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This is a crosspost from Reddit/r/adultbreastfeeding https://www.reddit.com/r/AdultBreastfeeding/comments/18texg6/discussion_breastfeeding_and_sti_transmission/
In the efforts of safety regarding adult breastfeeding I have been considering the experiences or thoughts others have had related to the infection or transmission of STIs from breastfeeding. Specifically HSV1/2. Not much legitimate medical information seems to be available however after some searching I have found a medical journal(?) Related to this topic.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327394/
I am not a medical professional so there is quite a lot of data here that I don’t understand but here are two excerpts I found interesting.
“One uncommon site of HSV infection of the skin is the breast. Reports of herpetic breast infections are predominately cases of transmission from a systemically HSV-infected neonate to the mother during breast-feeding. A comprehensive review of the English literature identified only six reports suggesting HSV breast lesions acquired by means other than through an infected infant. Three of these reports do not specify how the breast became infected with HSV, but the virus was either culture-proven or infected a previously healthy infant during breast-feeding (4–6). In one case, the virus was culture-proven and was presumably acquired by autoinoculation from an oral lesion (5). Only one report suggests transmission of HSV to the breast from a male sexual partner with recurrent oral HSV lesions (7). We present a second case of symptomatic herpetic mastitis acquired possibly from sexual contact in a 46-year-old woman..”
“Infection of the breast by HSV is uncommon. Only 2% of all extragenital herpetic lesions have involved the breast (12). Furthermore, development of breast lesions as the first and sole manifestation of clinically apparent HSV infection without oral or genital herpes is uncommon (13). However, oral and genital HSV infections can be asymptomatic. There is little information in the literature regarding transmission of HSV to the breast except in cases associated with neonatal breast-feeding, and because further inquiry failed to reveal the source of the herpes virus in this patient we are left to speculate as to the means of transmission.
To me, this interprets as HSV1/2 infection of the breast and transmission while uncommon is possible within a margin of 2% and there is little information or research available on this topic. As someone who takes safety regarding transmission of.. well anything, very seriously. this information does come somewhat as a surprise considering it is not exclusively sexually/orally transmitted risk in this case but a potential risk to people who participate in ABF. This may come as a surprise to others. It certainly did to me.
I am curious as to what the ABF community thinks of this. What measures do you take to ensure safety with your partners if no risk is apparent or disclosed? What are the measures you take to safeguard yourself from contracting or transmitting STIs during breastfeeding? Is this a subject that our community should pay more attention to?
TL;DR Can you contract or transmit STIs via breastfeeding? Research points to yes with chance of 2%(but that percentage may be inaccurate) is the ABF community aware of these risks? What are they doing about it?
Just some food for thought.
Before any intimate activity happens of any kind (including just kissing), both partners should do a current STI test. There is no HPV test for males, which means males are more likely to carry that asymptomatically to a female partner. There is an HPV test for females.
Always be honest with your partner about your STI status!Treasure Chest has a very valid thoroughly researched point! HPV is one of the top 4 incurable STIs that fall inline with HIV and AIDS. As pointed out, there is no test for males who carry it and females who harbor it should regularly get STI tested if body fluids are exchanged in kissing, oral involvement, manual sexual involvement, sex in any situation. Any exchange of bodily fluids sexual or just kissing enables the STI to be exchanged. There are over 800 different HPV varieties. The shot for it should be received from age 9-45 that covers a few hundred of the HPV viruses. Ask your primary care physician about it the next time you have your next OB/GYN appointment. This is a very serious cancer causing virus that infectes the uterus, ovaries, bladder, gastro intestinal, mouth, and throat.
Some people get through it and it goes dormant, others get horrible cancers.
If you have any skin to skin contact get tested regularly!
I like the information and viewpoints presented in both of these comments. Although the risk does appear minimal in relation to breastfeeding specifically. It is non zero which in my opinion deserves the same amount of caution regardless of risk and probability. As a male I do my part to make sure I can keep myself safe and ensure the safety of partner(s) First and foremost I make sure to get tested often and like to have any new partners do the same prior to anything physical just out of an abundance of caution. I am not opposed to and actually encourage inspections of prospective partners prior to any intimate act such as checking to make sure mouths or areas of potential skin/skin contact are clean and unaffected by wounds/sores prior to sharing them with eachother 🤭 I know this may sound a bit clinical and well.. “Not mood enhancing” to others but can be a very important act to not only ensure safety but to create trust between two partners as well. Granted my approach to things may be different others. I have been told that my approach may be too cautious which could be the case for some but I find that this is what works for me to ensure safety which is incredibly important to me. I’d like to ask if anyone else has some sort of specific safety protocol when it comes to new partners or just in general. Thanks again to those who have and will participate 😊
I think this is really important to bring up. Thank you for doing so, Tony. It’s something I worry about a lot getting in to the lifestyle, as I’m negative for HSV-1 (and 2, for the record) and so have no antibodies against it. Heck, I wouldn’t share your drink if you offered it to me.
My read on this is not that you have a 2% chance, but that 2% of documented lesions are on the breast. Most come from infants, but again most people drinking from the breasts are.
This is lightly informed speculation, but I could read something else in to this. When someone is infected with HSV, they can be shedding virus at a low level at any time, even when they do but have symptoms. The data show that most people contract herpes from those who do not have an active lesion. But, this is likely because disease avoidance instinct is going to discourage people to kiss someone with an active herpes outbreak, so most transmissions are when the virus is shedding more stealthily.
With that said, individuals with an active lesion are extraordinarily more infectious, and infection is almost guaranteed. So checking for sores is obviously a must-do activity, in my opinion. Also asking if your partner feels an outbreak coming on, as people often can. However, since most people have HSV-1 infection, testing for HSV-1 will restrict your dating pool substantially. It may still be prudent if you’re negative, however.
To my final point about why most breast lesions may come from infants: infected infants by definition must have been infected very recently, and so may be in that early stage of infection when the body has no defenses and viral load is extremely high. This is the case for HIV as well, where the first months after infection are when you are at your most infectious. An HSV-1+ adult is more likely to have a dormant infection that is less virulent.
As for avoidance, gosh I just don’t know. It’s hard to imagine what a barrier that only allowed fluid transfer from the giver to the receiver, while still feeling good for the giver, would even look like. HSV- givers avoiding HSV+ receivers may be prudent, albeit quite restrictive in terms of dating pool. Plus, it seems like antibodies from HSV+ givers aren’t even completely adequate, since that woman from the paper was able to infect her own breasts.
But yeah, wow. Herpes on my breasts? Horror of horrors. Just the thought of it is truly chilling.
I agree with Brooke on the horror of all horrors for having herpes in your breasts!
I had also never imagined that you could catch an STD from just nursing! I’ve never had an STD. Luckily my last two nursing partners had been tested and I’ve been tested. It makes you really even more cautious about who you nurse though!
A good take away for the men though would be that having test results may set you apart from the other guysA couple of notes on STI screening from someone who gets tested regularly:
1. As noted above, there is no HPV test for men. However, there is a vaccine available for men up to 45 years old. Age restriction and insurance coverage may vary depending on where you call home.
2. In the absence of symptoms, HSV testing is not necessarily included in a standard STI screening, as the test is prone to false positives. If someone claims to have tested negative, make sure they’ve got it in writing.Yeah, HSV 1 and 2 are not typically given in panels if you don’t insist on it. It’s not that the false positive rate is high so much as most adults have it, whether or not they have symptoms.
https://en.wikipedia.org/wiki/Epidemiology_of_herpes_simplex
Unfortunately an asymptomatic person can absolutely infect you, and if you don’t have antibodies yourself you’re more likely to get a primary infection at the point of exposure.
The infected person can take antiviral medication to reduce their odds of shedding virus or having an outbreak while you’re seeing each other.
That’s true that you can insist on screening, and that most adults have either HSV 1 or 2. But false positives for HSV2 are an issue according to the CDC, FDA, and NIH (this is also what I’ve been told by my primary doctor and the folks at Planned Parenthood).
I’m not arguing against getting screened, or taking steps to protect yourself. Just noting that HSV screening is not necessarily part of the standard protocol.
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