Oral and genital herpes

I agree with talking to a doctor... this is always a good idea. And, I appreciate the science that EhBeth offers. I don't think talking to a doctor is urgent unless you have symptoms. But, if it will make you feel better talk to a doctor. It is very likely the doctor will refuse to give you the test because it isn't medically indicated. They don't even routinely test pregnant women for herpes.

The CDC recommends against getting tested. It simply isn't worth it and the pain and stigma of a false positive is far worse than walking around with herpes and not knowing it.

There is a bit of concern trolling going on in this thread.

Okey dokey, I checked the CDC website and collected this i8nformation. It's lengthy, but if you care to see what the CDC says about Genital Herpes hears what they say. If the entire page doesn't get copied its easy enough to google CDC.gov for a more complete version. The CDC also provides specifics on just about every ailment (infectious) known to man.

But like some others have stated, see your urologist or GYN if you suspect you may have been infected.


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2015 Sexually Transmitted Diseases Treatment Guidelines

2015 STD Treatment Guidelines
Table of Contents
Introduction and Methods
Clinical Prevention Guidance
Special Populations
Emerging Issues
HIV Infection: Detection,Counseling and Referral
Diseases Characterized by Genital, Anal, or Perianal Ulcerscollapse
Chancroid
Genital HSV Infections
Granuloma Inguinale (Donovanosis)
Lymphogranuloma Venereum (LGV)
Syphilisexpand
Management of Persons Who Have a History of Penicillin Allergy
Diseases Characterized by Urethritis and Cervicitis
Chlamydial Infections
Gonococcal Infections
Diseases Characterized by Vaginal Dischargeexpand
Pelvic Inflammatory Disease (PID)
Epididymitis
Human Papillomavirus (HPV) Infection
Anogenital Warts
HPV-Associated Cancers and Precancers
Viral Hepatitis
Proctitis, Proctocolitis, and Enteritis
Ectoparasitic Infections
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References
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Questions and Answersexpand
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Treatment 2015 STD Treatment GuidelinesDiseases Characterized by Genital, Anal, or Perianal Ulcers
Genital HSV Infections
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Diagnostic Considerations
Virologic Tests
Type-Specific Serologic Tests
Management of Genital Herpes
First Clinical Episode of Genital Herpes
Established HSV-2 Infection
Severe Disease
Counseling
Management of Sex Partners
Special Considerations
Genital Herpes in Pregnancy
Neonatal Herpes
Genital herpes is a chronic, life-long viral infection. Two types of HSV can cause genital herpes: HSV-1 and HSV-2. Most cases of recurrent genital herpes are caused by HSV-2, and approximately 50 million persons in the United States are infected with this type of genital herpes (318). However, an increasing proportion of anogenital herpetic infections have been attributed to HSV-1 infection, which is especially prominent among young women and MSM (319-321).

Most persons infected with HSV-2 have not had the condition diagnosed. Many such persons have mild or unrecognized infections but shed virus intermittently in the anogenital area. As a result, most genital herpes infections are transmitted by persons unaware that they have the infection or who are asymptomatic when transmission occurs. Management of genital HSV should address the chronic nature of the disease rather than focusing solely on treatment of acute episodes of genital lesions.

Diagnostic Considerations

The clinical diagnosis of genital herpes can be difficult, because the painful multiple vesicular or ulcerative lesions typically associated with HSV are absent in many infected persons. Recurrences and subclinical shedding are much more frequent for genital HSV-2 infection than for genital HSV-1 infection (322,323). A patient’s prognosis and the type of counseling needed depend on the type of genital herpes (HSV-1 or HSV-2) causing the infection; therefore, the clinical diagnosis of genital herpes should be confirmed by type-specific laboratory testing (321,324). Both type-specific virologic and type-specific serologic tests for HSV should be available in clinical settings that provide care to persons with or at risk for STDs. Persons with genital herpes should be tested for HIV infection.

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Virologic Tests

Cell culture and PCR are the preferred HSV tests for persons who seek medical treatment for genital ulcers or other mucocutaneous lesions. The sensitivity of viral culture is low, especially for recurrent lesions, and declines rapidly as lesions begin to heal. Nucleic acid amplification methods, including PCR assays for HSV DNA, are more sensitive and are increasingly available (325-327). PCR is the test of choice for diagnosing HSV infections affecting the central nervous system and systemic infections (e.g., meningitis, encephalitis, and neonatal herpes). Viral culture isolates and PCR amplicons should be typed to determine which type of HSV is causing the infection. Failure to detect HSV by culture or PCR, especially in the absence of active lesions, does not indicate an absence of HSV infection because viral shedding is intermittent. Cytologic detection of cellular changes associated with HSV infection is an insensitive and nonspecific method of diagnosing genital lesions (i.e., Tzanck preparation) and therefore should not be relied on. Although a direct immunofluorescence (IF) assay using fluorescein-labeled monoclonal antibodies is also available to detect HSV antigen from genital specimens, this assay lacks sensitivity (328).

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Type-Specific Serologic Tests

Both type-specific and type-common antibodies to HSV develop during the first several weeks after infection and persist indefinitely. Accurate type-specific HSV serologic assays are based on the HSV-specific glycoprotein G2 (HSV-2) and glycoprotein G1 (HSV-1). Providers should only request type-specific glycoprotein G (gG)-based serologic assays when serology is performed for their patients (329-331).

Both laboratory-based assays and point-of-care tests that provide results for HSV-2 antibodies from capillary blood or serum during a clinic visit are available. The sensitivities of these glycoprotein G type-specific tests for the detection of HSV-2 antibody vary from 80%–98%; false-negative results might be more frequent at early stages of infection (330,332,333). The most commonly used test, HerpeSelect HSV-2 Elisa might be falsely positive at low index values (1.1–3.5) (334-336). Such low values should be confirmed with another test, such as Biokit or the Western blot (337). The HerpeSelect HSV-2 Immunoblot should not be used for confirmation, because it uses the same antigen as the HSV-2 Elisa. Repeat testing is indicated if recent acquisition of genital herpes is suspected. The HerpeSelect HSV-1 Elisa is insensitive for detection of HSV-1 antibody. IgM testing for HSV 1 or HSV-2 is not useful, because IgM tests are not type-specific and might be positive during recurrent genital or oral episodes of herpes (337).

Because nearly all HSV-2 infections are sexually acquired, the presence of type-specific HSV-2 antibody implies anogenital infection. In this instance, education and counseling appropriate for persons with genital HSV infections should be provided. The presence of HSV-1 antibody alone is more difficult to interpret. Many persons with HSV-1 antibody have oral HSV infection acquired during childhood, which might be asymptomatic. However, acquisition of genital HSV-1 is increasing, and genital HSV-1 also can be asymptomatic (318-321,338). Lack of symptoms in a person who is HSV-1 seropositive does not distinguish anogenital from orolabial or cutaneous infection, and regardless of site of infection, these persons remain at risk for acquiring HSV-2.

Type-specific HSV serologic assays might be useful in the following scenarios: 1) recurrent genital symptoms or atypical symptoms with negative HSV PCR or culture; 2) clinical diagnosis of genital herpes without laboratory confirmation; and 3) a patient whose partner has genital herpes. HSV serologic testing should be considered for persons presenting for an STD evaluation (especially for those persons with multiple sex partners), persons with HIV infection, and MSM at increased risk for HIV acquisition. Screening for HSV-1 and HSV-2 in the general population is not indicated.

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Management of Genital Herpes

Antiviral chemotherapy offers clinical benefits to most symptomatic patients and is the mainstay of management. Counseling regarding the natural history of genital herpes, sexual and perinatal transmission, and methods to reduce transmission is integral to clinical management.

Systemic antiviral drugs can partially control the signs and symptoms of genital herpes when used to treat first clinical and recurrent episodes or when used as daily suppressive therapy. However, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued. Randomized trials have indicated that three antiviral medications provide clinical benefit for genital herpes: acyclovir, valacyclovir, and famciclovir (339-347). Valacyclovir is the valine ester of acyclovir and has enhanced absorption after oral administration. Famciclovir also has high oral bioavailability. Topical therapy with antiviral drugs offers minimal clinical benefit and is discouraged.

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First Clinical Episode of Genital Herpes

Newly acquired genital herpes can cause a prolonged clinical illness with severe genital ulcerations and neurologic involvement. Even persons with first-episode herpes who have mild clinical manifestations initially can develop severe or prolonged symptoms. Therefore, all patients with first episodes of genital herpes should receive antiviral therapy.

Recommended Regimens*

Acyclovir 400 mg orally three times a day for 7–10 days
ORAcyclovir 200 mg orally five times a day for 7–10 days
ORValacyclovir 1 g orally twice a day for 7–10 days
ORFamciclovir 250 mg orally three times a day for 7–10 days
*Treatment can be extended if healing is incomplete after 10 days of therapy.

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Established HSV-2 Infection

Almost all persons with symptomatic first-episode genital HSV-2 infection subsequently experience recurrent episodes of genital lesions; recurrences are less frequent after initial genital HSV-1 infection. Intermittent asymptomatic shedding occurs in persons with genital HSV-2 infection, even in those with longstanding or clinically silent infection. Antiviral therapy for recurrent genital herpes can be administered either as suppressive therapy to reduce the frequency of recurrences or episodically to ameliorate or shorten the duration of lesions. Some persons, including those with mild or infrequent recurrent outbreaks, benefit from antiviral therapy; therefore, options for treatment should be discussed. Many persons prefer suppressive therapy, which has the additional advantage of decreasing the risk for genital HSV-2 transmission to susceptible partners (348,349).

Suppressive Therapy for Recurrent Genital Herpes

Suppressive therapy reduces the frequency of genital herpes recurrences by 70%–80% in patients who have frequent recurrences (345-348); many persons receiving such therapy report having experienced no symptomatic outbreaks. Treatment also is effective in patients with less frequent recurrences. Safety and efficacy have been documented among patients receiving daily therapy with acyclovir for as long as 6 years and with valacyclovir or famciclovir for 1 year (350,351). Quality of life is improved in many patients with frequent recurrences who receive suppressive therapy rather than episodic treatment (352).

The frequency of genital herpes recurrences diminishes over time in many persons, potentially resulting in psychological adjustment to the disease. Therefore, periodically during suppressive treatment (e.g., once a year), providers should discuss the need to continue therapy. However, neither treatment discontinuation nor laboratory monitoring in a healthy person is necessary.

Treatment with valacyclovir 500 mg daily decreases the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection (349). Such couples should be encouraged to consider suppressive antiviral therapy as part of a strategy to prevent transmission, in addition to consistent condom use and avoidance of sexual activity during recurrences. Suppressive antiviral therapy also is likely to reduce transmission when used by persons who have multiple partners (including MSM) and by those who are HSV-2 seropositive without a history of genital herpes.

Recommended Regimens

Acyclovir 400 mg orally twice a day
ORValacyclovir 500 mg orally once a day*
ORValacyclovir 1 g orally once a day
ORFamiciclovir 250 mg orally twice a day

*Valacyclovir 500 mg once a day might be less effective than other valacyclovir or acyclovir dosing regimens in persons who have very frequent recurrences (i.e., ≥10 episodes per year).

Acyclovir, famciclovir, and valacyclovir appear equally effective for episodic treatment of genital herpes (342-346), but famciclovir appears somewhat less effective for suppression of viral shedding (353). Ease of administration and cost also are important considerations for prolonged treatment.

Episodic Therapy for Recurrent Genital Herpes

Effective episodic treatment of recurrent herpes requires initiation of therapy within 1 day of lesion onset or during the prodrome that precedes some outbreaks. The patient should be provided with a supply of drug or a prescription for the medication with instructions to initiate treatment immediately when symptoms begin.

Recommended Regimens

Acyclovir 400 mg orally three times a day for 5 days
ORAcyclovir 800 mg orally twice a day for 5 days
ORAcyclovir 800 mg orally three times a day for 2 days
ORValacyclovir 500 mg orally twice a day for 3 days
ORValacyclovir 1 g orally once a day for 5 days
ORFamciclovir 125 mg orally twice daily for 5 days
ORFamciclovir 1 gram orally twice daily for 1 day
ORFamciclovir 500 mg once, followed by 250 mg twice daily for 2 days
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Severe Disease

Intravenous (IV) acyclovir therapy should be provided for patients who have severe HSV disease or complications that necessitate hospitalization (e.g., disseminated infection, pneumonitis, or hepatitis) or CNS complications (e.g., meningoencephalitis). The recommended regimen is acyclovir 5–10 mg/kg IV every 8 hours for 2–7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy. HSV encephalitis requires 21 days of intravenous therapy. Impaired renal function warrants an adjustment in acyclovir dosage.

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Counseling

Counseling of infected persons and their sex partners is critical to the management of genital herpes. The goals of counseling include helping patients cope with the infection and preventing sexual and perinatal transmission. Although initial counseling can be provided at the first visit, many patients benefit from learning about the chronic aspects of the disease after the acute illness subsides. Multiple resources, including websites (http://www.ashasexualhealth.org) and printed materials, are available to assist patients, their partners, and clinicians who become involved in counseling (354,355).

Although the psychological effect of a serologic diagnosis of HSV-2 infection in a person with asymptomatic or unrecognized genital herpes appears minimal and transient (356,357), some HSV-infected persons might express anxiety concerning genital herpes that does not reflect the actual clinical severity of their disease; the psychological effect of HSV infection can be substantial. Common concerns regarding genital herpes include the severity of initial clinical manifestations, recurrent episodes, sexual relationships and transmission to sex partners, and ability to bear healthy children. The misconception that HSV causes cancer should be dispelled.

The following topics should be discussed when counseling persons with genital HSV infection:

the natural history of the disease, with emphasis on the potential for recurrent episodes, asymptomatic viral shedding, and the attendant risks of sexual transmission;
the effectiveness of suppressive therapy for persons experiencing a first episode of genital herpes in preventing symptomatic recurrent episodes;
use of episodic therapy to shorten the duration of recurrent episodes;
importance of informing current sex partners about genital herpes and informing future partners before initiating a sexual relationship;
potential for sexual transmission of HSV to occur during asymptomatic periods (asymptomatic viral shedding is more frequent in genital HSV-2 infection than genital HSV-1 infection and is most frequent during the first 12 months after acquiring HSV-2);
importance of abstaining from sexual activity with uninfected partners when lesions or prodromal symptoms are present;
effectiveness of daily use of valacyclovir in reducing risk for transmission of HSV-2, and the lack of effectiveness of episodic or suppressive therapy in persons with HIV and HSV infection in reducing risk for transmission to partners who might be at risk for HSV-2 acquisition;
effectiveness of male latex condoms, which when used consistently and correctly can reduce (but not eliminate) the risk for genital herpes transmission (27,358,359);
HSV infection in the absence of symptoms (type-specific serologic testing of the asymptomatic partners of persons with genital herpes is recommended to determine whether such partners are already HSV seropositive or whether risk for acquiring HSV exists);
risk for neonatal HSV infection; and
increased risk for HIV acquisition among HSV-2 seropositive persons who are exposed to HIV (suppressive antiviral therapy does not reduce the increased risk for HIV acquisition associated with HSV-2 infection) (75,347).
Asymptomatic persons who receive a diagnosis of HSV-2 infection by type-specific serologic testing should receive the same counseling messages as persons with symptomatic infection. In addition, such persons should be educated about the clinical manifestations of genital herpes.

Pregnant women and women of childbearing age who have genital herpes should inform the providers who care for them during pregnancy and those who will care for their newborn infant about their infection. More detailed counseling messages are described in Special Considerations, Genital Herpes in Pregnancy.

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Management of Sex Partners

The sex partners of persons who have genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated in the same manner as patients who have genital herpes. Asymptomatic sex partners of patients who have genital herpes should be questioned concerning histories of genital lesions and offered type-specific serologic testing for HSV infection.

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Special Considerations

Allergy, Intolerance, and Adverse Reactions

Allergic and other adverse reactions to oral acyclovir, valacyclovir, and famciclovir are rare. Desensitization to acyclovir has been described (360).

HIV Infection

Immunocompromised patients can have prolonged or severe episodes of genital, perianal, or oral herpes. Lesions caused by HSV are common among persons with HIV infection and might be severe, painful, and atypical. HSV shedding is increased in persons with HIV infection. Whereas antiretroviral therapy reduces the severity and frequency of symptomatic genital herpes, frequent subclinical shedding still occurs (361,362). Clinical manifestations of genital herpes might worsen during immune reconstitution early after initiation of antiretroviral therapy.

Suppressive or episodic therapy with oral antiviral agents is effective in decreasing the clinical manifestations of HSV among persons with HIV infection (363-365). HSV type-specific serologic testing can be offered to persons with HIV infection during their initial evaluation if infection status is unknown, and suppressive antiviral therapy can be considered in those who have HSV-2 infection. Suppressive anti-HSV therapy in persons with HIV infection does not reduce the risk for either HIV transmission or HSV-2 transmission to susceptible sex partners (71,366).

Recommended Regimens for Daily Suppressive Therapy in Persons with HIV

Acyclovir 400–800 mg orally twice to three times a day
ORValacyclovir 500 mg orally twice a day
ORFamciclovir 500 mg orally twice a day
Recommended Regimens for Episodic Infection in Persons with HIV

Acyclovir 400 mg orally three times a day for 5–10 days
ORValacyclovir 1 g orally twice a day for 5–10 days
ORFamciclovir 500 mg orally twice a day for 5–10 days
For severe HSV disease, initiating therapy with acyclovir 5–10 mg/kg IV every 8 hours might be necessary.

Antiviral resistant HSV

If lesions persist or recur in a patient receiving antiviral treatment, HSV resistance should be suspected and a viral isolate obtained for sensitivity testing (367). Such persons should be managed in consultation with an infectious-disease specialist, and alternate therapy should be administered. All acyclovir-resistant strains are also resistant to valacyclovir, and most are resistant to famciclovir. Foscarnet (40–80 mg/kg IV every 8 hours until clinical resolution is attained) is often effective for treatment of acyclovir-resistant genital herpes (368,369). Intravenous cidofovir 5 mg/kg once weekly might also be effective. Imiquimod is a topical alternative (370), as is topical cidofovir gel 1%; however, cidofovir must be compounded at a pharmacy (371). These topical preparations should be applied to the lesions once daily for 5 consecutive days.

Clinical management of antiviral resistance remains challenging among persons with HIV infection, necessitating other preventative approaches. However, experience with another group of immunocompromised persons (hematopoietic stem-cell recipients) demonstrated that persons receiving daily suppressive antiviral therapy were less likely to develop acyclovir-resistant HSV compared with those who received episodic therapy for outbreaks (372).

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Genital Herpes in Pregnancy

Most mothers of newborns who acquire neonatal herpes lack histories of clinically evident genital herpes (373,374). The risk for transmission to the neonate from an infected mother is high (30%–50%) among women who acquire genital herpes near the time of delivery and low (<1%) among women with prenatal histories of recurrent herpes or who acquire genital HSV during the first half of pregnancy (375,376).

Prevention of neonatal herpes depends both on preventing acquisition of genital HSV infection during late pregnancy and avoiding exposure of the neonate to herpetic lesions and viral shedding during delivery. Because the risk for herpes is highest in newborn infants of women who acquire genital HSV during late pregnancy, these women should be managed in consultation with maternal-fetal medicine and infectious-disease specialists.

Women without known genital herpes should be counseled to abstain from vaginal intercourse during the third trimester with partners known or suspected of having genital herpes. In addition, pregnant women without known orolabial herpes should be advised to abstain from receptive oral sex during the third trimester with partners known or suspected to have orolabial herpes. Type-specific serologic tests may be useful for identifying pregnant women at risk for HSV infection and guiding counseling regarding the risk for acquiring genital herpes during pregnancy. For example, such testing could be offered to women with no history of genital herpes whose sex partner has HSV infection. However, the effectiveness of antiviral therapy to decrease the risk for HSV transmission to pregnant women by infected partners has not been studied. Routine HSV-2 serologic screening of pregnant women is not recommended.

All pregnant women should be asked whether they have a history of genital herpes. At the onset of labor, all women should be questioned carefully about symptoms of genital herpes, including prodromal symptoms, and all women should be examined carefully for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. Although cesarean delivery does not completely eliminate the risk for HSV transmission to the neonate, women with recurrent genital herpetic lesions at the onset of labor should deliver by cesarean delivery to reduce the risk for neonatal HSV infection.

Many infants are exposed to acyclovir each year, and no adverse effects in the fetus or newborn attributable to the use of this drug during pregnancy have been reported. Acyclovir can be safely used to treat women in all stages of pregnancy, along with those who are breastfeeding (317,377). Although data regarding prenatal exposure to valacyclovir and famciclovir are limited, data from animal trials suggest these drugs also pose a low risk in pregnant women. Acyclovir can be administered orally to pregnant women with first-episode genital herpes or recurrent herpes and should be administered IV to pregnant women with severe HSV infection. Suppressive acyclovir treatment late in pregnancy reduces the frequency of cesarean delivery among women who have recurrent genital herpes by diminishing the frequency of recurrences at term (378-380). However, such treatment may not protect against transmission to neonates in all cases (381). No data support use of antiviral therapy among HSV-seropositive women without a history of genital herpes.

Recommended regimen for suppressive therapy of pregnant women with recurrent genital herpes *

Acyclovir 400 mg orally three times a day
ORValacyclovir 500 mg orally twice a day

You do realize that the only reason to suspect the OP has herpes is that he received oral sex from someone who got a cold sore? Over 50% of people have the herpes virus. Honestly... has anyone here worried about whether their partner got cold sores after receiving oral sex. Prove me wrong, and tell me if you have ever had this worry. If you have had more than 1 or 2 partners, you likely have been exposed to the virus already. Are you getting tested... or even talking to your doctor?

If you are that worried about a virus that every sexually active person is likely to encounter, then you shouldn't be having sex. I know of very few people who use dental dams for women receiving oral sex or condoms for men during oral sex. Anyone here who has done either can speak up.... I haven't.

The CDC recommends this practice I have never heard of anyone who actually does it.

The truth is that any sexual activity comes with some risk. And kissing also comes with risk of getting the herpes virus. Sure, talking to your doctor is good, but this concern trolling is ridiculous.

If you are concerned about every little possibility of STD complication no matter how small, you shouldn't be having sex.

Oh excuse me Dr. Ruth....it was very uppity of me to print CDC information after you paraphrased the results. How about from now on I forward my potential responses to you or another smart man and get permission to publish. Or you could go crap in your Stetson.

There really is hypocrisy here. I assume we all have had more than 1 or 2 partners. I will tell you that you probably haven't ever been tested. If you have had a cold sore, then you have herpes. If you haven't had a cold sore... you might still have herpes.

You probably have had sex with someone who has herpes and didn't know it.

If you all really believe what you are saying.... then you all should go talk to your doctors right away.

I don't like concern trolling. You didn't post the part where the CDC suggests the use of dental dams. Tell me, have you ever used a dental dam?

Call my husband and ask for his permission to ask me ridiculous personal questions like that. Better yet, ask my sons.

It doesn't seem that personal a question to me. In my family we talk about condoms quite openly, it is an important topic that I would discuss with anyone. My daughter stumbled upon a box of condoms in my car... she thought it was embarrassingly funny. I considered it a good thing, her father practices what he preaches.

Do you even know if you or your husband carry the herpes virus? You most likely were never tested for it, and assuming you were sexually active before you met your husband, there could be 25% chance that you have genital herpes without ever knowing it... and a higher chance that you have oral herpes. That is what the CDC site is saying.

I would be happy to talk to your sons about sexual responsibility. You can PM me their number if you really want.

This concern trolling comes with a fair amount of hypocrisy. Everyone here is giving advice that they don't follow themselves.

Go talk to your doctor.

Oh really. I think you may have forgotten you are asking me to provide details about my sexual experiences, not my husband or sons or nephews need for education about sexual responsibility. In other words, you have no idea what you are talking about, you are naive about STD's and for reasons I will never understand, you want to censor advice or comments people make to others.

One other thing, we have recently celebrated our 39th wedding anniversary. Neither one of us carry condoms in our cars, because we are not hooking up outside of marriage. I'm happy you are taking precautions even if your opportunities are limited. Once again, Im happy you are being responsible.....but the only sex life I'm interested in is the one between me and mr. GB.

So go blabber to your little girl about your condoms and buy her a pack so she remains safe, and stop wondering about me or the advice given to that poor kid who wondered if herpes could cause an outbreak in only a few hours..

I guess you and I lead very different lifestyles, Glitterbag.

1. In a thread about STDs, it makes perfect to talk about using protection. I don't think that saying that I use condoms or that I have never used a dental dam counts as "details about sexual experiences". I also brush my teeth twice a day and floss but I don't use fluoride rinse. I don't see any of this as "personal details".

2. Hopefully you also "blabbered" to your kids about condoms. In my opinion, talking openly about responsible sexuality is good parenting.

3. Congratulations on your long marriage. Hopefully you can accept those of us who have different lifestyles.

You make me laugh. You said I am "naive" and have "limited prospects" as someone who has had only one sexual partner since the 1970s. I am curious where your great experience came from.

Any time I have a new partner, we talk openly about STD risk and contraception, I think most single adults do this. I get a panel of STD tests every time and talk about this. You may not approve, but often in a relationship that has been exclusive for some amount of time (years or even months) a couple will decide to have unprotected sex.

We know the risk, we weigh the risks and often we decide the risk is low enough to be worth it. I won't ask you any more questions, but I will tell you. In spite of the CDC recommendations, there are very few people who use condoms or dental dams during oral sex. I have had a partner even bring this up, and I have never heard of anyone using one.

This is what life is like for singles in the 21st century.

Damn the editing feature.... I meant to say that in spite of the CDC recommendation I have never had a partner suggest that we use a condom or a dental dam during oral sex.

In 1957 oral sex was still widely viewed as a perversion which normal people did not engage in, and genital herpes did not exist. How bright do you really need to be to figure that one out??

1957 Alfa Romeo:



1957 President:



1957 People burning leaves (the US was a free country then):



1957 Dealing with insect problems (prevenging malaria and polio):

I hear you and thanks it was her more worried than I am I know people with herpes and I know it is very common and treatable I just wasn't sure how this stuff worked normally I Google general information but I couldn't find anything for it and figured if post the question and while I appreciate your support and respect don't worry about me I'm used to the internet by now

The risk of herpes is silly to worry about. More than half the people you will meet have herpes and most don't know about it.

Your completely wrong. Most people don't want oozing ulcers on their genitals that last for weeks a a time. Do you realize that if you knowingly give herpes to another person without informing them beforehand that you can be legally sued in court ? Herpes literally makes us walking human weapons.

Also hpv was not rampant, possibly unheard of. The numbers of throat cancer in men has risen 600% in the past 10 years . Unfortunately for men there is no test for hpv. A man finds out either thru warts or cancer of the penile , throat or anus. Studies are now saying that if you are a male with more than 6 sexual partners in a lifetime that you are high risk for hpv cancer. Hpv is transmitted thru saliva.

Do you have a link to any of these said "studies"?

I did a quick search. This article suggests that throat cancer raised by 6.8% in White males which they speculated was due to the increase of oral sex. That is something, but 6.8% is far less than the "600%" you were claiming.

https://www.livescience.com/35991-throat-cancer-deaths-drop-in-us-but-rise-for-white-men.html

Laryngeal cancer kills 3,710 people (both men and women) a year. This is less than one percent of cancer deaths (595,930). And is far less deadly than heart disease (633,000), respiratory diseases (155,000).

For men, HPV is only slightly more dangerous than swimming.

We must be in the same category, you know, squeamish about oozing sores on genitalia. Max explains to me that I just don't understand what single life in the 21st century is all about. Maybe I don't, I'm real fussy about people brushing their teeth, and bathing or showering and unencumbered by puss filled lesions on their whatzits.
It must be so empowering to be so unencumbered by hygiene issues and thinking you can ask strangers about intimate issues as if they are family members. Real 21st Century renaissance dude.

Ain't that the truth.

You are being silly. You can say the grown up words... we are talking about "penis", "vagina" or "face".

I am adult... way past the 3rd grade. I hope you are too.