Cold Sores and Oral Sex

Patient

Q: I have had the occasional oral cold sore for a long time. I currently have what I believe to be one. My girlfriend does not mind getting it orally (she might have it already), but how easily is it spread to the genitals? What if I kiss her and she performs oral sex? What if I perform oral sex?

Doctor

A:   There are two types of Herpes Virus: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Both are closely related. HSV-1 is traditionally associated with orofacial (mouth and face) disease, while HSV-2 is traditionally associated with genital disease. HSV is transmitted by close personal contact, and infection occurs via inoculation of the virus into susceptible mucosal surfaces (eg, oropharynx, cervix, conjunctiva) or through small cracks in the skin. Reactivation is more common in HSV-2 infection than in HSV-1 infection. However, in individuals with no symptoms viral shedding in saliva or genital secretions may occur in 1%-2% of infected persons and may be as high as 6% in the first few months after acquisition of the infection.
Research studies show that daily antiviral therapy can be given to reduce episodes of asymptomatic (in individual with no symptoms) genital shedding and to further reduce the risk of transmission; however, it is unclear how long this should be administered. Although not easily applicable to oral-oral contact, barrier protection using latex condoms is recommended to minimize exposure to genital HSV infections.

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