Oral sex and herpes: A triple header

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

Kudos to all of you for looking out for your health and that of your partners. Unfortunately, herpes infections can affect all partners involved; if one partner has genital herpes, the other partner is at risk of contracting herpes, whether or not sores are present. It's up to you and your partner to decide what level of risk you're both 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 Shedding light on viral shedding for more information). Viral shedding can occur at any time (usually near where active herpes sores appear) and can lead to transmission of the virus.

Because herpes can occur on parts of the body that aren't covered by a barrier, and because of the possibility of viral shedding, transmission can happen especially during vaginal, anal, or oral sex even if you're using barriers. Transmission can also occur during non-penetrative sex acts such as frottage and heavy petting. Even though viral shedding occurs a few days per year at the most, we can't yet pinpoint the "shedding" days—meaning we do know when it's likely that transmission could occur by way of shedding. Furthermore, herpes can be transmitted by either the insertive or receptive partner. For example, it's 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 partner, if they have an active herpes sore or viral shedding in their mouth.

For safer oral sex, using an external 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  vulva or anus to prevent potentially infected fluids from contacting your sex partner. You can also use a non-lubed external condom as a dam by pulling off the ring, cutting off the tip, and then cutting along one side to make a rectangle; a small piece of plastic wrap (preferably non-microwaveable wrap because it's less porous) is also an option when nothing else is available.

One piece of good news is that people who have herpes can choose to take medication as "suppressive" therapy. Taking herpes medications (i.e., valacyclovir) can help reduce the frequency and intensity of outbreaks and help to reduce the number of viral shedding days throughout the year. Although suppressive therapy is more commonly used for the treatment of genital herpes, it can be used for oral herpes cases as well. You can speak with your health care provider to discuss this possibility; the downside to suppressive therapy is that it can be expensive and must be taken every day.

Another consideration is whether 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 or avoid certain types of contact. The American Sexual Health Association has information about herpes support groups that may help you 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, however, 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 status.