Oral HSV-2 can be passed via saliva

Dear Dr. Roach: I saw your recent article about a 57-year-old woman’s question about herpes, and thought it would be good to reach out to see if you could help me. I am struggling to find good information about my new condition.

A recent partner did not tell me he had HSV-2, and now I have it in my throat. I cannot find what precautions I need to take to, unlike this unscrupulous person, to protect other partners. A nurse practitioner I spoke with suggested it could be passed by saliva, so even kissing and sharing forks, for example, are risky. I’m not saying I don’t believe that, but it is gloomy news that I have been unable to verify.

HSV-2 in the throat is apparently pretty unusual, and finding information specific to it is a real challenge. Can you help me, please? Do you have any advice about finding a specialist?

J.A.

Answer: Herpes simplex virus 1 normally is passed orally and causes cold sores. HSV-2 is normally passed genitally and causes genital lesions. However, either virus may infect either location, so I have often seen genital HSV-1, but only rarely seen oral HSV-2. It happens more frequently in people with compromised immune systems, but occasionally in people with no medical conditions. Unfortunately, it is possible to transmit oral HSV-2 to a partner through contact with saliva. Although the risk is much greater if you have any symptomatic lesions, it is possible to shed infectious virus even with no symptoms.

I am terribly sorry you became infected. Your partner may have never known they were infected. Many people with genital herpes are unaware they have it, never having had a breakout, or not recognizing a mild breakout for what it was.

Primary care doctors have experience with genital herpes, as do all gynecologists. There are some doctors who make care of people with herpes their focus of practice and research, such as experts in infectious diseases. I recommend consultation with an expert to discuss all your concerns.