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herpes tranmission rate through oral sex
I accidentally posted this question, meant for expert forum, in the general free forum. Sorry for posting this again but I would like an answer from an expert.
From previous expert answers to related questions, I came away understanding the STD risk of a man receiving unprotected oral sex is very low with the highest chance being getting HSV1 genitally. I would like to know how low of a chance it is for a male, previously tested negative for both HSV1 and HSV2, is to getting herpes genitally from receiving oral sex. I know there may be no statistic and it is very hard to quantify this chance but if you can give me your educated guesstimate, it would help me a lot. For example, is it 1 in the thousands, 1 in 100's, 1 in 100 or higher/lower? I won't hold you to this number, I just would like to know from your professional experience, which of those range makes most sense to you. I have seen the number 5-10% being thrown out there on WWW for chance of a couple, with no regular condom use, transmitting herpes to an uninfected partner over the course of the year. This rate isn't specific to oral/vagina sex or hsv1/hsv2. Thank you.
From previous expert answers to related questions, I came away understanding the STD risk of a man receiving unprotected oral sex is very low with the highest chance being getting HSV1 genitally. I would like to know how low of a chance it is for a male, previously tested negative for both HSV1 and HSV2, is to getting herpes genitally from receiving oral sex. I know there may be no statistic and it is very hard to quantify this chance but if you can give me your educated guesstimate, it would help me a lot. For example, is it 1 in the thousands, 1 in 100's, 1 in 100 or higher/lower? I won't hold you to this number, I just would like to know from your professional experience, which of those range makes most sense to you. I have seen the number 5-10% being thrown out there on WWW for chance of a couple, with no regular condom use, transmitting herpes to an uninfected partner over the course of the year. This rate isn't specific to oral/vagina sex or hsv1/hsv2. Thank you.
A related discussion, Does MSM oral sex apply? was started.
MEDICAL PROFESSIONAL
Welcome to the forum.
You are correct that no data exist to provide a quantative estimate. For HSV-2, however, we can be highly confident that the risk is no higher than one in several million. Few people with HSV-2 have oral infections, and when they do, recurrent outbreaks and asymptomatic shedding of the virus are less common than for HSV-1 or for genital HSV-2. In 30+ years in the STD business, to my knowledge I have never come across a patient with genital HSV-2 acquired by oral sex.
The risks are obviously higher for HSV-1. But for any single exposure, you have to factor in a) the odds the oral partner has oral herpes, b) if so, whether or not s/he is having an outbreak at the time of exposure, c) if no outbreak, whether asymptomatic viral shedding might be present, d) whether the genital partner already has HSV-1, which would make him or her immune (or at least highly resistant) to a new infection, and e) perhaps other factors, like the duration and vigor of exposure, perhaps circumcision status, and maybe still others.
I believe the final statistic you quote comes from the research study on valacyclovir to prevent HSV-2 transmission. That study provides the best data on herpes transmission risk. Among several hundred couples in which one person had genital HSV-2 and the other did not, who had unprotected vaginal sex an average of 2-3 times per week, transmission occurred in 5% of couples per year (in the placebo group, lower in those given valacyclovir). That works out to somewhere around 1 transmission for every 1,000 exposures. But these data are only applicable to HSV-2 and vaginal intercourse and says little about transmission of either virus by oral sex.
Summarizing all this, of the range of transmission probabilities you cite, I would put the average chance of acquiring genital HSV-1 in the 1 in 1,000 range for any particular episode of oral sex, perhaps as low as 1 in 10,000. But these are only educated guesses.
If you remain concerned, you could have a blood test to see if you already have antibodies to HSV-1. In the US, about half of all adults have positive results. If you are among them, you can consider yourself immune to a new HSV-1 infection whether by oral sex or any other route of transmission.
Regards-- HHH, MD
You are correct that no data exist to provide a quantative estimate. For HSV-2, however, we can be highly confident that the risk is no higher than one in several million. Few people with HSV-2 have oral infections, and when they do, recurrent outbreaks and asymptomatic shedding of the virus are less common than for HSV-1 or for genital HSV-2. In 30+ years in the STD business, to my knowledge I have never come across a patient with genital HSV-2 acquired by oral sex.
The risks are obviously higher for HSV-1. But for any single exposure, you have to factor in a) the odds the oral partner has oral herpes, b) if so, whether or not s/he is having an outbreak at the time of exposure, c) if no outbreak, whether asymptomatic viral shedding might be present, d) whether the genital partner already has HSV-1, which would make him or her immune (or at least highly resistant) to a new infection, and e) perhaps other factors, like the duration and vigor of exposure, perhaps circumcision status, and maybe still others.
I believe the final statistic you quote comes from the research study on valacyclovir to prevent HSV-2 transmission. That study provides the best data on herpes transmission risk. Among several hundred couples in which one person had genital HSV-2 and the other did not, who had unprotected vaginal sex an average of 2-3 times per week, transmission occurred in 5% of couples per year (in the placebo group, lower in those given valacyclovir). That works out to somewhere around 1 transmission for every 1,000 exposures. But these data are only applicable to HSV-2 and vaginal intercourse and says little about transmission of either virus by oral sex.
Summarizing all this, of the range of transmission probabilities you cite, I would put the average chance of acquiring genital HSV-1 in the 1 in 1,000 range for any particular episode of oral sex, perhaps as low as 1 in 10,000. But these are only educated guesses.
If you remain concerned, you could have a blood test to see if you already have antibodies to HSV-1. In the US, about half of all adults have positive results. If you are among them, you can consider yourself immune to a new HSV-1 infection whether by oral sex or any other route of transmission.
Regards-- HHH, MD
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.
