HSV1 oral transmission risk

[gen0me]

I am a 27-year-old female negative for both HSV1 and HSV2. The man I am dating says he remembers having a cold sore in high school, which would be at least a decade ago, and has not had one since. I have not asked him for a recent herpes test result, but I would have to assume that he would be positive for HSV1.

I have let him perform oral sex on me once, but I am growing increasingly nervous about allowing him to continue doing it. I understand that the risk of transmission to my genitals is low, but from everything I've read, he is still shedding the virus asymptomatically at times. I have no antibodies from oral infection that would protect me genitally, and this is not something I'd want to have to explain to future partners.

What truly is the risk of him transmitting this to me genitally if he were to perform oral sex several times for the next several months/years/forever? If there is a real risk of transmission, would a dental dam provide adequate coverage and protection?

Thanks!

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

The first thing you should understand is that there is nothing special about the man you are dating have had oral herpes.  Half of all adults in the US have oral HSV-1 infections.  Every one of them potentially could infect a partner by kissing or oral sex.

There are many things that people mistake for cold sores, so it isn't certain your partner has oral herpes.  But even assuming if does, the chance of transmission during any single episode of oral sex (or kissing) is very low, probably one chance in many thousand.  Most likely he could perform oral sex on you daily for 50 years and you would never catch it.  You might, but the odds definitely are in your favor.  The chance might be higher if he still were having recurrent cold sores, but apparently he isn't; and of course it would be higher still if he performed oral sex while he actually had an oral herpes outbreak.

A dental dam would further reduce the risk, indeed would make it zero.  But honestly, I don't think it's worth the trouble.  The other thing to know is that genital herpes due to HSV-1 usually is no big deal.  Of course nobody wants genital herpes of any type, but HSV-1 genital infections typically cause few recurrent outbreaks and are not commonly transmitted sexually to new partners.  It's a very different problem than genital HSV-2.  Below are links to a couple of threads that discuss genital HSV-1 in detail.

http://www.medhelp.org/posts/show/969931
http://www.medhelp.org/posts/show/1159077

So I really don't think you should be worried about your sexual expression with your new partner.  Don't let this minor issue stand in the way of romance and rewarding sex!

I hope this has helped.  Best wishes--  HHH, MD

[gen0me]

Thank you very much, Dr. Handsfield!