[Question #6346] HSV-2 Transmission -- Oral sex

17 months ago
My boyfriend is hsv-2 positive, but I am not. (I just had blood testing done which showed Hsv-1 positive, which I’m assuming is oral because I’ve never had a genital lesion. I’ve maybe had an oral lesion once, but I thought it was a zit) I met with my obgyn to ask her questions about transmission and whatnot, but I feel like some of her responses were inaccurate, based on things I’ve read. However, there is so much conflicting information online, so I was hoping you could clear things up.

She told me that I could get HSV-2 with genital lesions simply by giving my boyfriend a blowjob. She said if I had a cut in my mouth, the virus would get in my bloodstream and travel to my nerves, which would infect me and cause me to have genital lesions. Is this accurate? Can it really spread that way? 

Also, what is the chance of me getting oral lesions from hsv-2? I’ve read it’s not as likely to create lesions on the mouth, but that it can happen rarely. How rare? Like, rare enough that it's odd to see that happen? Are there factors that make it more likely to happen, such as a poor immune system from HIV or cancer? Or is it just random?

Would having HSV-1 orally prevent me from getting HSV-2 orally, or could I potentially get both strains orally? Or can I potentially give my boyfriend HSV-1 lesions genitally if I have oral hsv-1? Or does him having Hsv-2 already prevent that?

Thanks!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
17 months ago
While it is possible to acquire HSV 2 orally, that is an unlikely event.  HSV 2 has a strong site preference for the genital area.  And it would not take a cut in your mouth for this to happen, if it did happen - the tissue of the mouth is very thin and the virus could enter without a cut.  But again, that is really unlikely.  And if you did acquire it by giving him oral sex, the infection would remain oral, it would not become genital.  That's totally inaccurate.  And yes, this is rare enough that I have seen it in my practice maybe 5 times in 35 years.
Once a person has HSV 2, they would almost never acquire HSV 1.  Period.  Having oral HSV 1 would like not prevent you from acquiring HSV 2 orally, but again, that is rare.

Terri
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17 months ago
Thank you for all of that info and clearing things up! 

So to follow up on what you said about HSV 2 making HSV 1 less likely, would the reverse be true for HSV 1?......Would having HSV 1 genitally decrease the risk of getting HSV 2 genitally?

I ask because, to my knowledge, I have not had sores in either area (besides maybe that zit near my mouth). My ex-husband has oral HSV 1 I found out, and I let him do oral sex on me several times in the past, so I’m guessing there could be a chance of me having HSV 1 in both locations, asymptomatically.  If I already have HSV 1 genitally, could I end up with HSV 2 genitally as well? And if the HSV 1 is asymptomatic, would a subsequent HSV 2 infection also tend to be asymptomatic?

Is there a reason that some people are just asymptomatic carriers while others have mild/few or sometimes severe/frequent outbreaks? Are there strains of the HSV 1 and HSV 2 that are "stronger" and affect people more, or do people's immunity or maybe just their genetics decide how their body will respond? (For example, if my boyfriend had mild/infrequent outbreaks and I got HSV 2 from him, should I expect the same severity/frequency as him?)

Also, to clarify, having HSV 2 makes acquiring ALL HSV 1 very unlikely, or just genital HSV 1? Basically, if I have oral HSV 1, could I give him oral HSV 1 as well? (His testing only showed HSV 2).
17 months ago
Sorry, I forgot to ask, can semen carry the virus? I know the virus doesn't live long outside the body, and that it's not found in semen, but I didn't know if it could semen could transport it, if that makes sense?  (I read on other posts that the shaft is the highest area for shedding and I didn't know if that meant just from the exterior skin, or if that meant internally as well?)  

So basically, if I were to give my boyfriend oral sex or a hand job, and I got semen accidentally on my pubic area, thigh, butt, etc, could that be a risk for transmission?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
17 months ago

 

So to follow up on what you said about HSV 2 making HSV 1 less likely, would the reverse be true for HSV 1?......Would having HSV 1 genitally decrease the risk of getting HSV 2 genitally?

The reverse is NOT true, but having HSV 1 can make the acquisition of HSV 2 happen with few or no symptoms

 If I already have HSV 1 genitally, could I end up with HSV 2 genitally as well? And if the HSV 1 is asymptomatic, would a subsequent HSV 2 infection also tend to be asymptomatic?

You could acquire HSV 2 genitally as well.  And if you did acquire HSV 2, it would be more likely to have symptoms if you have HSV 1 already but have no symptoms.

Is there a reason that some people are just asymptomatic carriers while others have mild/few or sometimes severe/frequent outbreaks? Are there strains of the HSV 1 and HSV 2 that are "stronger" and affect people more, or do people's immunity or maybe just their genetics decide how their body will respond?
The current opinion about this is that it's about the individual's immune response rather than something about the virus that makes recurrences more or less frequent or severe, not the virus itself.

Also, to clarify, having HSV 2 makes acquiring ALL HSV 1 very unlikely, or just genital HSV 1? Basically, if I have oral HSV 1, could I give him oral HSV 1 as well? (His testing only showed HSV 2).

ALL HSV 1.

Terri
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