[Question #10461] Cold Sore Transmission

22 months ago

I'm a male that gets cold sores every few months. I began a new sexual relationship about 4 months ago. My partner says she has never gotten cold sores. 2 weeks ago I noticed a sore at the tip of my tongue. I initially didn't consider it to be a cold sore as I usually get them on my lip. That night my partner and I had sex which involved mouth to mouth kissing and penile/vaginal intercourse with a condom. She also performed oral sex on me, but I didn't on her. 2 days later we again had protected sex, kissed, and she again performed oral sex on me. It was later that night that I developed a cold sore on my lip. I’m now concerned that the sore on my tongue was actually a cold sore. She hasn’t noticed anything yet, but how likely is it that I transmitted the virus to her? Could she have transmitted it to my genitals by performing oral sex on me?

Terri Warren, RN, Nurse Practitioner

22 months ago

Usually a cold sore would not show up on the end of the tongue but it's not impossible, and given that you developed a cold sore subsequently, it's a bit of a concern.

The risk here, if I am reading this correctly, is the kissing only. Her performing oral sex on you does not present a risk for her acquiring the cold sore virus from you. And you did not perform oral sex on her. She should keep an eye on her lips for about 10 days and see how this goes. Any abnormal skin lesions around her mouth should be swab tested for herpes.

Terri

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22 months ago

So it's been about a month and she did not develop any cold sores. I'm just a little surprised I guess. She said she has never gotten cold sores and has never mentioned that she has genital herpes. Obviously the only way to know if she did have the herpes virus would be to get tested. But for arguments sake let's say she doesn't have the virus at all (HSV 1 or 2). Given the fact that I have HSV 1 and have been kissing and performing oral sex on her regularly for 4 months, wouldn't it be likely that I would have transmitted the virus to her either orally or genitally? I know from your book that the virus can shed when no symptoms are present. Or perhaps she does have HSV 1 (I'm just assuming orally) but is asymptomatic?

Terri Warren, RN, Nurse Practitioner

22 months ago

Transmission would not necessarily happen, no. Partners can be together for years and never transmit. But it is also possible that she is infected but asymptomatic, as you mention. So I was apparently confused - you give her oral sex also which I missed earlier. That does present some risk but if she is aware of your status and is willing to take the risk, I think you are OK. You've done what you should if you've disclosed your status to her.

Terri

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22 months ago

Sorry just to clear things up, as far as she knows, she has never gotten cold sores or had symptoms genitally. So without testing I can only assume that she is not infected with the virus (either type orally or genitally). Continuing with this assumption, given that I have oral HSV-1, it would be possible for me to transmit the virus to her by kissing or through oral sex, correct?

I guess I just assumed that I would automatically transmit my oral HSV 1 to her, given that we've been intimate for 4 months, which has involved kissing and me performing oral sex on her. But, as you mentioned, I simply could have been lucky and not transmitted the virus yet, or she perhaps does have HSV 1 but doesn't get or notice any symptoms. In this latter case, I wouldn't be able to infect her if she had oral HSV 1, and from how I've understood it in your book, it's very unlikely to get HSV 1 in a part of your body, once it's established in another part. So infecting her genitally by performing oral sex on her would be unlikely if she did have oral HSV 1.

It seems like it may be a good idea to refrain from performing oral sex on her (and maybe kissing) until she can get tested and know for sure.

Terri Warren, RN, Nurse Practitioner

22 months ago

Well, about 70% of those infected with HSV 1 are unaware that they are uninfected and about half the population between 14 and 49 in the US has HSV 1. So her opinion about her status may or may not be accurate. If she is truly uninfected (and the IgG test for HSV 1 misses 30% of HSV 1 infections), the it would be possible to infect her by giving her oral sex or kissing her, correct.

And you are also correct that if you are infected in one location in your body, it is highly unlikely that you would get it in a new location.

You could refrain from giving her oral sex until she gets tested, but remember the test misses a third of infections. AND most transmission of HSV occur in the first three months of a relationship, though not all

Terri

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