I am a male in my 40’s in a long-term relationship with a woman in Canada. I often have had my scrotum licked by sex workers and gay strangers from Grindr (either with a handjob or when receiving condom-protected oral sex). Can you help me understand my risk of contracting genital HSV-1 during these activities? Here are my assumptions: i) This is a very low risk encounter, and the risk will be higher for the gay men than for the sex workers, ii) If one of these partners had an active outbreak, or was shedding, there could be some risk of transmitting their oral HSV-1 to my scrotum, but this risk would still be very low, iii) In the rare case that I did acquire HSV-1 via this route, I would know within 3-7 days (assuming it was symptomatic). 

Can you weigh in on the assumptions above? Also, would applying something like coconut oil to my scrotum ahead of the encounter reduce whatever risk there is? And would applying hand sanitizer afterwards be wise, or just shower with soap as soon as I can?  

I have never seen nor heard of a patient who acquired genital HSV1 simply from tongue contact of the sort you describe. HSV transmission probably depends largely on "massaging" the virus into tissues, and superficial exposure (like licking) probably carries little transmission risk. I agree with you that such contact with scrotal skin is nearly zero risk, but disagree that the risk is likely to be higher for gay men than for sex between men and women (whether or not one partner is a sex worker). HSV1 transmission risk also is greatly influenced by the fact that up to half of all people in the US (up to 90% in some countries) have had oral HSV1 in childhood, which basically eliminates the chance of new HSV1 infection of any body site.

Yes, the risk would be higher if the oral partner had an obvious oral herpes outbreak at the time of exposure. But all things considered, I would suspect the chance of infection from an single exposure of this kind would be under one chance in several thousand.

Almost certainly coconut oil (or any other oil, ointment, etc) would make no difference at all in the risk of infection. Research in animal studies -- i.e. deliberately infecting experimental animals -- suggests that nothing applied after exposure reduces the risk of virus transmission, even if done literally minutes after exposure. At least we know that giving such animals IV doses of anti-HSV drugs immediately after exposure does not reduce the likelihood of infection taking hold.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

I don't know why you're so concerned about this anyway. Genital HSV1 is a minor problem compared with HSV2. Recurrent outbreaks are rare and sexual transmission appears to be almost non-existent. (Terri has often said that in her 40+ years managing thousand of patients with herpes, she's never seen a case of genital to genital HSV1 transmission; all genital HSV1 comes from oral exposure. So even if you were to have scrotal HSV1 someday, it would have little or no effect on your health or the potential for sexual transmission.)

And thanks again to you and Dr. Hook (and Terri) for all of the wonderful work over the years. I was sad to see MedHelp go offline, but glad to find you all here.