Break down of different herpes strains and oral sex

Dear Worried, Reader #2, and Reader #3,

Kudos to all of you for knowing your and your respective partners’ herpes status! Having the "I have herpes" discussion with sexual partners may be a sensitive topic to talk about, but they’re critical to informing risk-reduction strategies and prioritizing each other’s health. Both HSV-1 and HSV-2 can be transmitted through oral sex, as the virus that causes herpes is transmitted through skin-to-skin contact. Generally speaking, when at least one partner has herpes and is considering performing or receiving oral sex, using a barrier method of protection, such as external condoms or dental dams, may reduce the risk of herpes transmission. Keep reading to learn more about these types of herpes strains and potential for transmission among partners!

Both HSV-1 and HSV-2 result in lifelong infections but vary based on their modes of transmission and where they reside within the body. HSV-1 most often lives in a collection of nerves near the ear and is transmitted through mouth-to-mouth contact (kissing) or oral sex. Since infections from HSV-1 most often results in oral infections, including fever blisters or cold sores, it’s commonly referred to as "oral herpes." Alternatively, HSV-2 lives near the bottom of the spine by the waist and is almost always transmitted through sexual contact. Since it most commonly causes infection on the genitals, it’s commonly referred to as "genital herpes." With all this said, it’s worth noting that HSV-1 can cause genital herpes and HSV-2 can result in oral symptoms — though this likelihood is very low and may vary depending on the kind of sexual contact.

Given that some of you and your partners have HSV-1 and HSV-2, it may be helpful to look at different scenarios for HSV-1 and HSV-2 transmission between sexual partners. Can you get...

• HSV-1 from oral sex? Yes. If either you or your partner has an oral or genital HSV-1 infection, oral-genital contact may transmit this virus in either direction.
• HSV-1 from having vaginal or anal sex? Yes. If your partner has genital HSV-1, genital-to-genital contact can transmit HSV-1.
• HSV-2 from oral sex? Yes, but it’s less likely. If you’re performing oral sex (your mouth on someone’s genitals), there’s a possibility of getting HSV-2 if your partner has a genital HSV-2 infection. If you are receiving oral sex (someone’s mouth on your genitals), there’s a possibility your partner can give you HSV-2 if they have an oral HSV-2 infection.
• HSV-2 from having vaginal or anal sex? Yes. The HSV-2 virus thrives in the genital area and is most often transmitted via genital-to-genital sexual contact.

To be more specific, Worried, since neither you nor your girlfriend have HSV-2, you can’t transmit it to one another unless one of you becomes infected by someone else who carries the virus. However, it's possible to transmit HSV-1 to her genitals, so you may wish to consider using a barrier, such as a dental dam, during oral sex. Reader #2, by performing oral sex on your partner, it’s possible that you can give him HSV-2, and he can give you HSV-1. Alternatively, if your partner wants to perform oral sex on you, there's a very slight chance that he might orally contract HSV-2 from you. To protect yourselves from either scenario, you both may wish to use barrier methods. Reader #3, since you and your partner both already have HSV-2, having oral sex with one another can have minimal impact on your respective health statuses — assuming no new partners or infections are added to the mix. That said, you too may wish to use dental dams or external condoms during oral sex, out of an abundance of caution.

Beyond using barrier methods of protection, folks may consider using suppressive therapy (by taking medicines such as valacyclovir) to reduce the risk of herpes transmission. Through this suppressive therapy, you and your partners can treat or manage your herpes, and lower the risk of transmitting a different herpes virus to one another. If you’re interested, or have questions about suppressive medicines, you might speak with your health care provider who may be able to offer guidance. Additionally, for information on herpes testing, treatment, and safer sex, check out the American Sexual Health Association's Herpes Resource Center.

While there's no magic bullet solution for oral sex with herpes, with open communication, safer sex strategies, and a problem-solving spirit, you and your partners can "come" to a happy ending!