Can a cold sore cause genital herpes?

July 22, 2015

Image: The Glow.

Anyone who suffers from cold sores knows there are several golden rules that will protect loved ones from being infected while the sore is active.

The drill goes something like this: Don’t kiss someone while you have a cold sore. Don’t share cutlery, lip balm, creams, face towels or anything else that could have come into contact with the infected area. Keep your hands clean so the virus can’t be transmitted to other parts of your body (or someone else’s).

So where does that leave us where sex is concerned? You can still have intercourse without kissing someone directly on the mouth, so… that’s safe, right?

Kissing is out of bounds... but what about sex?

Nice optimism there, but it's actually quite risky business due to how the two herpes viruses — HSV-1 and HSV-2 — interact.

"There are two different types of herpes virus — herpes type 1, which is on the lips traditionally; and herpes simplex type 2, which is in the genital area," explains Dr Dasha Fielder from Sapphire Family Medical Practice in Sydney's Bondi Junction.

"But because of the different types of sexual practises [like oral sex], it obviously can be interchanged, and somebody who has a cold sore can potentially give genital herpes to someone who has never been exposed to the virus if the right sexual activity is performed."

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You've probably figured by now that oral sex is a bit of a danger zone here. Herpes is a highly contagious virus, and you don't even need to have an 'active' lesion to spread it — a tingling or numb sensation on your face (hello, impending cold sore) indicates risk of infecting a sexual partner. (Post continues after gallery.)

Popular forms of birth control

Contraceptive pillThe Pillis the most popular form of birth control. There are two types: the combined pill, containing two hormones, and theprogestogen-only, or mini, pill, which only contains one female hormone. The combined pill works by preventing the ovary from releasing an egg each month. The mini pill changes the mucus at the entrance of the uterus, which stops sperm from entering. Both are 99.7% effective; however, they don't offer protection from STDs.

Intrauterine deviceIUDs are small, T-shaped devices that are inserted into the uterus by a doctor in order to prevent pregnancy. There are two types of IUD: copper, which affects the movement and survival of sperm in the womb while changing the lining of the womb;and hormonal, which releases progestogen (a synthetic version of the naturally-occurring hormone progesterone) into the uterus. Although IUDs have a success rate of more than 99%, only around 2% of Australian women currently use one.

CondomsThe male condom is a barrier contraception that prevents both pregnancy and the transmission of STDs. They work by collecting semen so it doesn't enter theman's partner's body. Condoms are 95 to 99% effective at preventing pregnancy.

The female condomThe female condom is a pre-lubricated sheath, which loosely fits inside of the vagina. The condom has a removable ring, which helps to insert the sheath and keep the condom in place. A larger ring remains on the outside to cover the opening of the vagina. They are designed to fit all women and can only to be used once. Due to misuse of the product it is only 79 per cent effective.

DiaphragmLike the male condom, the diaphragm is a barrier method of contraception. It's a shallow silicone dome that's inserted into the vagina andcovers the cervix, which is the entrance to the uterus. It's held in place by the pelvic muscles, and works by preventing sperm from entering the uterus. After sex, diaphragms need to remain in placefor another six hours, in which time the sperm inside the vagina die. This method is 88 to 94% effective at preventing pregnancy, although this rate increases with experience.

Birth control implantThis is a 4cm-longimplant that is inserted into a woman's upper arm, just under the skin, by a doctor. It releases a hormone called etonogestrel, which prevents ovulation and thickens the mucus in the cervix, which can stop sperm from entering. Contraceptive implants - usually sold as Implanon - are removed under anaesthetic every three years, and are close to 100% effective.

Vaginal ringVaginal rings are soft plastic rings that contain the same two hormones as the combined pill - oestrogen and progestogen. The ring is inserted into the vagina, where the hormones are absorbed into the body and then prevent the ovaries from releasing eggs. Once inside the ring can't be felt, and it needs replacing every three weeks (with one week's break in between). When used correctly, this method is more than 99% effective.

Depo ProveraDepo is a long lasting hormonal injection. The synthetic form of progesterone is administered every 12 to 14 weeks to woman, preventing pregnancy within this ongoing time period. The injection, which is given in the buttock or muscle of the upper arm, prevents ovulation and thickens the mucus in the cervix, helping to block sperm. The injections are 99 per cent effective but do not protect against STDs. Male contraceptive injections are currently being trialled

The morning after pillEmergency contraception (popularly referred to as the morning after pill) is used to prevent a pregnancy following unprotected sex. Other reasons include missing a contraceptive pill or a condom breaking. It is common in Australia to use the progestogen-only method. This entails a dosage of EC pills containing progestogen or the synthetic version. A doctor can prescribe the pill or they can be bought over the counter at a pharmacy without a prescription. Emergency contraceptionis 85 per cent effective in reducing the risk of pregnancy.

SterilisationSterilisation is a permanent form of contraception. For women there are two types of sterilisation: tubal ligation, in which clips are placed on the fallopian tubes, or tubal occlusion in which a device is inserted into the tubes. These methods work by preventing the sperm from reaching the egg. Tubal litigation is 99.5 per cent effective. The Vasectomy (for men) works by cutting and blocking the tubes called the vas deferens, preventing sperm from leaving the testicles. The chances of impregnation with a vasectomy are 1 in 1000.

"Usually people who get cold sores will know a day before, or 10 hours before you get the ulcer on your lip; you get a little tingle, a numbness, and then you get the lesion after that. [It's] the same thing with the genital area — you may just feel a bit of an itch or discomfort, but don't have a lesion yet and engage in sexual intercourse with your partner," Dr Fielder says.

Interestingly, Dr Fielder says people who have herpes type 1 (i.e. cold sores) have a reduced chance of contracting the genital form, because they've already got immunity to a type of herpes virus. "But if you don't have cold sores and you engage in sexual activity [like oral sex] with someone who does, they can absolutely give you genital herpes," she adds.

Genital herpes is extremely common in Australia; it's estimated to affect between one in six and one in four people, whether they're aware of it or not, and it's on the rise. Dr Fielder believes this is linked to an education gap with regards to the different forms of contraception and the protection they offer for different sexual acts.

"Since we've introduced the oral contraceptive pill and women are using it for contraception, they're forgetting to use barrier methods for contraception, like condoms," she says.

Be aware, not alarmed.

"With oral sex, some people just aren't aware that it's the same thing [as intercourse] and you can contract a virus that way. Sometimes people are unaware that they carry the virus. They don't even know they have a cold sore, it'll be just starting and that's how they can give it to their partner."

To prevent the spread of herpes, Dr Fielder recommends couples use barrier birth control methods like condoms, which can reduce the risk of STIs by around 70 per cent. "Also, make sure you wear the condom not just during the actual penetrative intercourse, but before that as well — herpes can be spread through any touching," she says.

For carriers of HSV-1 or HSV-2, it's best to avoid any sexual contact (including oral sex) from the moment you notice any tingling or numbness, and then for at least two days after any lesions have healed. (Post continues after video.)

While there is currently no cure for the herpes virus — once you contract it, you'll always have it — there are effective treatments available that help to suppress the symptoms, and ease your concerns about spreading the virus.

"If you do have genital herpes, and you would like to have a lesser chance of spreading it to your partner, you can speak to your doctor about going on suppressive medication. It's just a simple tablet you take every day, and it virtually eliminates the chance of you spreading it," Dr Fielder says.

There are also good treatments for oral herpes; Dr Fielder says anti-viral medications can suppress cold sores at a very early stage and stop the onset of those painful lesions, so you don't have to put up with them for days on end.

There's no cure for cold sores, but you can suppress them.

Being diagnosed with genital herpes in particular can be quite traumatic, Dr Fielder says, and having 'The Talk' with a new partner can be daunting for someone who is a carrier. The best approach here is to be open and communicative, and set rules about not having intercourse when symptoms present.

"It certainly opens a can of worms when you're in a new relationship and all of a sudden you have an ulcer in your private area and you start to worry. It's best to be open about it," Dr Fielder says.

"The important thing is putting thought into it, and being aware of how easy it is to spread herpes. It's not just sex; mothers spread it to their babies because they kiss them. We just have to be careful."

Do you have cold sores? Do you have any tricks for relieving them?

6 ways to get rid of a cold sore fast

Honey and Apple Mask.

2. Ice it, baby.

3. Make friends with Lysine.

4. Compeed = lifesaver.

5. Vitamin E caps.

6. Avoid chocolate.

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