Freaked out about cold sore giving girlfriend genital herpes

I just learned about the potential of oral HSV-1 to spread to the genital region, and I feel a little freaked out and worried about my girlfriend of 3 years.  I don’t believe I’ve ever kissed her or performed oral sex anywhere near the time of a cold sore break out, as they are rather infrequent for me (once every 1-2 years), but I have performed oral sex on her several times without protection.  On top of that, she has never had an outbreak of HSV-1 anywhere as far as I know, but what are the chances that I have given it to her, either orally and/or genitally?

More generally, why is genital HSV-1 on the rise? I read that it’s because more college-aged people are performing oral sex these days, so the incidence is increasing. But does this mean that it has always carried the potential to spread to the genitals, or is this a mutation or a new strand of HSV-1? Last, when they say that HSV-1 can spread to the genitals, what sort of probability are they talking about? 

Please give me some more information to help put my mind to rest.

As we covered in a recent post, the old way of thinking about Herpes Simplex Virus – that type 1 (HSV-1) only causes cold sores on the lips while HSV-2 only infects the genitals – isn’t really applicable anymore.  While HSV-1 does prefer to live above the belt and HSV-2 below, both can infect the mouth or genitals.  So unfortunately, you’re right to be a little freaked out.  But let’s go through your questions to hopefully put you at ease.

Why is genital HSV-1 on the rise? Has it has always carried the potential to spread to the genitals, or is this a mutation or a new strand of HSV-1?

Genital HSV-1 is on the rise.  In fact, among sexually active adults, new genital HSV-1 infections are as common as new oral HSV-1 infections[1].  This is especially true for college aged people.  A study done at the University of Wisconsin in 2003 showed that the proportion of newly diagnosed genital herpes infections resulting from HSV-1 increased from 31% in 1993 to 78% in 2001 in college students[2].  A 2011 study involving college students showed that this trend continues; HSV-1 accounted for 78% of female and 85% of male genital herpes infections[3].

This is not because of any new strand of Super Herpes, but because of changing beliefs in what constitutes “safe” sex.  College students report having vaginal intercourse and oral sex at about the same frequency, but the problem is that because they assume oral sex is safer, they are much less likely to use a condom.  While it certainly eliminates the risk of pregnancy, oral sex doesn’t eliminate the risk of transmitting sexually transmitted infections and in fact, increases the risk of transmitting HSV-1 because it is spread by direct contact.  So HSV-1 has always had the ability to spread to the genitals, it’s just getting more of an opportunity nowadays. 

When they say that HSV-1 can spread to the genitals, what sort of probability are they talking about?  What are the chances that you have passed HSV-1 on to your girlfriend, either orally or genitally?

Unfortunately, it’s really impossible to say.  The closest thing to an answer that I could find came from a 2006 study that showed that transmission of HSV-2 can occur pretty quickly in new sexual relationships[4]. In 199 people who acquired HSV-2 genital infection after beginning a new relationship, the median length of the relationship was 3.5 months and the median number of sex acts before transmission was 40.  But the most important finding is that it took a lot longer for participants whose partners told them up front that they had genital herpes to acquire the infection compared with participants whose partners didn’t – 270 days vs. 60 days.  So even though it’s kind of an awkward conversation to have at the beginning of a new relationship, talk to your partner about this stuff – it’s the best way to keep you both as safe as possible.

If you have any questions about HSV or any other sexually transmitted infections, make an appointment to see us at the Student Health Center.  We can answer your questions, take a look at what’s worrying you and perform any necessary lab testing.

John A. Vaughn, MD
Student Health Services
The Ohio State University

[1] Langenberg AG et al. A prospective study of new infections with herpes simplex virus type 1 and type 2. N Engl J Med. 1999;341(19):1432.

[2] Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis. 2003;30(10):797.

[3] Horowitz , et al. Herpes simplex virus infection in a university health population: clinical manifestations, epidemiology, and implications. J Am Coll Health. 2011;59(2):69.

[4] Wald A et al. Knowledge of partners’ genital herpes protects against herpes simplex virus type 2 acquisition. J Infect Dis. 2006;194(1):42.

9 thoughts on “Freaked out about cold sore giving girlfriend genital herpes

  1. Lastnight I have my girlfriend oral sex and I have a cold sore but it’s not blistered up anymore is it possible for her to get genital herpes if she also gets cold sores but neither of us have genital herpes?!?

    • Yes. It has happened to us. From the moment you feel a tingle until a week after any sign is gone don’t go near her.

  2. Well I found out I had HSV 1 last year but I have never had a cold sore. Me and my husband went 10 months without having oral sex but finally did it this month and I’m freaking out. Do you think we are at risk for getting it down under with me not ever having a cold sore or ever having a brake out? And also why did my test show up I had HSV 1 but never even had a cold sore in my life?

    • hsv1 is very common a lot of people have this virus some with symptoms and some go unrecognized. The good thing to know is when you already have oral herpes the chances of catching it down below are very low chance as your body already has antibodies to the virus. The chances of you passing on the virus from your mouth to genitals with no symptoms and no sores are very unlikely.

  3. My boyfriend of 2 years has a cold sore on the more inside of his lip and it has popped and it’s been a few days since it broke open, today we had intercourse and he licked his hand to use as a lubricant… should we be worried?

  4. My husband had gave me oral sex when he had a cold sore and a month later I was tested for hsv2. How is it posibable that I had got the 2nd when he just had a cold sore.

    • Because HSV-1 (oral hopes simplex or ‘cold sores’) can spread to the genitals via oral sex. If you have ever had a cold sore yourself, then you may have antibodies that will stop you getting it, as folk who get cold sores have antibodies against HSV-1 that stop them getting it down below. You can still get HSV-2 though, as its a different virus.

  5. Am freaking out, I had oral sex with my partner, in the morning he said his lip felt swollen and within a couple of hours it developed into a blister/ cold sore! I’ve never had one before and am freaking that I may have contracted herpes!!! 2 days later my bottom lip is tingling but I’m really worried about it developing down below, we did not know he had one as there were no symptoms one was coming! What are the odds I will contract herpes due to the oral????

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