Can I avoid HPV this way?

[KSteve]

If my partner and I limit our contact to kissing and manual stimulation of each other, will this make HPV transmission largely impossible? From what I read, the virus seems to be pretty opportunistic. Is kissing okay? Do we have to be careful about how quickly we go from touching the other's genitals to touching our own or our mouth? Does the virus live on hands? And what about oral sex? Is this a bad idea if we want to be sure of avoiding HPV? In some of your past posts you have said oral transmission is very unlikely, but I keep reading about discoveries about HPV and oral cancer, etc.

[H. Hunter Handsfield, M.D.]

Kissing is not known to be a risk for HPV transmission.  Theoretically it could occur, but if it happens at all, it is rare.  HPV probably can be transmitted sometimes by hand-genital contact, but it is rare.  This isn't because HPV "lives" on the hands; the genital types do not.  However, if someone had handled his or her own infected genitals and then masturbates a partner, there is some small (but uncommon) transmission risk.  Oral sex risks acquring HPV of the mouth and throat, but almost all oral infections remain asymptomatic, go away on their own, and are not transmitted to others.  The exact amount of risk isn't known.  Indeed, the risk of oral and head and neck cancers is increaing, and many cases might be due to the genital HPV strains--so it is logical to suspect that problem is rising beause oral sex is more frequent than it used to be.  But it's still a very rare cancer, only ~15,000 cases per year in the US, as I recall--hundreds of times less common than things like lung, prostate, breast, or colon cancer.

The 4 main take-home messages about genital HPV are:

1) Everybody gets it somewhere along the line.  It may not be desirable, but it is normal.  It is futile to try to prevent it. The only strategies that can work in the long run are permanent celibacy, or permanent, total, lifelong mutual mongamy between 2 people who never had sex with anyone else.  That might work for a few people, but it unrealistic for >90% of all human beings.

2) Most infections remain asymptomatic forever and go away by themselves, without ever causing warts, cancer, or precancerous lesions.  So what's the big deal?

3) The HPV vaccines, Gardasil (Merck) and Cervarix (GlaxoSmithKline, not yet on the market in the US) are very effective at preventing infection with some HPV strains.  But even immunized people will still get HPV of other types.

4) Women need pap smears. Aside from the vaccines, the main protection against bad HPV outcomes is to detect potentially pre-cancerous abnormalities before they get to a dangerous stage.

So you're going to get genital HPV someday, if you haven't already been infected.  In fact, you're probably going to get infected a few times as the years go by.  Don't lose a lot of sleep over it, but plan on regular pap smears to assure that you don't become one of the small minority that gets bad disease.

HHH, MD

[KSteve]

Thank you for your thoughtful response. I'm in a unusual situation, as I can't afford even a harmless HPV, if it's visible or detectable on a Pap, etc. I think you get my drift. That's why I wanted to make sure that even the small amount of "indiscretion" I've engaged in is going to go undetected. Ah to be single again!

[H. Hunter Handsfield, M.D.]

Actually, I do not get your drift.  Perhaps you are alluding to having more than one relationship, and worry that your other partner would find out.  But even if HPV pops up in a monogamous couple, it doesn't necessarily mean that someone has had other partners.  It happens all the time, mostly in women who develop an abnormal pap smear, having had no new partners for a long time.  Most of those cases probably result from reactivation of a distant past infection.

That said, warts are a bit different. New apparance of genital warts usually comes from a new partner.

[KSteve]

You did get my drift. Thank you for clarifying everything for me today.

[KSteve]

One final question, if that's alright. (I don't want to monopolize your time or ask more than this board allows.) But this one follows from my previous questions. Just how common are warts (genital, oral)? The literature talks about how prevalent HPVs are in general and that most of us get one or more in our lifetimes. But I know no one who has had actual warts. Are cases of warts a minuscule percentage of HPV cases? And those strains that do cause warts: how often do those strains actually manifest warts instead of being fought off by the body? 1 in 100?

I've learned that when you read medical information, it's easy to be convinced that you have everything under the sun. Please enlighten me to the likelihoods here. Thank you! I'm grateful for your indulgence.

[H. Hunter Handsfield, M.D.]

I don't remember the CDC statistics. but you probably can find the answer at www.cdc.gov/std, then folllow links to HPV and/or warts, or perhaps to epidemiologic reports.  If nothing else works, look for the 2006 national STD morbidity report.  But be aware that nobody really knows for sure; the CDC estimates are very soft.