All you need to know about recurrent yeast infection in females

Causes of recurrent yeast infection

In this section, we’ll go over the most common causes of yeast infection (which also are the most common causes of recurrent yeast infection).

To prevent some recurrences, it’s very important to understand the causes. (However, most causes cannot be identified or corrected.)

Yeast infections occur when bodily conditions are favorable for its growth. This can result from any of the following:

Genetics

Some women are genetically predisposed to yeast infection because they lack a protein that is normally produced by overgrowth of a Candida species.

Antibiotic use

When other bacteria that normally suppress Candida are killed by an antibiotic, yeast infection might occur.

• The longer you use an antibiotic, the greater the chance of a yeast infection.
• Consuming probiotics have not been proven to be beneficial in preventing vaginal yeast infection.

Douching

• Douching (cleaning the inside of the vagina with water and other solutions) disrupts the normal flora of the vagina and its acidity, promoting yeast infection.
• Douching is not recommended.

Sexual activity

• Yeast infection is not considered a sexually transmitted disease, but it is possible to pass yeast infection from one partner to another during sex.
• The number of lifetime sexual partners and the frequency of sexual activity are not connected to recurrent yeast infection.
• The type of sex engaged in may be a factor:
  • More risk with oral-to-genital sex
  • 50% of people have Candida species in the mouth
• Use of a lubricant containing glycerin can cause chronic yeast infection
• Using condoms and dams (during oral sex) can be helpful.

Wet or moist environment

• Candida prefers moist environments, so living in humid areas and wearing damp clothing can contribute to yeast and fungal overgrowth.
• Wearing cotton or breathable underwear and clothing without liners is beneficial.

Eating habits

• Eating certain foods (high-glycemic-index carbohydrates) is believed to cause recurrent yeast infection, but there is not enough research to support this. Moreover, a strict diet does not (most of the time) prevent recurrent yeast infection.

Weak immune system

• A weak immune system because of immunosuppressive medical conditions (e.g., HIV, lupus, cancer) or certain medications can induce recurrent yeast infection.

Rare yeast infection strain

• Most yeast infections are caused by the Candida albicans species.
• In 15% of people, the cause of yeast infection might be other Candida species.
• The medication given to treat yeast infection mostly targets the common Albicans species.
• Two other Candida species that can cause yeast-like symptoms, krusei and glabrata, do not respond well to the commonly prescribed medication.

Yeast-like symptoms might not be due to yeast infection

Other medical conditions, including STDs, can cause symptoms the same as or similar to those caused by yeast infection:

• Bacterial vaginosis (BV)
• Trichomoniasis
• Chlamydia
• Gonorrhea
• Skin allergy

With any recurrent yeast infection, common STDs and non-STDs should be ruled out.

How can I determine the cause of my chronic yeast infection?

It’s very difficult to determine the cause of a recurrent yeast infection. The cause is obvious in only a minority of cases.

The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction.

Testing for recurrent yeast infection

In this section, we will discuss what testing is necessary to diagnose yeast infection as well as what other health conditions might have similar symptoms and need to be ruled out.

Vaginal yeast infection testing

Self-diagnosis

Self-diagnosis is frequently inaccurate and is discouraged.

• Studies have shown that only 11% of females without a previous diagnosis can correctly diagnose vaginal yeast infection after reading online information.
• Self-diagnosis of yeast infection is somewhat more accurate (35%) when the patient has had at least one previous episode.

Office test

During office testing, an abnormal pH test can rule out other conditions that can cause similar symptoms, such as bacterial vaginosis (BV).

Laboratory vaginal culture test

• Many of the symptoms of vaginal yeast infection are similar to the symptoms of other infections (e.g., bacterial vaginosis (BV)). For this reason, a laboratory yeast infection test is usually necessary to establish the correct diagnosis.
• A vaginal culture test is mainly done for people with persistent or recurrent symptoms that might be suggestive of an infection other than the common Candida albicans species (e.g., C. glabrata).

Ruling out other conditions that are similar to yeast infection

• Other infectious conditions, such as BV, trichomoniasis, chlamydia, gonorrhea, and mycoplasma, need to be ruled out.
• This is usually done if the patient is not responding to one round of yeast infection treatment or has a sexual history suggestive of possible STD.

*HIV testing is not necessary, because the majority of females with recurrent yeast infection do not have HIV.

Treatment for recurrent yeast infection

Here we will discuss the treatment for recurrent yeast infection along with the treatment for regular (nonrecurrent) yeast infection. This should give you a better understanding of recurrent yeast infection treatment.

What is the treatment for regular yeast infection?

Most females with yeast infection (90%) have regular, or uncomplicated, yeast infection.

Topical versus oral medication

Many treatment options with similar effectiveness are available for uncomplicated yeast infection:

• Topical over-the-counter medication
• One-time oral medication

People prefer the one-time oral medication for its convenience.

• But oral medication has more side effects: rash, headache, and abdominal discomfort. These side effects are usually mild and infrequent.
• Oral medication takes longer (one or two days) to relieve symptoms.

If topical medication is chosen, vulva treatment alone is not sufficient to eradicate the reservoir of the infection, even if the vulval symptoms are the only ones. Vaginal therapy is necessary to eradicate the infection.

Initial treatment

Since most people prefer oral medication for convenience, we recommend fluconazole (Diflucan) 150 mg once.

Most people respond to one dose within a few days.

Sex during treatment might be uncomfortable because of the inflammation, but it is allowed.

Treatment of the infected person’s sexual partner is unnecessary.

If initial treatment fails

If the initial treatment with fluconazole fails, other health conditions need to be excluded:

• Trich
• BV
• Chlamydia
• Gonorrhea
• Mycoplazma
• Trich

What is the treatment for complicated yeast infection?

Only 10% of females get complicated yeast infection. People with complicated infection may need a longer or alternative treatment.

What is considered a complicated yeast infection?

• Severe symptoms (redness, swelling, formation of cuts)
• Yeast infection (confirmed by testing) more than three times a year
• Candida species other than C. albicans, especially C. glabrata

Please note that complicated yeast infection does not necessarily mean recurrent infection. Unlike recurrent (frequent) infection, the infection can be considered complicated because the symptoms are severe or because it’s caused by a less common organism.

Treatment for complicated yeast infection

• Oral medication is considered more convenient, and people prefer it over topical treatment. Taking two or three doses (depending on severity) of fluconazole (Diflucan) 150 mg 72 hours apart is advised.
• If the patient prefers topical treatment, it will be for 7 to 14 days with clotrimazole, miconazole, or Terconazole.
• For severe vulval inflammation, topical steroids are advised for 48 hours to relieve the inflammation (e.g., clotrimazole-betamethasone or nystatin-triamcinolone).

Treatment for Candida glabrata

• 50% of people with Candida glabrata fail treatment with fluconazole.
• 65%–70% of women infected with Candida glabrata respond to intravaginal (it is fatal if taken orally) boric acid (600 mg capsule intravaginally for two weeks).
• Over 90% of woman respond to intravaginal flucytosine cream or amphotericin B creams for two weeks

*Boric acid, amphotericin B, are flucytosine are available commercially and need to be ordered via compound pharmacies.

**Before treating Candida glabrata (which is not aggressive and usually does not cause a lot of symptoms), every effort should be made to rule out other conditions that can cause yeast-like symptoms.

Treatment for Candida krusei

Candida krusei is usually resistant to oral fluconazole but responds well to creams and suppositories, such as fluconazole, miconazole, and terconazole. Treatment continues for 7 to 14 days.

What is the treatment for recurrent yeast infection?

Here we will cover the different steps for treating recurrent yeast infection.

What is recurrent yeast infection?

Recurrent yeast infection is a vaginal yeast infection that

• gets fully better but reoccurs (more than four episodes a year), and
• the reoccurrence are confirmed with culture testing.

What is the therapy for recurrent yeast infection?

If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time).

Step 1

Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient).

Step 2

The next step is the same three doses of fluconazole followed by one year of weekly maintenance therapy with fluconazole.

How effective is long-term anti-yeast therapy?

• This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued.
• In 50% of females with recurrent yeast infection, a cure is not achieved.

When yeast treatment is not necessary

Twenty percent of women of reproductive age have yeast infection (or Candida species) normally living in the vaginal area. Therefore, if an asymptomatic person has a positive test result (after a Pap smear) for yeast (or Candida), no treatment is necessary.

Prevention of yeast infection

Here we will talk about proven and nonproven ways of preventing yeast infection.

• Behavioral changes

  Candida tends to thrive in wet conditions, such as sweat and saliva.

  • A lack of normal hygiene practices, such as a daily shower, or being in a constantly damp environment can lead to yeast infection.
  • Avoidance of panty liners, pantyhose, and topical lubricants help some women avoid yeast infection.
• Switch to contraception with a lower estrogen dose.
• Improve glycemic control or avoid beer
  • Eating fewer simple carbohydrates might be beneficial, but no special diet is recommended because of a lack of evidence supporting the effectiveness of diet in preventing yeast infection.
  • Some people report that yeast infection recurs when they drink beer.

  So, avoidance of precipitating food is helpful, but it’s usually insufficient to resolve symptoms once they appear.

• Probiotics use

  There is no evidence that females with yeast infection have a low level of lactobacilli in the vaginal area. Some females report improvements with continuous use of probiotics, but the benefits of consuming probiotics to prevent yeast recurrences are considered unproven.

• Treating sexual partners

  Treatment of sexual partners is not advised because sexual activity is not considered a significant cause of infection. But the topic remains controversial among clinicians.

• More purported treatments unsupported by evidence

  There is no evidence that garlic, tea tree oil, yogurt, or douching is effective for treating or preventing vaginal yeast infection.

Male post-sex hypersensitivity reaction

Male partners of females with Candida (yeast infection) can develop immediate postcoital (after-sex) itch, burning, and redness of the penis. This probably represents an allergic reaction to the Candida organism in the female vagina. It might occur even if the female has no symptoms of yeast infection.

Treating males with antifungal medication usually does not produce any results, since this is an allergic reaction of the penile skin to Candida infection. The key is to eradicate the yeast infection from the lower genital tract of the female, which usually requires a long-term therapy regimen.

The treatment for the male is a topical steroid cream that provides relief within 24 hours.

Who is at higher risk of having chlamydia infection in general?

It is important to know the general statistics on chlamydia prevalence based on age, gender, sexual orientation, and region (where the live) to know the likelihood of getting it. The higher the chance of having chlamydia in general the higher the chance of passing and getting it orally.

This list tells us the highest chance of chlamydia in different categories of people:

• Young people (15-24 years of age) have highest prevalence of chlamydia compare to other age groups
• Females has a higher chance of having chlamydia than male; 1.75 times higher chance than in male
• MSM- male having sex with male-have highest prevalence based on sexual orientation
• People with multiple partners
• Practicing unsafe sex increase the chances getting chlamydia
• Highest rate among ethnic minorities with highest among African American
• Highest chance of chlamydia in the South (Louisiana, Mississippi, South Carolina, and New Mexico)

Chance of having chlamydia orally for heterosexual male and female

The chance of being diagnosed with oral chlamydia during routine STD screening for heterosexual people:

• 1.6% of heterosexual men
• 1.7% of heterosexual female

Chance of having chlamydia orally for homosexual male

The chance of getting diagnosed with oral chlamydia for homosexual male during the routine STD screening is 2.3%

Chance of having chlamydia orally when you are positive genitally

Here we are mentioning the chance of people having oral chlamydia while being positive for it genitally.

• 2% for heterosexual male
• 7% for heterosexual female

This is the percentage of people that have chlamydia in both places and spreading it both ways. It is important of mentioning that chlamydia, when contracted, stays at the point of contact and testing of one area without testing the other area not helpful with ruling out chlamydia. All point of contacts (oral, rectal, genital) needs to be tested.

The reason oral chlamydia testing is not routinely performed on everybody because the chance of having it orally without having it anywhere else (rectally and genitally) only 0.8%.

What is the chance of getting and passing chlamydia via mouth to penis sex?

The likelihood of getting and passing infection via mouth-to-penis oral sex with one time contact differ significantly depending on the part infected at the time of the contact: mouth or penis

• The chance of getting oral chlamydia after contacting with infected penis is from 2.6% to 3.7%
• The chance of passing chlamydia from infected throat to penis is from 5.6%-15.6%.

What is the chance of getting and passing chlamydia via mouth-to-vagina sex?

The likelihood of getting and passing infection via mouth-to-vagina oral sex with one time contact differ significantly depending on the parts that is infected at the time of the contact: mouth or vagina

• The chance of getting oral chlamydia after contact with infected vagina is from 0% to 5%.
• The chance of passing chlamydia from infected throat to vagina can be as high as 40%

Chance of getting and passing chlamydia via mouth-to-rectum sex

The likelihood of getting and passing infection via mouth-to-rectum oral sex with one time contact differ significantly depending on the part infected at the time of the contact: mouth or rectum

• The chance of getting oral chlamydia after contacting with infected anus is from 2.6% to 3.6%
• The chance of passing chlamydia from infected throat to the rectum is from 13.1% to 32.5%

Getting and passing gonorrhea via oral sex

If you wish to understand how likely it is that you’ll contract gonorrhea through oral sex, you need to know a few things:

• How gonorrhea infection is passed
• What groups of people are more likely to have gonorrhea (so you’ll understand when you are at higher risk of contracting gonorrhea)
• When is transmission of the infection more likely
• How the type of oral sex (receiving it or giving it) affects risk

Let’s discuss each of these!

How gonorrhea is passed from person to person

One thing that’s very important to know: sexual intercourse (with penetration) is not required for gonorrhea to be transmitted. Contact with semen, vaginal fluid, or saliva that contains gonorrhea bacteria is all that’s necessary.

Gonorrhea is the gram-negative bacteria that live mainly on the mucosal columnar epithelial of the affected organ both inside and outside of cells (fluids). Transmission happens during sexual contact. Upon arrival to a new host, gonorrhea forms small colonies at the area of the contact and starts invading the mucosal cells. This generally takes one or two hours after contraction of the infection.

Facts about the contagiousness of gonorrhea

• Someone whose mouth is exposed often to fluids from the vagina or penis is more likely to contract gonorrhea. This is even more true if the fluids are swallowed.
• Someone who has more than five sexual partners in their lifetime is more likely to get gonorrhea. Clearly, the number of different partners matters.
• Gonorrhea can be transmitted immediately—as soon as a person becomes infected with it.
• It doesn’t matter if the infected person has symptoms of gonorrhea—they’re still contagious.
• An infected person can transmit the infection as long as they have it; i.e., until they’re cured, which is seven days after they finish treatment. Again, it doesn’t matter if they have signs or symptoms of the infection.

The groups of people more likely to have gonorrhea

If you know the groups of people who are more likely to have gonorrhea, you’ll know whether you’re at higher risk of contracting it. Obviously, if you have oral sex (or other types of sex) with someone in these groups, you’re at greater risk.

• People who are addicted to drugs
• People who have multiple sex partners
• People who don’t use condoms
• Homosexuals and other males who have sex with males
• Members of ethnic minorities; rates are highest among African Americans, Hispanics, and Native Americans

Chance of a heterosexual being found to have gonorrhea in a routine screen

The likelihood of a heterosexual male being diagnosed with oral gonorrhea during a routine STD screening is 3%–7%. For heterosexual females, it’s 2%–10%.

Chance of a homosexual male being found to have gonorrhea in a routine screen

The likelihood of a homosexual male being diagnosed with oral gonorrhea during a routine STD screening is up to 5.5%.

Oral or throat gonorrhea infection is the possible source of genital gonorrhea infection

One study has shown that if a person only receives oral penile sex (from male or female) without having any other sex types (genital or rectal), the chance of being diagnosed with oral gonorrhea during a routine screening is from 3.1 % (female giving oral penile sex) to 4.1% (male giving oral penile sex). This data allows us to suggest that oral gonorrhea infection may serve as a reservoir and source of urethral infection and that oral sex may be contributing to the ongoing transmission of gonorrhea. Moreover. It is more difficult to treat and eradicate oral gonorrhea infection than genital infection.

Throat-to-penis transmission is much likelier than the opposite

According to a study of homosexual males in Melbourne, Australia, it’s much more likely for a throat that’s infected with gonorrhea to transmit gonorrhea to the penis of another person than the other way around. For a one-time contact, here are the statistics:

• Chance of transmission from throat to penis: 23% to 42.3%
• Chance of transmission from penis to oral area: 2.3%

Throat-to-vagina transmission is much likelier than the opposite

Similarly, it’s much more likely for a throat that’s infected with gonorrhea to transmit gonorrhea to the vagina of another person than the other way around. For a one-time contact, here are the statistics:

• Chance of transmission from vagina to throat: 0% to 5%.
• Chance of transmission from throat to vagina: as high as 40%

Throat-to-rectum is much likelier than the opposite

And it’s much more likely for a throat that’s infected with gonorrhea to transmit gonorrhea to the rectum of another person than the other way around. For a one-time contact, here are the statistics:

• Chance of transmission from anus to throat: 3.8%
• Chance of transmission from throat to rectum: 42.3%

Chance of getting and passing gonorrhea via mouth-to-mouth (deep kissing)

The chance of getting oral gonorrhea after contacting with infected throat (deep kissing) is 23.2%

Getting and passing HIV via oral sex

To understand your individual chance of getting HIV infection via oral sex you need to understand:

• How HIV transmission happens
• Which group of people at higher risk (and if you came in to contact with that type of person the chance is higher)
• What make transmission easier to occur
• Type of oral sex: receiving or giving

Let discuss each portion in more details!

How does HIV transmission happen?

It is very important to understand how HIV transmission happens. It helps to understand what the necessary factors are and how soon you become infectious to other people.

The bodily fluid (semen, pre cum, blood, vaginal fluid, and rectal fluid) of an HIV-positive person must come into contact with the mucosa (found in the mouth, vagina, rectum, and penis) or damaged tissue (cut or abrasion) for the transmission to occur.

The groups of people at greatest risk of getting HIV

The following are the groups of people at higher risk of contracting HIV:

• People having sex with multiple partners
• People who have unprotected sex
• Homosexual males
• People who have anal sex
• People with other STDs (especially STDs that cause a sore or discharge—the chance of HIV being transmitted through a damaged body part is 6 to 10 times higher)

Factors that make passing HIV more likely

• Timing—an HIV-positive person who has recently been diagnosed and who has symptoms is more likely to transmit HIV
• The viral load of the HIV-positive person (the greater the amount of virus in a person with HIV, the more infectious they are)
• The susceptibility of the uninfected person (genital sores, vaginal discharge, genital irritation, and warts make contracting HIV more likely)

Facts about the risk of transmitting HIV when giving or receiving oral sex

Getting HIV through oral sex is very unlikely. The chance is close to zero, whether you’re giving or receiving oral sex. This is because mouth tissues rarely develop microscopic abrasions during sex, even if blood or sperm enters the mouth. However, it is difficult to scientifically determine the risk of oral sex alone because people having oral sex usually also have other types of sex (vaginal or anal) during the same sexual episode.

Factors that make transmission of oral HIV likelier

Someone with sores in their mouth or bleeding gums is at greater risk of contracting HIV when their mouth is exposed to vaginal fluids or ejaculate.

Giving oral sex is a bit riskier

The risk of getting oral HIV is slightly higher if you are giving oral sex (your mouth is on your partner’s genitals) than if you are receiving it (your partner’s mouth is on your genitals). The reason for this is that you may have microscopic abrasions in your mouth that you’re not aware of and your mouth and throat can come into contact with infected bodily fluids.

Mouth-to-penis vs. mouth-to-vagina vs. mouth-to-anus

Oral sex that involves the mouth and penis is slightly riskier than oral sex that involves the mouth and vagina. Oral sex that involves the mouth and anus is very unlikely to result in HIV (but it may cause a bacterial infection).

Risk of passing HIV in a one-time episode of unprotected oral sex

The risk of getting HIV through oral sex alone, whether giving or receiving it, is believed to be very low. However, no reliable studies exist because people having oral sex are likely to be having other types of sex during the same sexual encounters.

Giving oral sex is thought to be riskier than receiving it, and oral sex involving the mouth and penis is thought to be riskier than oral sex involving the mouth and vagina.

Facts about the risk of contracting HIV infection through giving oral sex

Here we will discuss the chance of getting HIV through giving oral sex to an HIV-positive person.

Giving oral sex with mouth-to-penis contact (giving a blow job) to an HIV-positive person

The likelihood of getting HIV through giving a single blow job to an HIV-positive person is no more than 1 in 2,500 acts (0%–0.04%).

Giving oral sex to an HIV-positive person with mouth-to-vagina contact (cunnilingus)

There is no likelihood of getting HIV by engaging in cunnilingus, as no cases of this occurring have been documented and reported in reliable sources.

Giving oral sex to an HIV-positive person with mouth-to-anus contact (anilingus or rimming)

There is very little likelihood of getting HIV by engaging in oral sex involving contact of the mouth and anus; the chance is negligible. In fact, the lifetime risk of transmitting HIV this way is less than 1%.

Facts about the risk of contracting HIV infection through receiving oral sex

Here we will discuss the chance of getting HIV through receiving oral sex from an HIV-positive person.

Receiving oral sex with mouth-to-penis contact (receiving a blow job)

The likelihood of getting HIV from being given a blow job is very low. HIV transmission this way is unlikely because enzymes in saliva neutralize many viral particles, even if the saliva contains blood.

Receiving oral sex with mouth-to-vagina contact

There is no likelihood of getting HIV when an infected person’s mouth comes in contact with your vagina, as no cases of this occurring have been documented and reported in reliable sources.

Receiving oral sex with mouth-to-anus contact

The risk of contracting HIV through one act of an HIV-positive person’s mouth coming in contact with your anus is negligible.

Getting and passing Herpes via oral sex.

To understand your individual chance of getting HIV infection via oral sex you need to understand:

• How Herpes transmission happens
• Chance of herpes transmission with symptomatic vs asymptomatic partner; protected vs unprotected oral sex
• HSV 1 vs HSV-2 difference and chance of having it orally

Let discuss each portion in more details!

How herpes is transmitted

Direct skin-to-skin contact is necessary for herpes to be passed. When a herpes blister on the skin of the infected person makes contact with their partner’s skin, it can rupture. The fluids in it contain a high concentration of herpes virus. The risk of transmission during the infected person’s first outbreak is greater because that is when the virus is most highly concentrated in the blisters.

Transmission of herpes transmission through oral sex: symptomatic vs. asymptomatic and with protection vs. without it

Since herpes transmission is through the direct skin-to-skin contact the oral to genital acquisition as well as genital to oral transmission follow the same general rule for herpes transmission

There are no statistics available on the probability of herpes transmission via oral sex (at least, we couldn’t find any).

Transmission of oral herpes when symptomatic versus when not symptomatic

The table below summarizes the risk of oral herpes transmission—over time, with multiple sex acts—when the infected person is symptomatic and when they are not.

These percentages are general estimates. They may vary from person to person based on immune system strength (people with low immunity are more susceptible to infection), skin condition (people with damaged skin are more likely to contract the infection), and race (Black people are more susceptible to herpes infection).

Transmission of oral herpes with protection versus without protection

The table below summarizes the risk of oral herpes transmission when protection (condoms) is used and when it is not. Unprotected sex is much riskier.

These percentages are general estimates. They may vary from person to person based on immune system strength (people with low immunity are more susceptible to infection), skin condition (people with damaged skin are more likely to contract the infection), and race (Black people are more susceptible to herpes infection).

Herpes shedding in patients positive for oral (HSV-1) and genital (HSV-2) herpes who have no symptoms

The table below summarizes the risk of shedding in the oral and genital areas.

Shedding of herpes is not accompanied by any symptoms or visible signs. Whether virus has shed is measured by attempting to isolate it on the skin (in saliva or vaginal fluid, for example) when a patient has no symptoms.

These statistics are not related to transmission, but rather to viral shedding. The medical community does not know how much shedding needs to occur for transmission to occur, but most likely, the higher the virus shedding rate, the greater the chance of transmission.

Facts about how, when, and why herpes is transmitted in the absence of symptoms

Most herpes-positive people want to protect their partners from getting the infection, but this is not always possible. This is because the infected person can pass herpes even when they have no symptoms.

Asymptomatic herpes transmission has been studied, but results to date leave many open questions. Physicians must make many educated assumptions.

How asymptomatic herpes virus shedding occurs

It is believed that silent (asymptomatic) herpes transmission occurs when active herpes virus from a local nerve ganglion migrates to the surface of the skin. Skin-to-skin contact where the virus is active is required for transmission. Still unknown is what concentration of virus on the skin is required for transmission.

When silent transmission occurs

It is believed that factors that cause herpes to flare up, such as stress, exhaustion, and other disease, make silent transmission of herpes likelier, but this hasn’t been proven. A strong immune system probably suppresses the virus quickly enough to prevent a visible skin flare-up, though transmission can still occur. This too hasn’t been proven.

When silent transmission is likeliest

• The risk of transmission is highest in the first year after the patient contracts herpes.
• The period from a few days before an outbreak to a few days after it is when the risk of transmission is greatest.

Facts about the common names for HSV-1 (“oral herpes”) and HSV-2 (“genital herpes”)

“Oral herpes” and “genital herpes” are not medical terms. Doctors usually don’t use them.

The general public uses these terms because the two types of herpes tend to primarily affect one or the other parts of the body.

• HSV-1 usually affects the oral area.
• HSV-2 usually (in 58.7% of cases) affects the genital area.

However, both herpes types can affect either the oral area or the genital area. Therefore, physicians refer to them as herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Here are a couple of additional facts:

• In up to 41.3% of cases caused by oral-to-genital sex, HSV-1 affects the genital area.
• Less often, HSV-2 can cause oral herpes.

Receiving oral sex from someone with a herpes infection in the throat can cause genital herpesz:

• On the penis
• In the vagina
• In the anus

How HSV-1 and HSV-2 are different

HSV-1 and HSV-2 are different in some ways, but they are treated the same and have the same prognosis (predicted outcome).

Body parts affected

Both HSV-1 and HSV-2 can affect either the oral or genital region. Nevertheless, type 1 primarily affects the oral region and type 2 primarily affects the genital region.

Prevalence

Type 2 is much less common than type 1. About 10% to 15% of the world’s population has HSV-2; for type 1, that figure is up to 80%.

Rate of transmission

Type 2 is a little more contagious than type 1.

When the virus is acquired

HSV-1 is typically contracted non-sexually during childhood from friends and parents. HSV-2, on the other hand, is typically contracted after age 14, and it is considered a sexually transmitted disease for that reason. However, either virus can be acquired at any age.

Outbreak frequency

Patients with HSV-2 in any anatomic location have outbreaks more often than those with HSV-1. This is most true early in the disease process and does not affect treatment or prognosis. Fortunately, the number of outbreaks decreases over time with both herpes types.

Getting and passing Syphilis via oral sex.

To understand your individual chance of getting and passing Syphilis infection via oral sex you need to understand:

• How syphilis transmission happens?
• What factors affect the oral syphilis transmission rate?
• Chance of contracting syphilis after contacting with symptomatic vs asymptomatic person

Let discuss each portion in more details!

How does Syphilis transmission happen?

The syphilis transmission happens via skin-to-skin contact. Normal skin should come into contact with one of the syphilis lesions depending on the syphilis stage:

• Chancre (first stage of syphilis)- painless sore that can be on any part of the body
• Rashes that usually brownish pink, not itchy, that affect any part of the body (but common to have in palms and soles as well as the trunk). Syphilis rashes can take any form or shape and for that reason syphilis is called the “Greatest pretender”

What factors affect the oral syphilis transmission rate?

Same factors that affect the transmission of syphilis in other body parts applied to transmission of syphilis via oral sex:

• Absence or presence of the syphilis sore or rashes and if those came into contact with partner skin or mucosa. This is the most important factor out of all.
• Duration of the sexual encounter
• Frequency of sexual contact with infected personr

What is the chance of getting and passing syphilis via oral sex with partner with symptoms?

Oral(both giving and receiving) syphilis transmission rate with symptomatic partner is about the same. Moreover the syphilis transmission rate for different syphilis stages-chancre (first syphilis stage lesion) vs skin rash(secondary syphilis lesions)- is the same as well:

• 10%–30% per unprotected contact
• 60% with multiple unprotected contacts with the same person.

What is the chance of getting and passing syphilis via oral sex with partner without symptoms?

Oral (both giving and receiving) syphilis transmission rate with asymptomatic partner is about the same.

• 15% per unprotected contact
• 30% with multiple unprotected contacts with the same person.

The risk of contracting oral syphilis through one protected sexual encounter with a syphilis-positive person

The likelihood of contracting syphilis through one sexual encounter (using protection) with a syphilis-positive person is 0%–26.7%. This range is broad because the risk varies based on the sore’s location and whether the condom completely covers it.

Degree of protection that condoms give

How much protection a condom provides varies widely depending on where the infected person’s syphilis sore is and whether the condom completely covers it. This is because syphilis is transmitted through skin-to-skin contact that includes the sore.