Oral-HPV and Recent Studies

Dr. Handsfield and Dr. Hook,

I appreciate the information found on this website, and almost feel like any question has been answered or that the answer could be found. Like many others, however, I feel fine asking and paying for your responses. FYI in properly addressing my questions; I am a 22 year old male, with 2 or 3 pack years under my belt, who occasionally smoked marijuana, and drinks maybe a little too much.

The situation:
I was most likely infected with HPV (High-risk) a little under a year and a half ago. Though I know of the prevalence of this virus for a long time I had severe anxiety and guilt related to the person I received it from. Also, it sounded as if she may have had an HPV infection for quite a while. I had no worrying sexual encounters until recently. The gist is, we preformed oral on each other at two different times, and she touched me then later touched the outside of her genitalia at two different times. No sex, no genital to genital.

The questions:
I'd like to know after all these new (oral cancer) studies does your advice remain the same that HPV is very rarely transmitted through oral sex, even perhaps Type-16? The likelihood of transmission seems to be presented online and in studies in either two ways; YES you WILL get it, or HARDLY EVER will you get it. What are your thoughts? About these new oral cancer studies? Should I be worried that I transmitted HPV to either her mouth or her genitalia through oral-genital contact?

Also, the typical genital-finger-genital question. Since, I know you'll probably respond by saying it is theoretical, but not probable, I'll ask in a different fashion. What would someone have to do to pass high-risk HPV to someone through G-F-G contact? Do you think preforming oral on her before she touched herself would have created the micro-fractures in the skin necessary for transmission?

Do you think after this type of contact the risk is high enough that I should tell her?

Thanks for your time!

[H. Hunter Handsfield, M.D.]

I'm happy to help, but my replies will be brief.  The reason we keep threads posted so long is that people will learn the answers they need and not ask the same questions again.  Since you already seem to know the likely replies, I won't go into detail.

In the entire US, the frequency of oral cancers amounts to around 16,000 cases per year.  Not all of those are associated with HPV.  But the rates are rising, more or less in parallel with rising rates of oral sex.  So probably there is a connection.  I have never said that HPV cannot be transmitted by oral sex, only that it's probably a lot less common than by genital sex and that it usually is asymptomatic.  For everybody with an oral HPV infection, probably less than one in many, many thousands are at risk for oral cancer.  Data may change, but if I were still a single man "out there" dating, I wouldn't give it a thought.

I haven't a clue what hand-genital exposures might or might not transmit HPV.  Why worry about a vanishingly rare occurrence?  You can assume that the more vigorous and prolonged the exposure, the higher the risk.  But I cannot put a number on the risk and won't try to guess.  Further, because it is vanishingly rare and has no public health importance, do not expect to ever have a clear answer, regardless of how long you life.  Nobody is going to spend any significant resources to figure it out.

If you have not had a specific HPV diagnosis yourself, or if you have and it is more than 6 months ago, I see no reason to mention it to any current or future sex partners.

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

[UMSt19d]

A related discussion, umm was started.