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What is the chance of herpes being transmitted by common household objects?
The chance of herpes transmission via common objects is very low and even questionable. According to the CDC, you can't contract herpes when touching objects such as
- Towels,
- Soap, or
- Silverware.
There is a theoretical risk of getting the infection by sharing the utensils with someone with an active outbreak. However, in the real world the probability of this transmission is close to zero because when the virus is exposed to air it dies within a few hours. However, the WHO still recommends avoiding sharing an object that may contain saliva (cups, utensils, etc.) with someone who has an active herpes outbreak. The chance of passing herpes via utensils is extremely low.
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What is the chance of getting herpes from a toilet seat?
It is extremely unlikely that you will get herpes via toilet seat. Here's why:
- The herpes virus usually spreads through direct skin-to-skin contact.
- The herpes virus survives for only a few hours outside the body (this applies to most surfaces).
- For transmission to happen, liquid with a high concentration of virus from a herpes sore would have to touch the toilet seat, and then another person would have to sit on the same exact spot shortly afterward (before the liquid dries).
- Typically, it's thigh skin that comes in contact with toilet seats, not the genital area where a sore could be. People usually don't rub herpes sores against toilet seats because the sores are extremely sensitive (painful) and located in the genital area. People avoid touching them.
- The skin of a healthy person that touches a toilet seat that has liquid with concentrated herpes virus in it is thick thigh skin, which is difficult for herpes virus to penetrate.
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Is a condom effective in preventing herpes transmission?
Condoms significantly decrease the likelihood of herpes transmission, but it can still happen. The protection offered by condoms is only about 30%–50%, since the parts of the genitals that are not covered by a condom may contain herpes virus and pass it via skin-to-skin contact. Learn more here: https://stdcenterny.com/articles/protected-herpes-transmission.html.
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Is it possible to get herpes from kissing or touching friends or family members?
The chance of acquiring a herpes infection from friends and family members through normal affection gestures like kissing on the cheek, hugging, and touching hands is very low but theoretically possible. This is why:
- Herpes transmission usually occurs through direct skin-to-skin contact with the outbreak area at the time when the concentration of the virus in the herpes sore is the highest. The concentration of the virus and infectivity drops significantly as the herpes sores heal.
- The herpes virus is most likely to penetrate the area where "regular" skin transitions to mucosa. The herpes virus prefers to enter the body through thin, moist areas that can easily be damaged and that facilitate virus penetration.
- The areas of skin that typically come into contact with friends or family members is the thicker skin of the cheeks and hands, which is difficult for the herpes virus to penetrate.
- Herpes-positive people try to avoid direct contact with the sore, since it is very sensitive to the touch.
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Can herpes be transmitted from one part of the body to the other (oral to genital or vice versa)? Is it common?
Yes, it is possible! Though the risk is low, herpes self-infection is possible via hand–genital–mouth contact. This means that a person may "transfer" the infection from the primary site of the outbreak (for example, the oral area) to other parts of the body (for example, the genital area or the eyes).
This is called autoinoculation. When it happens, it's usually during a person's first outbreak when there are a lot of sores and a high virus concentration. The chance of it occurring during subsequent outbreaks is lower.
Herpes does not travel through the body (for instance, through the blood or lymphatic system) to different areas. It must be transferred by direct contact.
Here is how herpes transfer from one part to the other part of the body happens:
- A person touches oral sores during an outbreak and then touches another part of the body right away, transferring fluids containing a high concentration of virus to the other area.
- The virus penetrates the skin and gets stored in the local nerve ganglion in the new area and becomes a new site where herpes outbreaks and transmission can occur.
Washing your hands with soap after touching the outbreak area eliminates the risk of herpes transmission.
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Is it possible for someone to get herpes from their parents? Is that common?
Yes, it is possible! And we believe (in our practice) that it's common.
We don't know of any statistics about the chance of getting herpes from one's parents, but what we see in our practice is that 50% of herpes-positive patients (especially with HSV-1):
- Remember having "cold sores" and "fever blisters" from childhood and didn't think anything of it until they get tested, and
- Remember their parents having outbreaks.
Note: The patients in our practice aren't a big enough group to reach a definitive statistical conclusion.
This is the most common scenario where herpes is transmitted from parent to child:
- A parent has a history of a "fever blister" and kisses their children playfully and bathes and cleans them while they're small. Areas of the children's skin that are most susceptible to herpes (transition skin areas that herpes prefers) are touched (eyelids, mouth, genitals).
- Shedding of the virus occurs from a few days before sores appear to a few days after they heal. Parents usually avoid touching their children while they have a sore, but not before and after.
- Moreover, transmission can happen during a silent shedding period when the parent is completely asymptomatic.
YouTube video by expert STD doctor (Dr.Slava Fuzayloff)
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