"Diagnosed" Oral HPV

[BadNewsBear]

Got out of a 3 yr relationship in March. Had one outside oral sex transgression in Oct 2009. Ex-GF did not have HPV and I doubt the other did (otherwise we would have seen something by now).  In Early Oct 2011, a female neighbor comes over. We make out and I go down on her playfully, but don't engage in full blown oral sex. She does not go down on me.  Fast forward to 2 weeks ago, noticed a skin tag of sorts on the top of my mouth.  Awaiting test results, but ENT discovered, removed and is biopsying what "could be a papilloma" on my soft palate membrane. I'm devastated at what this means. I barely even came close to her vagina & now I have it in my throat!

1. I'm assuming I now have oral HPV? No other real cause of a "skin tag" on your soft palate membrane right?
2. You state oral warts are rare, but I got 1, so what does that now mean for me? I'm nervous cause you say there's very little research done.
3. If I kiss girls in the future, will I give them oHPV?
4. If I go down on girls in the future, will I give them gHPV?
5. Auto-inoculation: If I have oral HPV and kiss a girl who doesn't have it. Then she performs oral sex on me, will I give myself genital HPV?  
6. Do I go see an oral surgeon from here on out to look for new clusters? Or ENT to make sure throat is clear? How often?
7. I read that your immune system can "beat" HPV but it never really "leaves your system." So for every future girl I kiss or go down on who doesn't have HPV at all, am I going to potentially / probably give it to her?
8. You mention that you don't need to tell future partners about gHPV infection, but what about oral?
9. Are there certain foods/drugs to take/avoid to minimize HPV "outbreaks"?
10. How contagious am I right now? How long should I wait before kissing to let my immune system try and "defeat" this virus?
11. He cut out the main "wart." Will it reappear in that area or move?

I'm sorry for the litany of questions, but maybe this post can be a resource. Thanks.

[H. Hunter Handsfield, M.D.]

I have no experience interpreting such reports, but it would appear that you don't have any of the usual genital HPV types.  This is consistent with my initial reply:  "Oral warts are not necessarily sexually acquired.  There are over 100 types of HPV, most of which are not sexually transmitted."

1,2) Yes, I think so.

2) Biopsies don't measure antibodies.  Antibody tests are done on blood.  There are no commercially available HPV antibody tests.

4,5) I have no experience with this sort of situation and cannot estimate contagiousness by sex, kissing, or any other route.

6) Gardasil would protect you from HPV types 6, 11, 16, and 18.  Immunization is a good idea for all sexually active people under 26 years old.

That definitely winds up this thread.  I won't have anything more to say.

[BadNewsBear]

Doc- Just need a skilled interpretation on the biopsy of the wart cause I'm getting mixed messages and really confused:

Removed: 12/14/11

Report on 12/16/11
Biopsy: Squamous Papilloma, HPV subclass is papilloma. No dysplasia or malignancy identified.
HPV Study: Pending.
Doctor says he got all of it. Clean edges.

Report on 12/20/11
HPV Low Risk / High Risk Test:
HPV ISH Low Risk: Negative
HPV ISH High Risk: Negative
Test: HPV Panel ISH, Paraffin
This test detests low-risk HPV (6,11) and high-risk HPV (16,18,31,33,35,39,45,51,52,56,58,66)

DNA positive control confirms the integrity of specimen nucleic acid.

**A negative results does not rule out the presence of an HPV genotype absent from the test, a low level infection or specimen sampling error.

Doc-

Not sure what this means, cause my ENT said I had Oral HPV, but all my reading shows the "genital HPV" or "oral acquisition from genital" is primarily 6,11,16,18.  

1. Does this mean I have another type of wart (maybe from my scalp - had one removed last year)?
2. Or does this mean that I had a recent wart infection a five (5) months ago and the anti-bodies haven't shown up yet?
3. Do I still have oral HPV, just not the "genital" kind all the articles have written about?
4. Again, how contagious might this be? (I know you can't really answer this one, but it's my biggest concern - spreading to others)
5. This one is a hypothetical- Since it may not be 6,11,16, or 18... if I kissed a girl a month ago and she performed oral on me while I had the wart, could it be transfered to my genitalia?  And could I then pass it on via sex with someone else in the coming weeks?
6. Probably not a bad idea to get the Gardasil shot now?

Ok doc, that's it - PROMISE! :)

Thanks and Merry Christmas to you!

[H. Hunter Handsfield, M.D.]

Sorry to hear the diagnosis is confirmed. Still, you shouldn't be so panicked.  This is an inconvenience, not a serious health threat to your or your current or future sex parnter(s).

Even if the timing is in fact more consistent with the playful sexual exposure you describe, I continue to doubt that is the source.  I doubt HPV can be transmitted by the fleeting sort of oral-genital contact you describe.  And you are absolutely mistaken to assume your earlier partner(s) didn't have HPV simply because they never were diagnosed.  All sexually active people have genital HPV at one time or another, and all those asymptomatic infections are transmissible to partners at least for a period of several months -- whether or not the infection is recognized or diagnosed.  Your oral infection most likely goes back to your prior partner(s), not the most recent one.

However, I suggest you not dwell on the source.  You're never going to know for certain and it isn't worth trying to figure it out.

To your new questions:

1) As I said in my first reply, I have no experience either diagnosing or referring patients with oral warts.  My guess is an oral surgeon would have more experience, but not necessarily.  I suggest you ask your GP and follow his or her advice about it.

2) My advice for genital warts is that recurrence or transmission are unlikely if warts to not recur within 6 months, not a full year.  As I already said, HPV almost never persists or can be transmitted indefinitely.

3) Auto-inoculation appears to be relatively uncommon, but there are just no data on which to base an answer.

6) Gardasil will fully protect you against any HPV types with which you were not previously infected.  If for example your oral wart were caused by HPV 6, the vaccine would protect you from HPV 11, 16, and 18 (assuming you hadn't previously been infected with one of those types as well).  Your own immune system protects you against new infections with the same type.  That is, with or without Gardasil, probably you would never catch HPV 6 again.

7-9) I recommend you not grasp at non-scientific straws. The anti-HSV drugs have no effect on any viruses outside the herpes group, and there is no evidence that diet, vitamins, or "immune supplements" have any effect on HPV or warts.  As you were already told, "time" is effective, in that all HPV infections eventually resolve to a point they cause no recurrent disease and are not transmissible.  Re-read yesterday's reply, the other thread I referred you to, and the further links shown there.

That will have to wind down this thread.  I won't have any further comments or advice.  Stay calm and treat this situation like the inconvenience it is, not a serious health problem.

[BadNewsBear]

Miscalculated the date- it was August, so this is about the right timing. Doc called on Fri. Said it was a benign papilloma, so it’s official. ☹ It will take 2-3 weeks to type it.  Knock on wood, because it was a wart, I’m hoping it’s not 16 or 18 that causes cancer.

I’m a bit of a mess right now cause I’m feeling like I can’t even date anymore. If I have a small wart in my mouth I can’t see, I will probably pass HPV on by just kissing someone.  How do you tell someone before you even kiss, “FYI, this could lead to warts in your mouth?”

A couple follow-ups (and please use your best educated guess. I won’t take it as fact):

1. My GP couldn’t believe I had an oral wart and the ENT just brushed it off like it was no big deal. I’m not sure if I go to an oral surgeon, ENT or both? Do you have any recs for docs in central TX? Also, do you have a STD-focused OS or ENT colleague that I could email/ask some questions to?
2. Let’s say it’s type 6/11. In gHPV, if a guy removes the wart and doesn’t show signs for a year, could he resume sex without passing the disease or is It forever able to be passed?
3. If I make out with a girl and she gets it orally.  Then a few weeks later, relationship moves to oral sex, can I go down on her and will she get vaginal warts from me? Or would her immune system prevent it since she already has it orally (similar to your take on HSV)?
6. If I already have 6/11, would me taking Gardasil help against 16/18? I read once I clear this initial infection, Gardasil could prevent me from 6/11 in the future (seems fishy). Would taking it now be a good/bad thing or should I wait til no more oral warts appear? Should I take it at all?
7. Would Famvir or Acyclovir or any other anti-viral suppressants help prevent “wart DNA” from being active so I could kiss without high “viral” numbers? If so, what?
8. Give me any ideas on good ways to clear HPV genitally/orally. Vitamins? Supplements? Diet? Time?
9. Am I forever going to be an oral carrier/disease-giver?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.

If you indeed have an oral papilloma (wart), it is not from the sexual exposure two weeks earlier.  Warts cannot appear sooner than 2-3 months after exposure to HPV and usually it's 6-12 months.  Oral warts are not necessarily sexually acquired.  There are over 100 types of HPV, most of which are not sexually transmitted.  Second, recent research shows that most people have various strains of HPV in their mouths at one time or another.  The long term health implications are not clear; more research will be needed.  However, overt warts, recurrent warts, and oral cancers are rare -- so probably the risk of anything serious is low.

I'm not an oral medicine specialist, and most of your questions are outside the expertise of STD specialists.  But I'll do my best.

1) I'm sure there are many potential causes of oral bumps, skin tags, etc other than HPV.  Your ENT doc will know the answer.

2) As far as I know, most oral warts clear up without any long term health problems.  Again, this is a question for your ENT doc.

3-5, 10) I cannot tell you the risk of transmission through either kissing or oral sex, or whether you currently could transmit HPV (if that's what you have).  This hasn't been studied.  Auto-inoculation doesn't seem to be common for most HPV infections, so I doubt this is a serious risk.

6) I have no experience with oral wart treatment or the pros and cons of an oral surgeon versus ENT specialist.  Sorry.

7) Yes, your immune system will suppress your oral HPV infection, if that's what you have.  Probably every HPV infection persists at the genetic level, i.e. persistent DNA.  However, that doesn't mean the infection remains active or can be transmitted.  Usually not.

8) I see no need to discuss past oral HPV infections any more than genital.  Whether or not you inform partners (whether sexual or kissing-only) probably isn't going to make any difference in whether or not they are infected someday, and not likely to have any important impact on their health.

9) Diet etc will make no difference.

11) Genital warts usually do not reappear after surgical removal.  I assume that's also true for oral warts, but I have no experience.  Again a question for your ENT doc.

You apparently have seen other threads that discuss HPV.  Here is one you might look at, if you haven't already; it contains links to others as well.  Although they discuss genital HPV, some of the principles probably apply to oral and to nonsexually transmitted HPV infections.  The main bottom line is that having HPV, even with overt warts, can be viewed as normal, largely unavoidable, and rarely a serious threat to health.

http://www.medhelp.org/posts/STDs/concerned/show/980849

Good luck--  HHH, MD