CARNAL NATION

A majority of people have oral herpes, which is usually acquired during childhood. Though not as ubiquitous, genital herpes is one of the most common sexually transmitted infections, and one of the hardest to prevent.

"Cold sores" or "fever blisters" are typically caused by herpes simplex virus type 1 (HSV-1), while genital herpes is usually caused by herpes simplex virus type 2 (HSV-2). But both viruses can infect either location, and yes, you can transmit herpes from the mouth to the genitals—or vice versa—through oral sex.

Herpes simplex lies dormant in the nerves, reactivating periodically to cause skin blisters that break to form open sores. The virus is spread through sex, kissing, or other skin-to-skin contact (herpes is not transmitted via semen). Touching the sores can spread HSV from one part of the body to another.

Many people with oral or genital herpes have no symptoms and do not even know they are infected, but they can still transmit the virus to others. Some experience only one or a few outbreaks over a lifetime, while others have them several times a year. Frequent episodes can be a sign of compromised immunity—so an HIV test is a good idea—but otherwise healthy people have them too.

Outbreaks can be triggered by a variety of factors including sun exposure, menstruation, and dips in immune function due to stress. As the name implies, herpes blisters often crop up when a person has a fever or is fighting another infection. But outbreaks may occur without warning—with no obvious triggering factors—so they are difficult to reliably predict.

Herpes can spread through intact skin even before an open sore develops. Many people feel a tingling, itching, or burning sensation (known as the prodrome) before lesions erupt. As you noted, emerging herpes blisters can look and feel like acne. But other people don't have advance clues, making it a challenge to protect their partners. While condoms offer some protection—reducing the risk by 30%, according to one recent study. However, this protective effect only applies to areas that are actually covered.

Herpes outbreaks can be treated with antiviral medications, usually acyclovir (Zovirax or generic) pills or ointment or valacyclovir (Valtrex) pills. Regular suppressive therapy can reduce recurrences in people with frequent outbreaks. It is not routinely used to prevent occasional outbreaks, however, since this could lead to drug resistance. While treatment can reduce the length and severity of outbreaks—and also lower the risk of transmission, it does not "cure" or permanently get rid of the virus. However, many people find that the frequency of outbreaks diminishes over time.

If you have not already done so, have a frank talk with your boyfriend and tell him you have oral herpes with regular outbreaks. Do avoid sexual or other skin-to-skin contact during active outbreaks, but both of you should be aware that this will only reduce—not eliminate—the risk of transmission.