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Safe Sex & Herpes
Hello Doctor,
My new boyfriend has genital Herpes and wanted me to know before we had sex. I am not sure if it's been confirmed as HSV-1 or HSV-2. I believe you can have HSV-1 on the genitals even though HSV-1 doesn't prefer to 'live' in that region. He's getting antibody tested to see what specific type he has, in the meantime I have some questions.
Some background: He says he's never had a cold sore or outbreak around his mouth. His outbreaks have been genital only and severe at times over the past 20 years. He's been on Valtrex now for the past four months, and will be taking 500mg/daily of L-Lyseine and has been outbreak free for the past four months. We plan to avoid sex when he thinks he may be getting or has an outbreak. Between outbreaks, we plan to use a condom.
1) I know you can have HSV-1 orally without signs in some people, could he have HSV-1 on his mouth with no symptoms and HSV-1 on his genitals with symptoms, sometimes severe?
2) I will use a condom for vaginal and oral sex on him. What are my risks if he performs unprotected oral sex on me both if he has HSV-1 or if he has HSV-2?
3) If my hands or other parts of my body (not my face and vaginal area) are exposed to bare penis and semen, will not touching my face or vaginal area after contact and washing with soap and water be sufficient to eliminate my risk? If I have any minor cuts on my cuticles such as after a manicure, or minor scratches on my skin where contact is made, will this affect my risk of transmission?
4) I understand that viral shedding can occur before any signs are present. Are there any further precautions we can take beyond condoms that will minimize the risk of transfer during sex? I read on another post that someone's husband wore his boxers and a condom during sex to minimize skin contact in case he was shedding between outbreaks. Is this a useful precaution or pointless?
Thanks for the advice, any other tips you have are appreciated.
My new boyfriend has genital Herpes and wanted me to know before we had sex. I am not sure if it's been confirmed as HSV-1 or HSV-2. I believe you can have HSV-1 on the genitals even though HSV-1 doesn't prefer to 'live' in that region. He's getting antibody tested to see what specific type he has, in the meantime I have some questions.
Some background: He says he's never had a cold sore or outbreak around his mouth. His outbreaks have been genital only and severe at times over the past 20 years. He's been on Valtrex now for the past four months, and will be taking 500mg/daily of L-Lyseine and has been outbreak free for the past four months. We plan to avoid sex when he thinks he may be getting or has an outbreak. Between outbreaks, we plan to use a condom.
1) I know you can have HSV-1 orally without signs in some people, could he have HSV-1 on his mouth with no symptoms and HSV-1 on his genitals with symptoms, sometimes severe?
2) I will use a condom for vaginal and oral sex on him. What are my risks if he performs unprotected oral sex on me both if he has HSV-1 or if he has HSV-2?
3) If my hands or other parts of my body (not my face and vaginal area) are exposed to bare penis and semen, will not touching my face or vaginal area after contact and washing with soap and water be sufficient to eliminate my risk? If I have any minor cuts on my cuticles such as after a manicure, or minor scratches on my skin where contact is made, will this affect my risk of transmission?
4) I understand that viral shedding can occur before any signs are present. Are there any further precautions we can take beyond condoms that will minimize the risk of transfer during sex? I read on another post that someone's husband wore his boxers and a condom during sex to minimize skin contact in case he was shedding between outbreaks. Is this a useful precaution or pointless?
Thanks for the advice, any other tips you have are appreciated.
MEDICAL PROFESSIONAL
Congratulations. It is good of your BF to have told you of his infection and the two of you are doing things exactly right. Condoms and preventative therapy with a medication such as valacyclovir are the cornerstones of prevention of transmission. At the same time, the topic of herpes is a complex one. The disease is common with HSV-1 being present in over 60% of adults and HSV-2 (the virus which causes most genital herpes) being present in about 1 in 5 Americans. For both infections, the majority of people who have the infections are not aware that they are infected, either because they either acquired it without knowing in the past or because they misidentified their herpes as something else. I will do my best to answer your questions but in general, many of these questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).
As for your questions:
1. It would be most unusual for him to have the same type of HSV infection both on his mouth and genitals. Statistically, if he has genital recurrences, they are most likely to be HSV-2. His blood test results should help to sort this out.
2. His performing oral sex on you unprotected is very low risk. For you, using a condom is a good idea unless (see below)
3. Unlikely to be a concern for you.
4. No other precautions needed. For him to keep his underwear on is not necessary.
One other suggestion (this is the "unless" I mentioned above). I would advise you to have a blood test as well. Surprisingly but as you've inferred above, you could have gotten either HSV -1 or-2 at some time in the past and not know it. Knowing if you have the same or a different HSV type might influence future interactions between the two of you. If you are both infected with the same type, then no need for precautions of any type If one is infected and the other is not, then the precautions you describe are right on target.
Hope this helps and my congratulations to you both for the mature and appropriate way you are approaching this. EWH
As for your questions:
1. It would be most unusual for him to have the same type of HSV infection both on his mouth and genitals. Statistically, if he has genital recurrences, they are most likely to be HSV-2. His blood test results should help to sort this out.
2. His performing oral sex on you unprotected is very low risk. For you, using a condom is a good idea unless (see below)
3. Unlikely to be a concern for you.
4. No other precautions needed. For him to keep his underwear on is not necessary.
One other suggestion (this is the "unless" I mentioned above). I would advise you to have a blood test as well. Surprisingly but as you've inferred above, you could have gotten either HSV -1 or-2 at some time in the past and not know it. Knowing if you have the same or a different HSV type might influence future interactions between the two of you. If you are both infected with the same type, then no need for precautions of any type If one is infected and the other is not, then the precautions you describe are right on target.
Hope this helps and my congratulations to you both for the mature and appropriate way you are approaching this. EWH
Thanks Dr. Hook, we appreciate your guidance and I'll review the information on the ASHA site as well. Again, thanks, you've made two people (and anyone else who reads this one) better informed and more at ease with moving into this phase of our relationship.
All our best!
All our best!
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
