HSV-I (Oral Herpes) : The Cunnilingus Infection Connection

dear dr. pinhas
my boyfriend had a chancre sore in his mouth. and he went down on me. can i get herpes like that? please don’t publish my name

Response from Dr. Pinhas

Presuming your boyfriend has herpes and has a papules ( fever blisters/cold sores) on his lips, or the inside of his mouth, his gums, his tongue or his throat, cunnlingus can be a mode of transmission for Herpes Simplex I, oral type. These papules are tiny painful blisters that have clear fluid with a tremendous amount of viral load. If and when the blisters rupture, they form an open sore and a red ring around it which means that an individual is shedding the virus and is highly contagious. Usually, people with oral or genital herpes  (Simplex II) experience an aura, which, a person is highly infectious and contagious, so it is wise to avoid contact during the warning stage until all the blisters and sores have healed.

Once the lesions have healed doesn’t mean that you are done with the virus.  Like all viral STD’s, there is a no return policy at your favorite department store.  You received it and it is yours for life.  The virus travels down the nerve pathways and lives in the basal ganglia in the back of the neck until some stressor nudges it out again to the surface of the oral cavity, in which case you become contagious again.  Stressors are varied: there are good ones and bad ones.  Winning the lottery; getting an A in class; having a hot date; going on vacation; bathing in the sun are all examples of eustress– good things that put your body into disequilibrium and cause the HSV-I to travel back out. Examples of  bad stressors,  known as distress, can be a cold; final exams; premenstrual tension; a visit to the dentist; a fight; depression, anxiety and generalized agitation can make the virus erupt like Mt. Vesuvius.  Sometimes certain innocuous foods can awake the HSV-I virus ( nuts, tomatoes, citrus fruits, etc.).

For the most part Oral Herpes is not transmitted sexually but rather through casual contact…drinking glasses and utensils not put in the dishwasher on sani-cycle. ( Be careful of those handwashed bar glasses- they are treacherous). Hand and face towels, lipstick, sharing cigarettes , joints or pipes are other casual ways of passing along the virus. Casual kissing, french kissing and oral sex whether it be fellatio or cunnilingus can also pass the virus along.  Over 100 million have HSV-I, so your boyfriend  is not alone but rather one of many.  Informal surveys of my classes suggest that two thirds of all of my students have been infected with fever blisters in their lifetime.  Whether all of these cases are HSV-I is hard to ascertain, but it gives us a good idea of the high prevalence rate of this ubiquitous virus.

If your beaux has transmitted HSV-I to your vulva, there are a number of actions you can take.  Going on a protocol of acyclovir, sold as Zovirax,  either in topical cream or pills  can reduce viral shedding, the number of  outbreaks in the future,  and the severity of the fever blisters.  So instead of them lasting 7-10 days, they might only show up as an aura ( pins and needles tingling)  lasting only a few days with less pain. Be aware that the  topical cream  isn’t as effective and can’t be used orally.  Some individuals find that taking L-Lysine, an amino acid,  purchased in the health food store, is helpful as a suppressive therapy. (I know that you did not ask me about Genital herpes, but if you have HSV-II, the same type of painful blisters occur on the gentialia and cervix,  lasting longer ( 10-16 days)   with more painful lesions than HSV-I. Valtrex, an anti-viral medication can be used daily as a suppressive therapy.  (This may prevent reactivation of the herpes lesions). Take ibuprofen ever 4-6 hours for pain; reduce stress ( easier said than done) and use relaxation techniques such as meditation and yoga.

Oral herpes can be avoided by being mindful during an active outbreak or prodromal symptoms ( pins and needles tingling).  Don’t let people come into contact with anything that has come into contact with your oral cavitity.  Your boyfriend needs to be aware of the symptoms of fever blisters emerging in his mouth so that he doesn’t go down on you during this time period.