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Oral HPV Transmission Question

I understand that there is an impulse (here and elsewhere) to assuage the anxiety of people who have been exposed to high risk HPV, but I am just looking for solid, detailed explanations. Several months ago I had sexual relations with a woman who had high risk(HR) HPV, most likely HPV 16/18 (she later developed cervical cancer). I am male.    
As an expert on this forum previously noted, the medical field's understanding of HPV continues to evolve. One example seems to be with regard to oral-to-oral transmission. Dr. Gillison's May 2009 study indicates that oral HPV infections may be transmitted by "french kissing." Are you familiar with this study? What are your thoughts about the chances of transmitting HR oral HPV by kissing (e.g. do you think people would need to kiss frequently or for a long period of time to transmit an infection?). Are you familiar with any other such research? Just as I think I understand all the ways of transmitting oral HPV I learn of other possibilities. I just saw that Dr. Gillison was quoted as saying that other means of transmitting oral HPV, such as by sharing a drinking glass or utensil, cannot be "ruled out." While her statement is not concrete, it is concerning. I have shared drinking glasses (one sip from me, then one sip from someone else; had chapped lips and some gum bleeding when I flossed earlier in the day) since I was exposed to HR HPV, and am now concerned that I might have passed it on. Can you speak to my concern regarding this kind of transmission, in light of Gillison's statement, and explain the rationale underlying your conclusion in scientific terms? If HR HPV can be transmitted by french kissing, then why not by using the same glass/utensil? What distinguishes HR HPV from viruses that can be transmitted by sharing glasses? Thanks for your assistance.  

5 Responses
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300980 tn?1194929400
MEDICAL PROFESSIONAL
Although I would challenge your concern that she had oral HPV and transmitted it to you, you are correct about the issue of transmission in the unlikely scenario you describe.  Sharing drinking glasses or eating off of the same utensil is not something to worry about.  EWH
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Avatar universal
Thanks for the follow up. Sorry, one last clarification and I will leave you alone.  Assuming that she had an oral infection as well and that I contracted it would that change your perception about notifying people regarding drinking glasses? I'm assuming based on your first response that you think that sharing a drinking glass is not something I should worry about from a transmission standpoint even if I have the infection orally, but just want to make sure I understand.  

Thanks for you help.
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300980 tn?1194929400
MEDICAL PROFESSIONAL
No, there is no need to notify persons who you have shared a drinking glass.  As I said, in my opinion, there is no reason for you to worry that you shared a glass or utensils witha  person who had HPV either, particularly since her disease was in the genital tract, not the mouth.

The difference between synergistic effects and additive effects is that with synergy the effect is greater than the sum of the effects while in additive processes the effects are simply additive.  The difference is subtle and sometimes difficult to prove scientifically.

To try to guide you to pertinent articles and discussions would take far more time than I have available.  My comments are based on reading numerous papers and attending scientific meetings where such things are discussed, often at a molecular level.  This is beyond the scope and purpose of this Forum.  Sorry.  EWH
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Avatar universal
I certainly understand your point about media hype. Thanks for your response. I have a couple follow up questions.  

So in your opinion do I need to notify anyone who I have shared a drinking glass with recently?

Here is a link to the editorial review (published in the New England Journal of Medicine) of the Gillison article I mentioned (it is actually cited as D’Souza et al., but I think Gillison was involved): http://www.journals.uchicago.edu/doi/pdf/10.1086/597756?cookieSet=1
Any thoughts on the study would be appreciated.

My understanding is that the studies published so far on the relationship between oral cancer and high risk HPV indicate that, unlike with cervical cancer, smoking does not seem to have a synergistic effect on the risk of HPV-related oral cancer, but had an additive effect (I don't really understand the difference). I would be grateful if you could refer me to any relevant articles/studies. I am having a hard time understanding the total risk of oral cancer to someone who has high risk oral hpv, particularly hpv 16.

Thanks again

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300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome to the Forum.  I am not familiar with the study you mention but I have read a number of studies on HPV of the mouth.  As you note, this aspect of HPV and our understanding of oral HPV infections is still in evolution.  Sadly there are many alarmist statements being made.  Please remember that when news is concerning it is somehow thought to be more "newsworthy" than when person state that risk is low.  

We do now know that despite its tendency for genital HPVs to "prefer" to infect the genital area, infections have been found n the oral cavity. In the vast majority of cases it is thought to have gotten there through direct, oral sexual contact and there is VERY little credible evidence to suggest that the virus is spread through casual contact such -as sharing a glass or even kissing.  I suppose it could happen but......

Even more important however is the result of oral HPV infection should it occur.  There are about 6000 cases of HPV-related oral cancer which occur annually in the U.S. ( that’s 1 per approximately 58,000 people) and nearly all occur in persons who have HPV AND who smoke, the carcinogens in tobacco amplifying the risk for transformation to cancer.  When they occur, it is likely that most oral HPV infections do not cause disease.

I realize that these answers do not provide the "solid, detailed" answers that you want but I hope it does provide some perspective.  It is unlikely that your contact with a woman who had cervical cancer puts you at meaningful risk for HPV-related oral disease.  Furthermore, at this time, the best method of reducing risk of such problems is early detection through regular visits to dentists who now typically inspect the mouth for non-dental problems such as cancers as well.  I hope my comments are helpful.  EWH
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