[Question #6254] HSV 1 - Oral Sex - HIV Risk

15 months ago
Dear Doctors:

I had a positive HSV 1 blood screen several years ago and I do suffer the occasional cold sore a couple times per year.  I'm a heterosexual male and although I do try to be careful about providing oral sex to a female when I have a cold sore, sometimes the breakout is subtle or I might simply forget in the heat of the moment.  I know this is a risk to my partner for passing HSV 1 to the genital area, which is the reason I do try to avoid engaging in oral sex during those times.  But mistakes do happen and I've also recently become concerned with my risk for acquiring HIV if I happen to perform oral sex on a female when I have a cold sore present.  I've also read studies that suggest those with HSV (regardless of type) are at greater risk for HIV even when symptoms are not present due to shedding, greater susceptibility, etc.

So my question is generally what the relative risk of acquiring HIV might be if I happen to perform oral sex on a female when I have a cold sore present?  

Also, because of my HSV 1 status, should I avoid performing oral sex altogether to protect both myself and my partner from the possibility of infection?

Thanks so much for all the great work and advice you provide on this forum.
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Welcome to our Forum.  I'll try to help.  As I suspect you know, HSV-1 is widespread.  Estimates are that as much as 60% of adult population may be infected, of whom many are unaware that they are even infected.  In recent years the prevalence of HSV-1 has begun to decline somewhat in the general population but the infection is still common and there is a better then 50/50 chance that any partner you have will have HSV-1 and therefor not be at risk for acquiring infection.  Nonetheless, the best practice is for you to let partners know that you get cold sores since transmission of HSV-1 can occur even in the absence of a visible lesion due to asymptomatic infection.  

With regard to HIV risk, the risk for acquisition of HIV is associated with genital infection and you are correct, having genital herpes is associated with increased risk for sexual acquisition of infection.  On the other hand, the risk for acquiring HIV through oral sex is very low.  There are rare occasions when HIV has been acquired as the result of performing oral sex on the penis of an infected man (fellatio) but this is rare (average risk for infection, IF partner is infected is less than 1 infection in 10,000 exposures). I am not aware of any cases in which oral sex has been acquired as a result of cunnilingus however.  Your female partners are more likely to acquire genital HSV through oral sex from you than you are to acquire HIV from them.

I hope that this information is helpful. EWH 

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15 months ago
Thank you for the information Doctor.

I suppose that if up to half of the US population carries HSV-1, there have likely been many instances in which someone with a cold sore has performed oral sex on a female, but still no documented cases of HIV infection through performing cunnilingus?

One other question - because I do try to avoid kissing or performing oral sex on a partner when I have a cold sore, I might instead engage in mutual masturbation.  If I were to inadvertently touch my lip or the cold sore with vaginal secretions on my fingers, would that constitute a potential risk for HIV infection assuming my partner were actually infected?

Thanks again.
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

The are certainly no numbers to refer to as to how many times a person with a cold sore has performed cunnilingus on an infected person but I would presume that it has occurred millions of times and, as I said, there are no data to suggest this has led to acquisition of HIV.

Good question regarding mutual masturbation.  These infections are transmitted through DIRECT contact and transfer of infection from an infected site on the hands had not been described.  I would not worry about this.   There is no known risk of AHIV from mutual masturbation.

EWH

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15 months ago
Thanks again and I know this is my last question.  The scenario I described of having masturbated a female partner and then inadvertently touched a cold sore on my lip with secretions on my fingers is exactly what occurred about a week ago.  I don't know my partner's status.  Does this warrant HIV testing?

I would not have otherwise thought anything of the experience but for the presence of the cold sore, which of course is now causing me some anxiety.

Really appreciate all the work you do here.
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Sorry if I was not clearer earlier.  There are no STIs, including both herpes and HIV, in which the transfer of genital secretions from one person to another on the hands results in infection.  The process of transfer in this was is a biologically inefficient process in which the organisms will not longer be transmissible.  It is for this reason that mutual masturbation is considered safe sex with no STI risk.  That you might have a cold sore at the time does not change this-still a no risk event. 

As you note, with this, 3rd response, this thread is no complete and as per Forum guidelines will be closed.  Please don't worry. Take care. EWH

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