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Oral HSV2 Risk, Questions

Hi all,
I am a woman and have a female casual partner who recently informed me she has genital HSV2.  We haven't had sex yet and I would like to have sex with her, but I want to stay safe as possible.

She's had it for quite some time, is on daily antivirals, and to her knowledge, has never transmitted it to any partners.  She uses condoms consistently with men for penetration, but does not generally use protection for oral sex.

I'm trying to determine what is safest for me, protection wise.  So here are my questions:

1) What is the risk level for performing oral sex unprotected on her if she does not have an outbreak?

2) Is it advisable to use a dental dam for oral sex on her, regardless of an outbreak or not?

3) Would a dental dam protect me fully from risk?

4) Is there anyway to have safe genital/genital contact with her or should this be avoided?

I have HSV1 (cold sores, since childhood, only 1 outbreak in my life many, many years ago) and show up as "equivocal" for HSV2 (I take this to be negative since I've never had symptoms or an outbreak).  I don't see HSV as the biggest deal, and I'd rather not have a lifelong STI that requires treatment, so I want to be as safe as possible.

Thanks so much!
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207091 tn?1337709493
COMMUNITY LEADER
So we don't have any same-sex transmission studies for hsv2, unfortunately. Generally speaking, women who have sex with women have the lowest STD transmission rates of any group. I'll do my best to answer your questions, but keep in mind that some things will be best guesses.

1) What is the risk level for performing oral sex unprotected on her if she does not have an outbreak?

Oral hsv2 is uncommon, and when it does happen, it rarely recurs, rarely sheds, and therefore almost never transmits. Herpes also doesn't go as easily from the genitals to the mouth as it does from the mouth to the genitals.

2) Is it advisable to use a dental dam for oral sex on her, regardless of an outbreak or not?

You can, if it makes you feel better. Most people don't.

3) Would a dental dam protect me fully from risk?

Yes, but the risk is really low.

4) Is there anyway to have safe genital/genital contact with her or should this be avoided?

As I said, we don't have transmission stats for same sex partners. We do for opposite sex partners, though, so let me give you those. As I said, women having sex with other women have the lowest transmission rates of all STDs, so I'm going to use the lowest transmission rates we have, which is female to male.

These rates are assuming a long term, monogamous relationship, sex 2-3x a week, and avoiding sex with any symptoms.  

Only avoiding sex during an outbreak - 4-5%

Adding condoms OR daily antivirals - 2-3%

Adding condoms AND daily antivirals - 1-2%

So basically, at best, since she's on antivirals, you have a 2-3% chance of getting it a year. I'd expect it to be lower.

I mentioned earlier that herpes goes from the mouth to the genitals. Normally, your oral hsv1 can be transmitted to someone via oral sex, causing genital herpes type 1. Because she has hsv2, that gives her strong protection against hsv1. Unfortunately, your hsv1 doesn't offer protection against hsv2.

Also, I agree that your equivocal hsv2 test probably is a negative.

Hope this helps. Let me know what other questions you have or if I missed any.
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4 Comments
Thank you so much for such a detailed response!  This is so helpful.  I did tell my partner I have HSV1 so she's aware--good to know her status will protect her.  I think, given this information, it feels safe enough to stick to unprotected oral and avoid any genital/genital contact just to keep the risk level low.  I feel very comforted by all this information!  Thank you!
Ohh I do want to clarify one thing because I'm not sure it's clear - those stats are per year, not per encounter.

Per encounter is much lower without symptoms.

In any case, I'm glad it helped. We're here if you have any other questions. :)





Got it!  That makes sense :). I appreciate the help!
You're welcome. :)

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