Oral sex and herpes — a triple header

Originally Published: November 7, 1997 - Last Updated / Reviewed On: April 22, 2014
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(1)
Dear Alice,

An incredible woman, who I've been seeing for a few weeks, has just informed me she has genital herpes. I really like her and am going to continue seeing her. Although it is not an issue right now, as we get closer and more intimate I am concerned about our sexual relations. I know that wearing a condom will prevent the transmission of herpes, but how can I prevent the transmission if I perform oral sex on her? I enjoy giving oral sex and would like to know how I can do this with her. Please help.

Thanks,
Need Info

(2)
Dear Alice,

My partner and I are desperately seeking information regarding safe sex and herpes. HELP!!! First, we want to know if oral sex is a possibility. Second, can we rub up against each other when no sores are present???

Signed,
Desperate

(3)
Dear Alice,

My boyfriend has genital herpes — I do not. We are currently practicing safe sex, but would like to know what risks are involved in having sex without a condom when no episode is present, and if oral sex without a condom is a possibility and what the risks are. Please help us!

Signed,
Safe, but curious

Dear Need Info, Desperate, and Safe, but curious,

Kudos to all of you for looking out for your health and health of your partners. Unfortunately, herpes is a frustrating infection; essentially, if one partner has genital herpes, the other partner is at risk of contracting herpes, whether or not sores are present. This is true whether you're having oral, vaginal, or anal sex. It's up to you and your partner to decide what level of risk you are comfortable with. When sores are visible, the risk of transmission through sex and skin-to-skin contact (around the area with sores) is highest. When no sores are visible, the risks are less certain, but there is a possibility of the herpes virus being present on the surface of the skin even without causing a sore — this is called viral, or asymptomatic, shedding (read What is viral shedding? for more information). Viral shedding can occur at anytime and usually occurs near where active herpes sores appear.

Because herpes can occur on parts of the body that aren't covered by a condom, and because of the possibility of viral shedding, transmission can happen during vaginal, anal, and/or oral sex, even if you're using protection. Viral shedding occurs a few days per year at the most; however it's not possible to pinpoint the "shedding" days, so take this into consideration when making your decisions.

For safer oral sex, using a condom (for oral sex on a penis) or a dam (for oral sex on a vulva or anus) is still safer than nothing at all. A dam is a thin, square piece of latex that is placed over the clitoris, vulva, or anus. You can also use a non-lubed condom by pulling off the ring and cutting along one side to make a rectangle; or, use a small piece of plastic wrap (preferably non-microwaveable wrap because it is less porous). And just to be clear, herpes can be transmitted by either the giver or receiver of oral sex. It is possible for the person giving oral sex to get herpes if their partner has genital herpes and a sore is active or there is viral shedding. It is also possible for the person giving oral sex to give herpes to their parther, if they have an active herpes sore or viral shedding on their mouth.

One piece of good news is that people who have herpes can choose to take medication as "suppressive" therapy. Taking herpes medications (typically valacyclovir) can help reduce the frequency of outbreaks and help reduce the number of viral shedding days throughout the year. In fact, the Centers for Disease Control (CDC) recommends suppressive therapy for people with herpes, to help prevent transmission to partners. You can speak with your health care provider to discuss this possibility; students at Columbia can contact Medical Services (Morningside) or the Student Health Service (CUMC) to make an appointment. The downside to suppressive therapy is that it can be expensive.

Another thing to consider is whether or not your concerns are in the context of a committed relationship. If the person with herpes is someone with whom you would like to, or plan to, have a long-term partnership, then you may be more willing to take and accept risk. If you're not sure, you may choose to practice safer sex and/or avoid certain types of contact. The American Sexual Health Association's Herpes Resource Center, which has information about herpes support groups that may be especially useful in helping people with and without herpes determine how to have sex comfortably and safely.

You may want to have some open, frank discussions about what sexual activities you're willing to do with your partner. It's not an easy situation to be in, knowing that there's a potential for herpes to be transmitted, and no one but you and your partner(s) can decide the best course of action. In time, you'll likely come up with a few ways that will let both of you feel safe and enjoy your sexual adventures, regardless of herpes.

Alice