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Oral Sex Risk
Hello Doctor,
I recently started dating a guy monogamously and this weekend we had our sex talk - history, testing, etc. Although we've both come from previous long term monogamous relationships and feel pretty confident in receiving a clear bill of health, we've decided to get tested together prior to having sex with each other and to make a date of it. He told me that he has had cold sores since he was a young child - and that if he has one he won't even kiss me, and that he knows when they're coming on. Last night we did perform oral sex on each other for the first time, and I'm just a little worried and confused about this sort of thing. Is there any risk to me contracting something vaginally if he doesn't have a cold sore? Should I be asking him to be put himself on suppressive medication? I'm assuming that because of his relationship and sexual history that he has a grasp of things, but I still feel jut a little worried today and would like some further education from an expert. Thanks so much for what you do.
I recently started dating a guy monogamously and this weekend we had our sex talk - history, testing, etc. Although we've both come from previous long term monogamous relationships and feel pretty confident in receiving a clear bill of health, we've decided to get tested together prior to having sex with each other and to make a date of it. He told me that he has had cold sores since he was a young child - and that if he has one he won't even kiss me, and that he knows when they're coming on. Last night we did perform oral sex on each other for the first time, and I'm just a little worried and confused about this sort of thing. Is there any risk to me contracting something vaginally if he doesn't have a cold sore? Should I be asking him to be put himself on suppressive medication? I'm assuming that because of his relationship and sexual history that he has a grasp of things, but I still feel jut a little worried today and would like some further education from an expert. Thanks so much for what you do.
MEDICAL PROFESSIONAL
You should not be at all worried about HSV-1. Presumably you have dated (and had sex with) other men. You can assume half of them had oral HSV-1 infections. That your most recent partner happened to know it and told you doesn't make HSV-1 any more likely from him as from those other guys you don't know about.
And if you had been infected, almost certainly you would have known. Most "asymptomatic" initial herpes cases in fact have mild symptoms -- and anxious people usually would notice. It is the non-anxious, not worried about herpes, and not considering the possibility who are most likely to blow off or not remember mild symptoms. That obviously doesn't apply to you.
Presumably you didn't have an HSV blood test, as I suggested above. You could still do that; re-read my initial advice about it. However, until you report an HSV blood test result, this forum can't really help any further. But in the meantime, you should try to stop obsessing about genital HSV-1. It is exceedingly unlikely you were infected in your recent relationship.
And if you had been infected, almost certainly you would have known. Most "asymptomatic" initial herpes cases in fact have mild symptoms -- and anxious people usually would notice. It is the non-anxious, not worried about herpes, and not considering the possibility who are most likely to blow off or not remember mild symptoms. That obviously doesn't apply to you.
Presumably you didn't have an HSV blood test, as I suggested above. You could still do that; re-read my initial advice about it. However, until you report an HSV blood test result, this forum can't really help any further. But in the meantime, you should try to stop obsessing about genital HSV-1. It is exceedingly unlikely you were infected in your recent relationship.
Hi again Dr. Handsfield,
Well, as luck would have it, the guy has broken up with me. In retrospect, I am feeling incredibly foolish and full of some regret. In addition, I am finding myself feeling incredibly anxious about the whole HSV-1 thing. I haven't seen him in about 10 days now. He never had any cold sores while we were seeing each other, and incidentally, we only had oral sex that one time. We did however, continue to make out when we'd see each other once to twice per week. I haven't had any signs of anything genitally or orally-- I realize there is only so much you can do from a distance-- but how great of a risk of transmission was there?
Thanks for your help.
Well, as luck would have it, the guy has broken up with me. In retrospect, I am feeling incredibly foolish and full of some regret. In addition, I am finding myself feeling incredibly anxious about the whole HSV-1 thing. I haven't seen him in about 10 days now. He never had any cold sores while we were seeing each other, and incidentally, we only had oral sex that one time. We did however, continue to make out when we'd see each other once to twice per week. I haven't had any signs of anything genitally or orally-- I realize there is only so much you can do from a distance-- but how great of a risk of transmission was there?
Thanks for your help.
MEDICAL PROFESSIONAL
Thanks for the thanks. Same to you.
Dr. Handsfield,
I really want to thank you for your time and the information. I may come back and report further information once we go in for testing together. This all helps me move forward with things feeling a bit less blind and a lot more educated.
I hope you have a wonderful remainder to the weekend.
I really want to thank you for your time and the information. I may come back and report further information once we go in for testing together. This all helps me move forward with things feeling a bit less blind and a lot more educated.
I hope you have a wonderful remainder to the weekend.
MEDICAL PROFESSIONAL
No data are available on which to base a per-exposure risk. But the frequency of unrecognized HSV-1 (50%), the frequency of oral sex, and the relative infrequency of genital HSV-1 suggests the chance of transmission for any single exposure is well under 1 in a thousand. Among monogamous couples in which only one partner has HSV-1 and who routinely have oral sex, probably 90% go an entire lifetime without transmission occurring. That's why I said you shouldn't be worried about it.
I have been tested previously, and do not have HSV1 if that fine tunes anything for you! Thank you for the comprehensive response. How high is my risk from last night's exposure? This is all a little scary to me.
MEDICAL PROFESSIONAL
Yes, this was obvious. No problem.
MEDICAL PROFESSIONAL
Welcome to the forum.
Oral herpes, almost always due to herpes simplex virus type 1 (HSV-1), can indeed be transmitted to the genitals of a partner by oral sex. Avoiding such contact during an outbreak usually is effective. However, your partner may have asymptomatic shedding of the virus from time to time, i.e. the virus may be present when he isn't having an obvious outbreak. The same can occur by kissing, of course, in which case you would get oral herpes yourself.
My advice is that your mutual STD testing include blood tests for HSV, i.e. evidence of infection with both HSV-1 and HSV-2. Your partner probably will have a positive result for HSV-1. In addition, since half of all adults have positive results for HSV-1, even without histories of cold sores, there is a 50% chance you would have a positive result yourself. If you do, that would actually be good news, because people generally do not acquire new infections with the same virus type they already have. If your HSV-1 test were positive, you are likely immune and would never catch your partner's infection.
If your result is negative and you are susceptible, I still would not necessarily recommend your partner be on treatment, especially if his oral herpes outbreaks are infrequent. Even if you catch the virus, either orally or genitally, you would be on the alert and could start treatment at the earliest symptoms, before they become severe; and recurrent outbreaks are uncommon for genital HSV-1, so it's usually not too big a deal.
Finally, the most important issue may arise if your HSV-1 test is negative and your relationship matures to the point of pregnancy and children. If and when that happens, it will be especially important to avoid a new genital HSV infection during the last 3 months of pregnancy, to prevent transmission of the virus to the baby during delivery. That can result in neonatal herpes, a very serious, sometimes fatal infection. Not to alarm you now, but keep it in mind for the future, and in the event of pregnancy discuss your herpes history with the obsetrician.
If you want to let me know your and your partner's HSV blood test results, I might be able to fine-tune this advice. In the meantime, don't let this issue stand in the way of your growing relationship and rewarding sex together. Until the test results are available, just avoid kissing and oral sex (on you) if he has an outbreak.
I hope this helps. Best wishes for a rewarding partnership-- HHH, MD
Oral herpes, almost always due to herpes simplex virus type 1 (HSV-1), can indeed be transmitted to the genitals of a partner by oral sex. Avoiding such contact during an outbreak usually is effective. However, your partner may have asymptomatic shedding of the virus from time to time, i.e. the virus may be present when he isn't having an obvious outbreak. The same can occur by kissing, of course, in which case you would get oral herpes yourself.
My advice is that your mutual STD testing include blood tests for HSV, i.e. evidence of infection with both HSV-1 and HSV-2. Your partner probably will have a positive result for HSV-1. In addition, since half of all adults have positive results for HSV-1, even without histories of cold sores, there is a 50% chance you would have a positive result yourself. If you do, that would actually be good news, because people generally do not acquire new infections with the same virus type they already have. If your HSV-1 test were positive, you are likely immune and would never catch your partner's infection.
If your result is negative and you are susceptible, I still would not necessarily recommend your partner be on treatment, especially if his oral herpes outbreaks are infrequent. Even if you catch the virus, either orally or genitally, you would be on the alert and could start treatment at the earliest symptoms, before they become severe; and recurrent outbreaks are uncommon for genital HSV-1, so it's usually not too big a deal.
Finally, the most important issue may arise if your HSV-1 test is negative and your relationship matures to the point of pregnancy and children. If and when that happens, it will be especially important to avoid a new genital HSV infection during the last 3 months of pregnancy, to prevent transmission of the virus to the baby during delivery. That can result in neonatal herpes, a very serious, sometimes fatal infection. Not to alarm you now, but keep it in mind for the future, and in the event of pregnancy discuss your herpes history with the obsetrician.
If you want to let me know your and your partner's HSV blood test results, I might be able to fine-tune this advice. In the meantime, don't let this issue stand in the way of your growing relationship and rewarding sex together. Until the test results are available, just avoid kissing and oral sex (on you) if he has an outbreak.
I hope this helps. Best wishes for a rewarding partnership-- HHH, MD
I also just realized that my profile says I am a male-- I'm not sure how to change it - but I should clarify that I am a female!
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.
