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Ethical Dilemma about HPV
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Ethical Dilemma about HPV

I had a recent sexual interaction with a woman I met at a social event. Six months ago, I was diagnosed with a small genital wart at the base of my penis near the scrotum...just one wart. For various reasons, I have not had it treated yet, so it is still there. Back to the current situation. Against my better judgment (and I feel absolutely terrible about this), I allowed her to perform unprotected oral sex on me two times. My penis was probably in her mouth for about 10 minutes total. My concern is this...considering that I have genital HPV, she probably contracted oral HPV from performing oral sex on me. I will NEVER repeat this mistake again and will inform all future partners, but my question is whether or not to inform her after the fact. Since the wart is at the very base of the penis, I don't think her mouth had any contact with it. In any case, I've been debating if telling her about my genital HPV at this point would do more harm than good. There is no test for oral HPV anyway, so even if she caught it from me, there would no way to know unless she developed an oral wart. I could tell her she "might have it now" and should consider using a condom when performing oral sex on other partners in the future. But then again, she might not have it. Even if she did acquire oral HPV from going down on me, there is no way of knowing how long it would be before her body clears the HPV virus, and if she could transmit it to other men by performing oral sex on them. I know I did the wrong thing by not informing her, and I feel terrible, but the question is, WHAT NOW? I will be sure to inform all future partners, and I'm going to get the wart treated. But I'm concerned that telling her after the fact would just create psychological harm for her, given that there is no test for oral HPV and no treatment. I don't know what to do in this situation.
239123_tn?1267651214
Welcome back to the forum.

While it would have been a kindness to inform your partner about your presumed wart, I don't agree it was a major ethical lapse that you didn't do so.  The odds any particular person will catch a genital HPV type -- whether in the genital area or orally, isn't any higher in people with or without known exposures.  In other words, your partner is at no greater risk of oral HPV from this event than she would be anyway.  Why not?  Because genital HPV is so prevalent that every sexually active person is repeatedly exposed anyway; any single event makes no difference in risk.  That's why the standard recommendation by CDC and other expert authorities is that there is no need for partners of people with warts or other genital HPV infections to be referred for examination.  

In any case, the genital HPV types don't readily infect oral tissues.  For example, despite the near universality of oral-genital sex in sexually active persons these days, the frequency of oral HPV is one fifth that of genital infection.  And oral warts are very rare -- so even among people known to be exposed to the wart-causing types, warts don't usually develop.

By the way, you can't assume that just because your wart is at the base, oral contact with your penis carried no risk for HPV transmission.  In some (most?) persons with overt warts, the HPV infection involves nearby areas that appear entirely normal.  You can assume the virus is present elsewhere on your penis.  But that doesn't change the main point -- that regardless of exposure, your partner is at little risk for any important health problem.

Should you inform your partner after the fact?  I pretty much agree with your own analysis, i.e. I don't think it's a good idea.  It might help you get beyond your guilt, but perhaps not best for your partner, for the reasons you state.  On the other hand, some people would want to know.  So this is a personal decision and I can't make it for you.  Just don't be selfish -- i.e. don't do it just to relieve your own guilt if you think the main effect would be to freak out your partner.

I hope this helps.  Best wishes--  HHH, MD

Oh, and by the way:  get that wart treated!
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Thank you so much for your response. It has helped clarify my decision. Although I do feel awful about not telling her, it is a learning experience and I will not repeat the same mistake again. I'm definitely leaning toward not telling her, because I can't see how having this information could be helpful to her. I am concerned about her well-being, but also her potential to spread HPV to other men through oral sex and/or kissing, if she acquired oral HPV from me. But from what you're telling me, HPV is so common anyway that I'm not contributing much in a negative way to the public health by having her not know. Another final question...we also had "dry" sex. I was wearing thin nylon mesh shorts and she had on panties, and we "dry humped" for a long time. What are the chances I could have given her HPV from this, or that I could have acquired HSV2 (genital herpes) from grinding against her?
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239123_tn?1267651214
No worries from the "dry sex".  No STDs can be transmitted through clothing.
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Thank you again. I do have one last question. I promise I will not ask anything else after this. I'm concerned about the possibility of her transmitting HPV to other men through oral sex and/or kissing, if she acquired oral HPV from performing oral sex on me. What are the chances that she could transmit HPV to other people in this way? (The concern of her transmitting it to others is an important factor in my decision to inform her or not.)
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239123_tn?1267651214
Boy, you really are looking to be led by the hand, aren't you?  The answers to this question are obvious from our previous discussion.  But to be even more explicit, here we go again.

Her risk of transmitting any STD to future partners is none of your business.  And we already discussed all the reasons that she almost certainly doesn't have oral HPV and that her risk for it is no higher on account of your encounter with her than it otherwise would be.  And oral to genital HPV transmission almost never occurs anyway, and it certainly can't be transmitted by kissing.

Your highest ethical priority by far is to entirely drop any and all further worry or consideration about any of these issues.  Suck it up and move on.

That's all for this thread.
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