Can Cold Sores Give Me Genital Herpes?

Young woman touching lips, close-up
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Question: Can Cold Sores Give Me Genital Herpes?

Answer: Although the majority of the time, HSV-1 infects the lips and HSV-2 infects the genitals, it is possible to transmit the two herpes viruses to their less preferred sites during oral sex. In fact, HSV-1 accounts for approximately one half of all cases of genital herpes in developed countries... so much for it "just" causing cold sores or, for that matter, for cold sores being protective against a genital herpes infection.

Background: Many people are surprised to learn that they can be infected with genital herpes if their partners "go down" on them when they have a cold sore. The assumption that oral sex is safe sex is a pervasive one, and few parents, doctors, or educators talk about the fact that it does have risks. However, there is some data suggesting that HSV-1 is actually MORE infectious than HSV-2, which explains why a growing percentage of genital herpes cases are caused by the virus formally known as the oral herpes virus.

The stigma associated with herpes can make it particularly hard to have these discussions. People are ashamed to talk about the virus, which leads to a lack of knowledge. It may also lead to increased transmission. After all, you can't accurately evaluate your risk tolerance and decide how and when you want to have safe sex if you don't even know that the risk exists. In contrast, being aware of the risk can help you take proper precautions and reduce the likelihood of infection...

or at least increase the amount of time before infection takes place.

Fortunately, it is possible to reduce the risk of herpes transmission during oral sex by using condoms (for fellatio) or dental dams (for rimming or cunnilingus.) These barriers aren't perfectly protective, but they can definitely make transmission less likely.

So can avoiding oral sex during a breakout, because although transmission is possible even when symptoms aren't present, it's more likely when they are. Furthermore, if someone with cold sores has frequent outbreaks, they can use suppressive therapy to both reduce their symptoms and the possibility of transmitting the virus to their partner during kissing or oral sex.

Source:

Jin F, Prestage GP, Mao L, Kippax SC, Pell CM, Donovan B, Templeton DJ, Taylor J, Mindel A, Kaldor JM, Grulich AE. "Transmission of herpes simplex virus types 1 and 2 in a prospective cohort of HIV-negative gay men: the health in men study." J Infect Dis. 2006 Sep 1;194(5):561-70.

Gupta R, Warren T, Wald A. "Genital herpes." Lancet. 2007 Dec 22;370(9605):2127-37.

Wald A, Krantz E, Selke S, Lairson E, Morrow RA, Zeh J. Knowledge of partners' genital herpes protects against herpes simplex virus type 2 acquisition. J Infect Dis. 2006 Jul 1;194(1):42-52.

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