STDs Expert Forum
unprotected oral sex/herpes/ and anti virals
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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unprotected oral sex/herpes/ and anti virals

I am really confused about oral sex.  It has been stated on more than a few posts  that "few STD's are acquired from oral sex."  Does this mean that my partner, who is HSV2  (genital) and I, who am HSV1 (cold sores lips), can have mutual unprotected oral sex and I will not get infected?  Or does this mean that he can give me unprotected oral sex but I cannot give him unprotected oral sex?

Also, he cannot take Valtrex/Acyclovir because he has one kidney and RSD and his doctor advised against it.  We have a long distance relationship and I was wondering:  if I take  acyclovir or valtrex, say, a week before we get together and continue it during the week we're together and then one more week after I return home, will this help protect me?   I appreciate your answer.  
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

The general risk of STDs from oral sex really isn't the issue here, is it?  It seems the only concern is transmission of HSV, right?

You certainly could acquire oral herpes due to HSV-2 by performing oral sex on your partner, if he happened to have an outbreak or to be shedding virus without symptoms at the time of the exposure.  Similarly, oral sex by you on him could transmit HSV-1 to his penis.  In the absence of an obvious outbreak, both of these are unlikely for any individual episode of oral sex, but either could happen -- and the chances will rise with the number of such events occur.

Am I to understand you and your partner are only having mutual oral sex, and not vaginal intercourse?  Why?  The HSV transmission risks would  be only a little higher (and maybe not any different) with vaginal sex compared with oral sex.

I am skeptical that your partner cannot take valacyclovir or other anti-HSV drugs.  I don't know the meaning of "RSD" -- but if his kidney function (measured by blood test results) is reasonably normal, having only a single kidney is not a contraindication to these drugs.

If either of you is taking an anti-herpes drug, it will help protect the partner from infection.  However, the effectiveness to protect her person actually taking the drug is unknown.  Most likely, if you took acyclovir or valacyclovir as you describe, you would indeed be protected from catching your partner's HSV-2 -- but I cannot guarantee it.

I hope this helps.  Best wishes--  HHH, MD
4 Comments
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Avatar_n_tn
RSD is Reflex Sympathetic Dystrophy.  

Regarding his kidneys, he had kidney cancer resulting in the loss of of one kidney.  With all that's involved with RSD and the meds, he is already prone to gout attacks.  Doctor thinks partner doesn't need to take chances with the drug.

Regarding oral sex, we have not had oral sex.  We have had only vaginal sex and mutual masturbation.  I didn't want to have oral sex until the parameters were clear.    Please clarify...oral sex....with no breakouts, do either one us need to wear condom or a female condom?

It occured to me that you might think that I am a little "thick."  I am 62 years old and this is the first time I have had a partner that has had HSV2. Thanks for your patience with me.
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239123_tn?1267651214
Thanks for the clarification.  I misunderstood your current sexual practices.

The "need" for barrier protection for oral sex is relative.  In the absence of an overt outbreak with visible lesions, the transmission risk is low for each exposure -- as a guess, somewhere on the order of one chance in 1,000.  And thus after 100 events, the cumulative risk might be 10%.  If these numbers don't frighten you, I would say oral sex without barriers would be fine.  (Most people don't find condoms for oral sex tasteful, either figuratively or literally.)  And you can also factor in how big a deal it would be if transmission occurred.  If you acquired oral HSV-2, it would probably be mild and easily treated; ditto for his risk of genital HSV-1.  In both cases, recurrent outbreaks are rare and asymptomatic viral shedding relatively uncommon.  If I were in your circumstances, my personal view would be to not worry about it, even if transmission occurred.

I won't continue a second hand debate with your partner's doctor, but I would not hesitate to recommend acyclovir or valacyclovir to a patient like your partner, assuming his renal function is reasonably nomal (e.g. serum creatinine under 2.0).
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Avatar_n_tn
Thank you very much for your frank and insiteful reply.  I feel much more informed now and will relay your responses to my partner.

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