A Few Questions on STDs

[Marty2007]

Hi Doctor,

I am female and enjoy engaging in mutual oral sex as well as mutual masturbation.  I had a case of genital warts about a year ago from a past partner that cheated on me and had them removed and have not had any other outbreaks to date.  I have found that I prefer oral sex (both ways) much better than intercourse and feel that overall it is much safer for me because of my trust issues.  Anyway, a friend and I were talking and he brought up some concerns about the safety of oral sex.  So, I started doing research and have read many of your past posts regarding the safety of oral sex and STD transmission.  I know that for HIV, etc., the risk is almost 0 but you have also stated that HPV oral infection is common but usually remains asymptomatic and causes no harm.  My question is that if a person were to obtain an asymptomatic oral HPV infection causing genital warts for example, why would they not then be able to transmit it to a partner if they then perform oral sex on that partner.  Similar to how HSV1 is transmitted to genitals.  I have searched and searched and found no data on this...can you shed some light.  Also, just a few other quick questions.  Can I assume at this point, hand to genital is safe as well as mutual oral sex.  I do discuss STD status with partners but did not feel an obligation to discuss this before.  Would you agree?  Also, in some of your past posts, you refer to a condom study that was conducted on HPV and shows that condoms are highly effective.  Can you give me a percentage on the safety with condom protected sex for HPV and also can you direct me to that research.

Thanks so much for your help!

[H. Hunter Handsfield, M.D.]

In general, you are absolutely right that oral sex is inherently much safer than genital intercourse with respect to STD and HIV transmission.

But as for HPV, you are asking quite sophisticated quesions, and there are no data to answer them as well as you might like.  What is known is that few people present with genital warts if they have not had genital (or anal) intercourse.  And despite the increase in oral sex among young people in recent years, visible oral warts are rare, and STD clinics see few patients with genital warts whose only exposure was oral.

These facts suggest, but do not prove, that transmission of warts and other HPV infections from mouth to partners' genitals is relatively uncommon.  However, some transmission almost certainly occurs by oral-genital or hand-genital contact--a lot less than genital-genital, but until more sophisticated research is done, we won't know more than we do now.

I agree that you do not have an ethical obligation to discuss your past genital warts or other HPV issues with your oral sex partners.  However, others disagree with me on this, and this advice could change with future research.

The study you cite was done by my colleagues at the University of Washington, Drs. Rachel Winer, Laura Koutsky, and others and was published in the New England Journal of Medicine last June (NEJM vol 254, p. 2645).  Condoms are "highly effective" against HPV only with highly consistent use:  among university student women who used condoms 100% of the time, the reduction in new HPV infections was 70% compared to those who didn't use condoms at all.  Women who used condoms 55% to 99% of the time had a 50% reduction in new HPV infections.  Below 55% use, there was no effect.  The importance of that research was not that condoms are a solution to HPV transmission, because it is unrealistic to expect 100% proper condom use by most sexually active people.  The study was significant because it put the lie to those from the religious or political right who had used HPV as the poster child for an argument that condoms "don't work".

It sounds like you have a level headed approach to sex and sexual safety.  I hope this helps you stick with the program.  Best wishes--

HHH, MD

[surfergirl2]

Thanks so much doctor, it looks like there is still research to be done.  Once final question.  So I am safe to assume that though their are no guarantees, the overall risk of transmission after one year or longer is drastically reduced.

I know you keep some incredible hours, thanks again for all that you do!

[H. Hunter Handsfield, M.D.]

Most experts believe that warts usually cease to be infectious within a few months after the last visible wart has cleared up.  After a year the transmission risk should be zero or close to it.