Oral Sex and Herpes

[Aly_]

Hi there, my boyfriend and I of many years are sexually active, but use condoms for penetrative sex (I am also on birth control). We are both clean and have only been each other’s partners. My boyfriend used to get cold sores often when he was younger - it’s been quite a few years since he’s had an outbreak though. I’ve never had one, just had canker sores on my gums before (I don’t think that this counts as herpes, maybe I’m wrong? Haha they usually appeared after consuming too much sour candy ). If he ever had an active one in the past, I steered very clear of him lol. Lately, we sometimes engage in unprotected oral sex. I was wondering, how likely is it that he could pass on his HSV complex to my genitals when doing this now? I’ve read your articles on it, and I know that there’s more of a risk when a cold sore breakout is active (which hasn’t been the case for him in so long), but I believe that I read that there’s still also a risk of passing it on from his mouth just bc the virus is in his system forever. I don’t think that we would consider using dental dams, since it just doesn’t seem like something we’d want to do for the rest of our lives together, but it makes me wonder about our sexual health. Just curious on this issue - thank you!

[Melamyl]

I got infected with herpes simplex virus 4 years ago when I was very active with different kinds of sex. One thing my doctor told me (that I will never forget) was that herpes will stay in me forever, it will be dormant for some time then it will be active again by showing bumps on my nodes (whenever my body feel extreme stress, it will show) and that it will be contagious forever. I'm not sure if my boyfriend of 3 years has gotten it but as of this moment, he hasn't shown any related symptoms with herpes. It may show differently to others but I'm not so sure.

[Heather]

Hey there, Aly.

I wouldn’t suggest making decisions about safer sex for the present based on what you may or may not want to do for the rest of your life. Separate from the fact that very few people have one lifelong sexual partner, that’s just not a sound way to make health decisions. We want to make them based on our current circumstances, not project them far into the future in this way, you know? If you’re going to project into the future with this, the sound way to do that is to think about how genital herpes might impact that future.

It is certainly possible that you will contract his oral herpes genitally, and you’re right, it is way, way more of a risk if he’s getting or having an outbreak. But it is still a risk when he isn’t, as the virus can still shed at other times.

So, how do you feel about that risk? Would you rather go without protection dams can offer with the understanding that it means taking that risk or use (or at least try and use?) dams and reduce that risk? That’s ultimately for you to decide, and there’s really not a right or wrong answer here.

[Aly_]

That's a good point, thank you. We're planning on getting married soon, which is why I mentioned our future together since I really don't see us ever breaking up, but that makes sense. I know that we could just not use oral sex, but sometimes it feels extremely intimate, and to have a barrier feels partly like a removal of that intimacy. I suppose I view it as the same way that I view sex with a condom - right now we need one, as we're unmarried, still in school and I want to use more than one method of contraception to avoid pregnancy, but once we're past this stage, I would like to experience sex without it, because I feel like that would be a big step in our relationship, and I'd be comfortable at that point. I'm not sure if my comparison is making sense, but I view him as the only partner who I would like to experience wholly. The same way that any two people would have consensual, condom-less sex; knowing the risks, but trusting the process along the way.

We've tried dams once before, but the feeling, taste, and sensation was not something that I enjoyed personally. It just seems (pardon my childish language!) a bit unfair to think about the fact that having unprotected oral sex with my only, long-time partner of so many years could lead to such harrowing consequences, especially since we're each other's firsts for everything!!! I know that doesn't really matter but idk, it's a part of my mentality I think. Like, I could potentially never experience (for my whole life) barrier-free oral sex again if I let this worry overtake me.

I was wondering if there were stats available regarding how likely the contraction of genital herpes is when an outbreak is not apparent? I read here that using dams could help reduce it by 70%, but was just curious. Thanks again for the reply!

[Heather]

You don't have to deal with this by worrying (or by avoidance so you don't have to worry). That doesn't do anything, anyway, save create stress. The way to deal with it is just by doing what you're doing: getting all the information you can, then thinking about it, then talking about it together with your partner.

Per the stats you're asking for, let me poke around a little bit more and circle back. That information is obviously going to be tricky to come by, because a) acquiring the virus when the carrier is asymptomatic is far less common than the alternative, and b) it's very hard to study something that isn't happening and that people don't usually know about. I'm not finding anything new or that specific on it in a cursory swoop. Based on what I know, I'd say it's rare, but I haven't tried to find this particular info in a while, so I want to make sure I'm not missing anything new. I'll hop back after I do that a little more, I just didn't want to leave you hanging.

I'm also happy to talk with you about how to make dam use feel better if you're interested, now or later.

I do think that whatever choice you make with this, it would probably be beneficial to rethink some of the ideas you have about this stuff, because not only do I think they're probably playing a part in your decisions (and not in a good way), you may well have to do things like add safeties for yourself or other partners throughout life. So, I just want to take a sec to quickly debunk a couple things.

Intimacy is emotional, not physical. In other words, the intimacy we experience with physical sex is something we do because of our brains and our emotions. Even our idea certain things are more or less intimate is itself intellectual. A condom or a dam can't get in the way of intimacy (unless risk-taking is something intimate for you), just like a prosthetic hand, a sex toy, a piercing, an inability to get an erection, or a lack of desire to have intercourse can't. Heck, people don't even feel barriers most of the time once they know how to use them and get good at it. So, one, be it now or later, if and when something is involved in sexual intimacy besides just your bodies with literally nothing else, please just know nothing like that or a million other things are impediments to intimacy, and sex without any of those things isn't more intimate by default. <3

I want to make clear that an STI, herpes included, isn't harrowing circumstances. Herpes is one of the most common infections on the planet, and particularly if you're with someone with it, it'd be good for everyone if you can dial that down some and normalize it, you know? Getting an STI also is something that happens to people all the time, including to people who are each other's first partners for all or some kinds of sex. Not getting an STI isn't a reward for good behaviour, just like getting one isn't a punishment for bad behaviour. The hardest part of living with any STI (or infection like oral Herpes that can be classified as such and transmitted that way), assuming a person doesn't become very ill, is usually social stigma. That can be a lot harder when it's in your immediate life, and sometimes even partner who have internalized stigma and aren't being overt about it can wind up having it leak out in some ways.

So, for your partner's sake, but also just to give you something else to let go of that can mess with our heads when we're trying to make these choices, I'd encourage you to just take an inventory of how you think about things like Herpes and see if you can't start to adjust that a little so instead of thinking of it as a horror, for instance, you think of it like you might think about a flu, arthritis or even COVID: as value-neutral. Get what I mean?

[Heather]

Also, if you want another solid source of information about Herpes and other infections, ASHA has been reliably providing good information for over 100 years. Their page on Herpes is here: https://www.ashasexualhealth.org/herpes/

[Heather]

I found a few things worth sharing.

The recent research portion of this article at Nurx may be of interest: https://www.nurx.com/faq/can-you-get-he ... -oral-sex/

It also appears HSV-1 is more present in oral secretions in some than previously thought (rather than almost only being about sores and skin), which is probably part of the why for the shift mentioned in the next batch of research I posted below: "Apparently, asymptomatic shedding of HSV-1 in oral secretions is relatively common, having been reported in as many as 9% of adults. Therefore, among HSV-1-seronegative women, receptive oral sex from a partner with oral herpes should be considered an activity that can result in transmission of the virus." That's from here:

From this study (https://bmcmedicine.biomedcentral.com/a ... 019-1285-x), looking at how HSV-1 is currently being transmitted, it doesn't give a rate of HSV-1 to genital transmission when people are asymptomatic, but it did find this, which I think is important to bear in mind when making these decisions:

For those aged 15–49 years, nearly 25% of incident infections are genital. Most genital acquisitions (> 85%) were due to oral-to-genital transmission through oral sex, as opposed to genital-to-genital transmission through sexual intercourse.

HSV-1 epidemiology is undergoing a remarkable transition in the US, with less exposure in childhood and more in adulthood, and less oral but more genital acquisition. HSV-1 will persist as a widely prevalent infection, with ever-increasing genital disease burden.

So, doing more looking around at recent research, I'd probably move my "rare" from earlier to a higher level of risk.

[Aly_]

Wow, Heather. Thank you SO much for all of these resources. I think that it's so important what you said about intimacy - sometimes I just forget that it's really about our emotions and the way we feel; not physical proximity. Thank you so much for that. Also, I didn't mean to contribute to the unfair stigma that herpes is harrowing, I suppose I really just meant that while a diagnosis may seem harrowing at first, an STI can just make someone feel isolated and afraid, when they really do not have to be since there are so many resources like this great website to help. I really didn't mean to make it seem as though I judge those with herpes at all, sorry if it came across that way Thank you for all of those additional resources, and for taking the time to educate and talk to me about this. I appreciate it!!

[Heather]

No worries, and no judgements from my side, either.

I’m glad to help, and also happy to keep working this through with you if you want or need any more help or support.