Herpes, Cold Sores, and Oral Sex: What You Need to Know
Cold sores are not something most people think to tell their potential sexual partners about. But the term “cold sore” is a softer and often unknown synonym for herpes simplex virus type 1 (HSV-1).
The World Health Organization (WHO) estimates that nearly 3.7 billion people across the globe under the age of 50 (67 percent of people) have HSV-1. Additionally, researchers estimate that nearly 140 million of these are genital HSV-1 infections. While most genital herpes cases are caused by herpes simplex virus type 2 (HSV-2), genital HSV-1 has been on the rise due to suspected increases in oral sex.
Because herpes is so common, it’s not surprising that many people question how to protect themselves and negotiate safe oral sex with partners that may have herpes infections. Here’s what you need to know.
HSV-1 vs. HSV-2: Know the difference
HSV-1 and HSV-2 are part of the larger family of herpes viruses, formally known as Herpesviridae, of which chicken pox and shingles are also members. HSV-1 prefers to lay dormant in the base of the neck, while HSV-2 calls the base of the spine its place of residence.
Both viruses can cause sores either orally or genitally (depending on where you were infected). Most of the time, but not always, HSV-1 is responsible for breakouts around the oral cavity, while HSV-2 causes breakouts in the genital region. Further detail about the differences between the viruses can be found here.
Despite the social stigma that herpes results in severe symptoms, that is not always the case. According to the Centers for Disease Control and Prevention (CDC), most people infected with HSV are asymptomatic, although some will inevitably present symptoms.
Genital HSV-1: Is it on the rise?
Because oral HSV-1 rates have been on the decline in children, it is possible that “people may become more susceptible to contracting a genital herpes infection from HSV-1” as adults, according to the CDC. Someone who receives oral sex from a partner who is infected with oral HSV-1 is at risk of contracting genital HSV-1.
This transmission can bring uncertainty and doubt even in monogamous and the most secure relationships. For example, a husband who has oral HSV-1 and orally pleasures his wife may transmit the virus to her genitals. Because transmission of herpes is not often discussed in these terms, couples may be left confused, and perhaps even feeling unnecessarily betrayed in these instances.
How is herpes transmitted?
Herpes is spread through skin-to-skin contact. Oral HSV-1 is spread through contact with the virus in sores, saliva, and areas surrounding the mouth. Genital HSV-1 and HSV-2 are transmitted through genital contact with skin, sores, and fluids of those infected. HSV-2 is more common in women than men because “sexual transmission of the virus is more efficient from men to women than women to men” based on genitalia and mucosal membranes.
While condoms and dental dams offer some protection, there are still areas of the skin left uncovered and susceptible to potential infection. Both HSV-1 and HSV-2 are most likely to be transmitted when symptoms are present; however, this is not always the case.
Most people with herpes don’t have symptoms, which makes it difficult if not impossible to know if the virus is active underneath one’s skin. This further reinforces how important communicating about our sexual health is with current and potential partners and advocating for ourselves.
Can I get genital HSV-1 if I have oral HSV-1?
The WHO states that those who have HSV-1 in one location are at very low risk of getting it again in another location, however, they are still at risk for contracting HSV-2 and should take the appropriate measures of protection. These protection methods include barrier methods (such as condoms, female condoms — although they are harder to come by these days — and dental dams), antiviral medications, and navigating around skin-to-skin contact during outbreaks (if they are visible).
Should I tell my partner if I have oral herpes?
If you plan on engaging in a sexual relationship with your partners, it shows respect to tell them before contact takes place. Some may argue that it is unnecessary to tell a partner before kissing takes place, but having these conversations before contact, as opposed to interrupting contact, may yield better results.
Bradley H, Markowitz L, Gibson T, et al. Seroprevalence of herpes simplex virus types 1 and 2—United States, 1999–2010. J Infect Dis, 2014. 209(3):325-33.