Q. Can HSV-2 infection affect sperm count?

Answered by
Dr. Shubadeep Debabrata Sinha
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 28, 2022

Hello doctor,

I am a 40-year-old male, have HSV-2, and am currently asymptomatic. I am planning to have a baby with my partner through IVF. I am planning to make a sperm deposit to be frozen and used later for IVF with my female partner in our plan to have a baby. My partner does not have HSV-2. I know that HSV-2 can be present in my sperm even if I am asymptomatic. My first question is, how can I minimize the presence of HSV-2 in my sperm for my sperm deposit for my IVF procedure? I understand that if there is HSV-2 in my sperm, it can cause transmission of HSV-2 to my partner. If I take Valacyclovir at treatment dose, days before and leading up to my planned sperm deposit date, will I be able to reduce or eliminate the chance of HSV-2 being present in my sperm altogether so that my sperm is free of HSV-2 for the sperm deposit for our IVF procedure? My second question is if my sperm has HSV-2 and fertilization happens, will it cause transmission of HSV-2 to my baby? I have been asymptomatic for almost all my life. I have only had two symptomatic outbreaks, the first was when I was about 20-year-old and had my first primary infection, and the last one was this year when I was 40. Otherwise, there have been no symptoms or outbreaks of HSV-2 besides those two times. But I know that asymptomatic viral shedding does happen without any clinical signs or outbreak. My third question is, if I take Valacyclovir at treatment dose, days before and during my planned sperm deposit, will Valacyclovir affect my sperm deposit quality and quantity such that it will severely affect fertilization during our IVF procedure? As I understand it, during IVF, they will select good quality sperms from the sperm sample they have from me, but if I take Valacyclovir daily before and during my sperm sample deposit day, will the usage of it severely affect my sperm deposit quality and quantity such that fertilization chances via IVF will be severely affected. Do I have to worry about this?



Welcome to

At the outset, please let us know more details about your HSV-2 (herpes simplex virus) outbreak by sharing your clinical records, diagnostic workup, and treatments being taken or taken earlier. The next step is to rule out HIV (human immunodeficiency virus) as HSV2-HIV coinfection is not uncommon as both are transmitted sexually. Please let us know the source of HSV-2 infection that you might have acquired in your late teenage years. Based on the data you shared (first outbreak at around 20 years of age). You also did mention the recurrence of HSV-2 infection with two symptomatic episodes. Recurrent HSV-2 infection could be treated. Treatment for recurrent HSV infection includes no cure (for infrequent episodes, which you have) or episodic therapy with topical agents or oral antiviral drugs. Antiviral oral medicines are used for short periods during the triggered reactivation of disease. Long-term suppressive therapy, which can be continued for up to one year, is another alternative. However, a modest benefit with lower recurrences has been reported using this method. It is important to determine the frequency and severity of recurrent infections. Options for long-term suppressive therapy include Acyclovir (Aciclovir) 400 mg orally twice daily or Valacyclovir (Valacyclovir hydrochloride) 500 mg orally twice daily for up to a year, with reassessment at the end of therapy. There is no need to stop suppressive treatment if you suffer from frequent herpes outbreaks. Antivirals are effective when taken within three days of the lesion appearance in genital herpes. Anticipatory treatment is recommended in situations where decreasing viral shedding decreases the likelihood of infecting seronegative individuals (similar to your partner) with the virus. The antivirals (oral, intravenous, and topical) Acyclovir, Valacyclovir, Famciclovir, and Pensiclovir are well-established treatments that all interfere with the viral DNA (deoxyribonucleic acid) polymerase and hence, viral genome replication. HSV-2 infections are observed perinatally (from a maternal episode at delivery). Maternal acquisition of HSV in the third trimester of pregnancy carries the highest risk of neonatal transmission. A primary outbreak in the first trimester of pregnancy (first three months) has been associated with neonatal chorioretinitis, microcephaly, and skin lesions in some cases. Women with a primary or nonprimary first-episode pregnancy outbreak and women with a clinical history of genital herpes should be offered suppressive therapy beginning at 36 weeks of pregnancy. Alternatively, for primary outbreaks that occur in the third trimester, continuing antiviral therapy until delivery may be considered. The only real danger that herpes poses to pregnancy is in the form of an extremely rare strain of the virus, HHV-6A (human herpesvirus 6), which can lead to miscarriage. The presence of HSV in sperm does not affect the efficiency of fertilization or cleavage of zygotes. At the same time, in cases of virus-infected male gametes, the frequency of blastocyst formation was two times less. Hence it is best to conduct tests for HSV-2. Herpes might not impact fertility levels in females; however, in the case of an outbreak, it is recommended that those experiencing herpes abstain from sexual intercourse. Herpes can reduce a man's sperm count. A study found that herpes was associated with low sperm count among men tested. This is the only known effect of herpes on fertility. 25-30 % of pregnant women have genital herpes, and less than 0.1 % of babies get affected. However, most pregnant women with herpes carry a healthy baby to term.

Thank you.

The Probable causes:

You might have acquired it in your late teenage years.

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