The Truth About HSV1, HSV2, and Oral Sex
A reader writes: “I am just beginning a relationship with a new partner. He has revealed to me that he has HSV2 (genital), but is asymptomatic and has never had an outbreak. I have HSV1 (oral), basically a cold sore 2 or 3 times a year. We are using protection every time we have intercourse, but we’re wondering about oral sex. Since I already have HSV1, is it possible to transmit that to him (when no symptoms are present), and vice-versa. If we were to have ORAL sex with no protection, can we pass HSV1 and HSV2 to each other, or is it “once you’ve got one of the viruses, you’ve got herpes”? If we were to have oral sex, then kiss (again, symptom free), are we risking his currently unaffected mouth and my currently unaffected genital area?”
HSV-1 and 2: Apples and oranges, or just apples?
Under a microscope, HSV-1 and 2 look nearly identical. Both types infect a mucosal surface, usually the mouth or the genitals and then ascend the nerves and lay dormant latency in the nervous system.
For both types, at least 2/3 of those infected have no symptoms or symptoms to mild to notice.
BOTH types can recur and spread even when symptoms aren’t present. Studies show that people with recurrent oral HSV-1 shed virus in their saliva about 5% of the time even when they show no symptoms.I n the first year of infection, people with genital HSV-2 shed virus from the genital area about 6-10% of days when they show no symptoms, and less often over time.
The primary difference between HSV 1 and 2 are where they tend to establish latency. HSV tends to live in a collection of nervesnear the ear. From there it tends to recur on the lip or face. HSV2 likes a collection of nerves at the base of the spine and tends to recur in the genital area.
However, did you know that either type can reside in either or both parts of the body and infect BOTH areas? In some parts of the world,genital infection with HSV-1 is as common as HSV 2 genital infection.
But, if you already have one type of HSV, it is harder to get the other type. That’s because the virus causes the body to produce antibodies that provide some crossover protection against the other type should it entering the body.
That’s why when a person with a prior HSV infection does contract the other type, the first episode tends to be less sever than in a person who has no prior antibodies.
So, let’s look at a few scenarios:
You have genital HSV-1 and your partner has genital HSV-2 and you have unprotected sex.
There is a small risk that you will get HSV-2. However, it’s not verylikely that your partner will get genital HSV-1. It’s rare for a person with genital HSV-2 to get HSV-1.
Your partner has genital HSV-2 and you perform oral sex on him or her. Will you get oral HSV-2?
Not likely. Almost 100% of HSV-2 infection is genital. Part of the reason is that most people have oral HSV-1 - providing some immunity against infection against HSV-2.
You have genital HSV-1. Can you give your partner a genital HSV-1 with genital sex?
Yep. But not as easily as it istransmitted through oral sex. Remember. The mouth is the preferred site for HSV-1 infection and the virus sheds less often outside its site of preference. A study in 1995 shows that about 25% of people with asumptomatic genital HSV-1 shed virus vs.55% of people with genital HSV-2.
Charlotte Grayson, M.D., is an internist in the Atlanta, Georgia, area. She is a 1995 graduate of Boston University School of Medicine. She completed her internal medicine residency in 1998 at the Medical University of South Carolina in Charleston. Previously, Dr. Grayson was Senior Medical Editor for a leading healthcare content company. She frequently speaks to the media about health, appearing on Fox News and CNN and contributing to TIME, Real Simple, Women’s Health, and WebMD magazines.