Oral HPV/Cancer Risk

Dear Doctor(s),

Thank You, as I have read many of your posts related to this topic.  Recently, I came across an article/video from a dentist, regarding oral sex/HPV on the health area of a major news website.  It mentioned the risks of "deep kissing."  After reading/watching this I immediatly remembered a girl I had dated whom after approximately ten deep kiss sessions (and no oral/vaginal sex) she told me that she had cervical cancer based HPV.  She informed me that she was diagnosed 4 years ago.  She said she did not have cancer but it is not the one that causes warts.  She told me that she had a colposcopy done and a biopsy which indicated HPV.  We have spoken recently and she told me that she never had a cone biopsy or leep procedure, nor has she ever had "my cervix scraped."  As she does not want to talk about it anymore, I have read through numerous websites (specifically the Journal of Infectious Disease (May 2009)/CDC/etc.) and with each one my anxiety/confusion builds.  I have extremely limited/cautious sexual experiences to avoid these situations and had assumed that deep kissing was relatively safe.  Questions:

1.  How real is my risk of having become orally infected with HPV-16 from this (10 deep kissing sessions) encounter?
2.  What are the chances (if you could put a tentative % on it) that she has it in her mouth?
3.  Can HPV-16 in the cervix clear after 4 years?
4.  If I take the orarisk-hpv test and it comes back negative 2 times, over 6 months, is that a good sign?
5.  When they test for HPV in the cervix do they look for the virus in the cells or do they simply look for proteins an infected cell produces?

Thank You For Your Time and Efforts!

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for scanning the forum for other threads on HPV and perhasp other research.  However, you seem to have picked up some misunderstandings about HPV,.

The genital HPV types are not transmitted by kissing, french or otherwise -- as least not as far as we know.  Of course there are over 100 types of HPV, only 30-40 of which normally involve the genital area and are transmitted sexually.  I suppose it is possible that some non-genital types are transmitted by kissing, and some are transmitted by skin-skin contact, especially among children.  That's how common hand warts originate.

That you had a partner with known genital HPV infection at one time is irrelevant to your risk of having HPV.  If "extremely limited/cautious sexual experiences" means you have not had vaginal or anal sex, then you may have escaped a genital HPV infection so far.  But if you had had such experience, you may already be infected.  In any case, you can expect to catch HPV someday; it is pointless to try to prevent it.  However, you could be immunized with Gardasil, which will prevent the 2 most common types of cancer-causing HPV (HPV-16 and 18) and the types that cause 90% of genital warts (types 6 and 11).

To your specific questions:

1) Kissing carries no known risk for the genital HPV types, including HPV-16.

2) This hasn't been well studied, but the chance she had oral HPV-16 probably is under 5%.

3) HPV-16 and other cancer-causing HPV types generally clear within 2 years.

4) Oral HPV testing is not recommended by health experts; although promoted by various companies and labs, there are no data on how well it works and I have no experience with it.  If positive, it won't necessarily mean you are at risk for anything; if negative, it won't reliably mean you are not infected.  I suggest you save your money.

5) Cervical HPV testing looks for HPV DNA, not viral proteins etc.

You are more concerned about HPV in general, and about oral infection, than is warranted.  I fear you are on the way to a rather restricted sex life, if you really intend to avoid HPV.  That's a campaign that almost certainly will not be successful, nor is it worth the effort.

Here are some other threads that enlarge on these issues:

http://www.medhelp.org/posts/STDs/concerned/show/980849
http://www.medhelp.org/posts/STDs/HPV-and-oral-cancer-risk-in-male/show/1181303

Regards--   HHH, MD

[Denny09]

For those too concerned about catching HPV(which most will do anyway), there's great news about the use of the lopinavir drug to cure HPV. What do you think, Dr. Handsfield?

[H. Hunter Handsfield, M.D.]

Research suggests that lopinavir and related drugs may inhibit HPV in the lab.  As yet there is no evidence of any effect in people or even, to my knowledge, in experimental animals.  Clinical trials may be coming, but at this point don't get your hopes up.  Even if effective, it will be years before we know whether it works, the dose of drug (oral versus creams), etc.

[malin1]

Earlier studies noted an increased incidence of head and neck cancers among the husbands of women diagnosed with HPV-based cervical cancers

[gateway101]

Thank you again for your help.  I read the other 'blog' post on mgoodmans post and it was very informative.  In my case, the woman told me that she tested negative the past two times for "it" after 4 years (she is 36).  Based upon your previous answer (w/in 2 yrs) is this even possible/probable?  Do you agree that oral hpv-16 transmission, with a known oral carrier, via kissing is probably very low risk?   Do you believe that the oral hpv's are more likely related to oral sex than kissing?  The previous poster said that husbands of cervical cancer patients tested positive orally.  Do you believe that repeated exposures over the years is what leads to the increased risk, or does risk remain equal from first to last exposure.  The reason I asked about the DNA is because I know that epithelial cells from the basement membrane take approximately 30-40 days to reach the surface, therefore viral integration/DNA into the host genome should show up, by testing, after that period of time, regardless of whether it causes cancer or not. Wouldn't it make sense for patients to be informed of their status, orally, so that the patients dentist is better informed?

Thanks again!!!

[H. Hunter Handsfield, M.D.]

Of course clearance of HPV is possible; that's the usual course.  Even without treatment, HPV can no longer be detected within several months.  I answered the kissing question in my original reply; probably little if any risk.  I would be surprised if husbands of women with cervical cancer have oral HPV any more frequently than anyone else who has performed oral sex on partners.

Whether partners of people with HPV infection, with or without cancer or pre-cancerous lesions, is a legitimate question.  However, the strong consensus among experts is that, in light of current knowledge, it is neither necessary nor recommended.  People who are the sex partners of known-infected persons -- whether in oral, genital, or anal sex -- are probalby at no higher risk of HPV, or of HPV-related cancers, than anyone else. Most have had other infected partners, who weren't known; the vast majority of infections do not lead to cancer or any other serious outcome; tests for HPV in such situations are either highly unreliable or of unknown reliability; and there is no treatment.

It may be valid that dentists and primary care physicians would have a lower threshold to recognize cancers earlier, if they knew a patient had HPV.  But I tend to doubt it.  With only 10,000 cases per year in the entire US, probablly most dentists never even see any patients with HPV related throat cancer; and screening and early diagnosis have never been shown to make any difference in prevention of rare cancers, only the common ones (e.g. colon, breast, cervix).  But for now CDC and virtually all other such agencies and experts recommend against informing partners.  We'll see what evolves over the next few years, however.

With or without a known oral HPV exposure, nobody should go around worrying about throat cancer as a result.  If you die of cancer someday, the odds are hundreds of times greater it will be one of the common ones, like colon, prostate, lymphoma, lung, etc, etc -- and not one of the very rare ones like HPV related throat cancer.

So my advice is to keep things in perspective.  Worry about and work to prevent life's real risks, not the ones that have 1 chance in a million.

That should end this thread.  Take care.