Cold sores + oral sex = genital herpes?

Originally Published: November 8, 1996 - Last Updated / Reviewed On: January 18, 2013
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Dear Alice,

I sometimes get herpes blisters (HSV-1) next to or on my lips and this is the case with my girlfriend as well. I was wondering if there is any danger of causing herpes on her genitals (either HSV-1 or HSV-2) by performing oral sex on her when I have a sore around my mouth.

— Worried

Dear Worried,

Worry not! Herpes is a common condition that affects up to 80% of the United States population. Approximately one-fourth of New York City inhabitants have genital herpes. However, the herpes virus has mostly cosmetic ramifications. If you’re concerned about preventing transmission, it’s important to understand the differences between herpes simplex 1 (HSV-1, also referred to as oral herpes), and herpes simplex 2 (HSV-2, also called genital herpes). The bottom line is that both HSV-1 and HSV-2 can be transmitted through oral sex, but transmission is uncommon, and there are many easy, cheap, and even tasty ways to prevent this from happening.

Many people infected with herpes have no visible symptoms and confuse outbreaks with pimples, insect bites, razor burns, allergic reactions, and jock itch. As a result, around 80% of 14 to 49-year-olds with HSV-1 or -2 are never officially diagnosed with the virus. Although genital herpes are considered to be less common than oral herpes, both HSV-1 and HSV-2 may be expressed (symptomatic) orally and genitally. For example, even if you are diagnosed with HSV-1, you may experience herpes in your genital area, or vice versa. In general, HSV-1 prefers the mouth, and HSV-2 calls the genitals “home.” The two strands of herpes don’t typically like to swap locations, but oral-to-genital (or genital-to-oral) transmission is possible.

You’ll be happy to know that it’s more difficult for someone already infected with HSV-1 than someone who is herpes-free to become infected by genital HSV-1 or HSV-2. In fact, studies show that genital HSV-1 and HSV-2 infections are most common among individuals who do not have either type of HSV infection at the time of exposure. Additionally, even though you may consider your cold sores a nuisance, already being infected with HSV-1 makes you 40% less likely to contract HSV-2 from an infected partner. Additionally, you and your girlfriend cannot transmit HSV-2 to one another unless one of you becomes infected by someone else who carries the virus.

For most people the herpes simplex virus is unlikely to cause significant health issues. In fact, herpes is more socially stigmatized than detrimental to your health. Fortunately, it’s not difficult to protect yourself. As previously mentioned, it’s impossible for you to transmit HSV-2 to your girlfriend unless you become infected with it. However, it is possible to transmit HSV-1 to her genitals, so you may consider using a barrier during oral sex. Dental dams — little squares of latex, sometimes flavored — are available for Columbia students at various campus locations at no cost. You can also carefully cut a male or female condom down the middle and lay it flat — it will work just as well. You can also try medications that prevent herpes breakouts (or “viral shedding”) from happening, thereby reducing transmission risk for herpes and other sexually transmitted infections, including HIV. However, keep in mind that HSV-1 and -2 can both be transmitted even when you aren’t in the midst of a breakout and don’t have any visible sores.

If you’re a Columbia student and you want to meet with a medical provider to discuss herpes, safer sex materials, HSV-suppressing medications, or any other remaining concerns, contact Medical Services on the Morningside campus, or Student Health at the medical center to make an appointment. In the meantime, try using a dental dam so you can enjoy yourself while also reducing risk.

Alice