Positive HPV test - what's next

[HJK58]

Long story short - 11 months ago gave oral sex to another male.  Obsessed over possible HPV infection for months.  Finally found a lab (MdLab.com) to do an oral swab test via PCR

Was shocked when results came back today - positive for HPV 16 and 18 in the mouth.  

Question - are there high rates of false positives for PCR tests?    Should I get tested again using the same lab and method.  If the test comes back positive again, is my wife at risk?

I was looking forward to a negative results so I could have put all of the **** behind me.  Now, I'm facing the possibility of having to tell my wife about an indiscretion and test result that will wreck my life.

Thanks for any assistance you can give me.

[H. Hunter Handsfield, M.D.]

I cannot comment on the reliability of the test, beyond what I already said.  No HPV test is approved by the US Food and Drug Administration for oral testing.  Further, the top national experts in HPV diagnosis and prevention cannot agree among themselves about the best way, if any, to test for oral HPV.  I simply cannot judge how likely it might have been falsely positive.  

But I'm glad you're feeling relieved, having discussed the situation with your wife.

[HJK58]

Doctor, thanks for your response.  I admitted the whole can of worms to my wife this evening.  She took it well considering the bomb that I dropped.  I'm amazed that I didn't get thrown out of the house.  She did clearly see how remoresful and regretful I was and accepted my apologies.  

Again, I do ask, is there a decent chance that this PCR swab test came back as a false positive?  FYI - mdlab.com performed the test.  It just seems a bit over the top that it came back positive for both 16 and 18.

My wife did not seem too concerned about the infection - she did ask that I consult my physician as to the ramifications of the results.  

I'm thinking that I should just let this go and put all of this into God's hands at this point.  What happens, happens.  There does not seem to much that I can do.

In some ways I'm relieved - I'm not carrying around this big secret anymore

thanks!

[H. Hunter Handsfield, M.D.]

Well, you have created a bit of difficulty for yourself.  I would have strongly urged you not to be tested for oral HPV infection.  I'm somewhat surprised you were able to find someone to test you -- and among other things, you should know that no such test has regulatory approval for testing for oral HPV, so I can't say how reliable your test results are.

But at this point, you have to assume you have (or had, at the time the test was done) an oral infection with HPV 16 and 18.  It would have been better not to know, especially since there is nothing to do about it now.

What we know is that oral HPV infections with the genital HPV types are relatively uncommon.  They rarely cause symptoms and the best available information suggest they are not transmitted to other persons, sexually or by other means.  And the large majority of infections undoubtedly go away without ever causing disease.

You probably got tested in part because you were worried about the reports of a rising rate of throat cancers due to HPV 16, including some scare stories that suggest the risk of such cancers is associated with oral sex.  But other facts about that trend are that there are only around 6,000 such cases per year in the entire US; most of those occur in people age 50 and over; and there is no evidence that their oral HPV-16 infections were actually acquired by oral sex or by other kinds of exposure.

As to telling your wife, there are no data here either.  HPV 16 and 18 are among the most common HPV types, so if or when she ever comes up with an abnormal pap smear or other evidence of a genital infection, there will be no need to acknowledge your sexual indiscretion.  In other words, in the large majorify of female genital infections with HPV, including those that appear in monogamous women, no particular sexual indiscretion is implicated; she could just as easily have a chronic genital infection of her own, that shows up in a pap smear many years after she caught it.  That said, I cannot tell you there is no risk of transmitting the infection to her by oral sex, or for that matter by kissing.  There simply are no data.

As I said, it would have been better if you didn't know and I am sorry you are tested.  Personally, I believe it is irresponsible for any website or provider to be offering such testing outside research settings -- and especially to offer testing to people on their own request, without involvement of a knowledgeable health care provider.  Unfortunatley, there simply are no data to answer your questions in the detail that you undoubtedly would like.  But I hope this information helps a bit.

Good luck--  HHH, MD