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Oral HPV
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Oral HPV

Dear Doctor:

After reviewing various studies that have been done on oral HPV, there seems to be a clear link between HPV and oral, head, and neck cancer.  I believe the American cancer society also supports this link.  That being said, ~18 months ago, a female friend of mine performed oral sex on me twice within about a 3 week period.  I learned 6 months later that she had an abnormal pap, and tested positive for high risk HPV (not sure which type).  That brings me to the following questions:

1. What are the chances of my female friend having oral HPV if she also performed oral sex on the person who gave her genital HPV?  Is it possible for her to concurrently become infected with a genital and oral infection?  
2.   Assuming my female friend had HPV at the time of our encounter, is it possible for me to become infected, or is oral to genital infection more difficult than genital to oral infection?  I have read on past threads that it is very uncommon for the virus to pass orally, but there must be some risk factor if people with throat cancer have tested positive for the virus in their throats.      
3. I know the clear rate for the virus is ~90%; is there any unique attribute of the 10% who do not clear the virus, or it is pretty random?

I know that most experts agree that in a developed country, HPV is a mere inconvenience, but my current girlfriend/ soon to be fiancé is a virgin, and I would not want to pass something on to her.  I also have not had much in the way of sexual contact outside of this one exposure, so there is very little risk of me having HPV outside of this contact.

Thank you very much
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Hello,
Thank you very much for your posts and welcome to our forum.  I am terribly sorry that it has taken us a few days to reply to your query.
I totally agree with your statements:  certain strains of HPV are not only associated to cervical, vaginal, penile and anal cancers, but also oral, head and neck cancers.  However there are many other factors in this case that would contribute to oral, head and neck cancers, and not just the presence of HPV in the mouth.  Smoking and/or alcohol consumption for example are more important factors.
More than 20% of sexually active people between the ages 15-49 carry one or mores strains of HPV, and of these less than 10% would show any symptoms.  Most HPV strains do not cause cancer, and even if one carries a high risk strain, not all of these express the carcinogenic genotype.  And in any case, after a couple of years the HPV strain present would disappear from your system anyway.
Let em answer to each of your questions here below:

1. What are the chances of my female friend having oral HPV if she also performed oral sex on the person who gave her genital HPV?  Is it possible for her to concurrently become infected with a genital and oral infection?  
IT IS CERTAINLY VERY POSSIBLE, BUT IT WOULD BE MUCH LESS COMMON THAN GENITAL TRANSMISSION ALONE.  AROUND 5% OF CASES WOULD HAVE OROGENITAL TRANSMISSION.
2.   Assuming my female friend had HPV at the time of our encounter, is it possible for me to become infected, or is oral to genital infection more difficult than genital to oral infection?  I have read on past threads that it is very uncommon for the virus to pass orally, but there must be some risk factor if people with throat cancer have tested positive for the virus in their throats.
IT IS CERTAINLY POSSIBLE AND DIFFERENT STUDIES SHOW DIFFERENT FIGURES, BUT IT IS AROUND 5% FOR ALL TYPE OF OROGENITAL TRANSMISSION, SIMILAR BOTH WAYS.  AS MENTIONED ABOVE, APART FROM PRESENCE OF HPV (NOT PRESENT IN ALL CASES OF HEAD/NECK CANCERS THOUGH), THERE ARE MANY OTHER IMPORTANCE FACTORS FOR SOMEONE TO DEVELOP THESE CANCERS.
3. I know the clear rate for the virus is ~90%; is there any unique attribute of the 10% who do not clear the virus, or it is pretty random?
IT IS USUALLY IN PEOPLE WHO ARE IMMUNOSUPPRESSED WITH A POOR IMMUNE SYSTEM.

My advice to you regarding your girlfriend is for her to be tested regularly with cervical smears and not worry so much about something that there is very little that you can do about.  The only way for her not to get HPV (if you already have it) is to remain virgin, which might not be a very satisfactory situation for either of you.
Best wishes,
Dr José

4 Comments
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Avatar_m_tn
Does this article change your thinking at all:

http://www3.interscience.wiley.com/journal/119464559/abstract
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Avatar_m_tn
So would it be safe to say that given the time frame of the incedent, I have cleared the virus by now if I ever contracted it?  Also, do researchers know whether or not an infection that has cleared can be reactivated, or would a peroson have to be exposed to the virus again to re-contract it?

Thank you for your time
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936016_tn?1332769204
Good Morning

Jose is off duty today - lucky man. A lovely sunny day in London.

You've asked two further questions:-
"Does this article change your thinking at all:
http://www3.interscience.wiley.com/journal/119464559/abstract"

I can't speak directly for Jose but my question to you would be, why on earth would this change my/our thinking? All it illustrates is something you referred to originally and which is established - that HPV is implicated in some oral squamous cell carcinomas. We know that HPV is indeed involved in squamous cell cancers and precancers - squamous cells are skin cells. The squamous cells in the mouth/anus/vulva/cervix/on the penis are all vulnerable. Indeed there is evidence that HPV is implicated in the development of squamous cell carcinomas of the skin of the body - that'll give you something else to worry about.

The reality is though that certain types of HPV in the anogenital and oral areas do cause premalignant and malignant lesions BUT - the vast majority of oral cancers and precancers are caused by a) smoking b) smoking and drinking alcohol heavily c) excess alcohol use. HPV is part of the picture but it hugely outweighed by the others.

Your second question:-
"So would it be safe to say that given the time frame of the incedent, I have cleared the virus by now if I ever contracted it?  Also, do researchers know whether or not an infection that has cleared can be reactivated, or would a peroson have to be exposed to the virus again to re-contract it?"

First part - no - the clearance time varies from person to person.

Second part - if the contamination is "cleared" then there is no HPV on the target tissue in which case reinfection would be necessary.

Not all high risk HPV contamination of the target will result in pre-cancer or cancer of the target area. Most people will have at least one type of HPV infection at some time in their lives at a sexual site = mouth/anus/penis/female genitals or any combination of the above. Most HPV infections, including high risk types are TRANSIENT. A small but significant number of high risk HPV infections will progress to a cancer of the mouth/anus/penis/female geintal tract or any combination of. HPV detection methods such as the one you have highlighted in the unhelpful article you have picked ou can identify the presence of the virus but they are unable to identify whether that virus has ONCOGENIC ACTIVITY - ie whether the high risk HPV is actually going to switch the genes in a persons target cells to change to cnacers. It is the expression of viral oncoproteins E6 and E7, which affect cell cycle control, that will initiate the cancer process - certainly in the cervix and probably elsewhere. The detection of E6/E7 mRNA confirms the persistent expression of viral oncoproteins in human cells.

The benefit of a negative HPV PCR swab especially one which will by default identify mRNA to detect E6/E7 oncogene expression, is its negative predictive value. That means that someone with a negative HPV PCR for high risk subtypes - especially types 16,18, 31, 33 and 45 is at virtually no risk of developing an HPV related cancer in the target cells. HPV DNA PCR tests will identify and type the virus only, whereas HPV mRNA tests will detect whether that HPV virus has the CAPACITY to switch cellular function to create a malignant process.

best wishes, Sean
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