Oral HPV transmission clarification

[concerned1889]

Dear Drs.
I have read through many of the existing threads concerning oral hpv. In result, many of my questions I feel have been answered. However, I do want to share specifics of my situation to get a better understanding.

1) I am a 35 year old male. I have now been married for six years and have one child. 7 years ago, I noticed several genital warts. One was rather large in size and I had it removed. The other I left, hoping they would resolve on their own. They pretty much are unnoticeable without careful inspection. To this day, it seems they remain. I feel my body has not cleared them on its own. I do want to point out that I do have Crohn’s Disease and asthma, and an unsure if these would work against my immune system from clearing the warts. Do you have any thoughts?

2) I also performed oral sex on the individual I contracted warts from numerous times. I have never developed any signs of wart in or around my mouth area. However, since hpv-16 is so common (at least from what I have read), I am left concerned. If my body has struggled to clear the warts, should I assume if I did contract hpv-16 orally, that it too would remain?

3) To be safe, should I be limiting contact with my daughter (no sharing spoons, straws, food, etc) on the chance that I might have active hpv-16? I wasn’t aware of the issue of oral hpv until near the beginning of her second year, and I have already sometimes (but not often) let her lick from a popsicle stick I have just finished, shared a straw, or even shared a spoon that I put in my mouth and then hers with food on it. I know I may be stretching on this one, but I have never cared for anyone in my life like I do for her.

4) What are your thoughts on the work of Dr. Maura Gillison? She claimed early on that French kissing could transmit oral hpv.
http://www.foxnews.com/story/0,2933,520037,00.html

I appreciate your feedback and all you do.

[Edward W Hook, MD]

Welcome to the Forum.  You have reviewed other posts on our Forums so I will not repeat the facts that we have stated repeatedly about HPV and particularly oral HPV ant the (modest) risk for transmission of this ubiquitous infection.  I will summarize how I see your questions however because I think they are examples of the sorts of "what if" questions that we encounter so often- your question is based on the fact that you have genital warts, infections caused predominantly by HPV 6 or 11.  You go on to say, in essence, that because you performed oral sex on the person who you got HPV 6 or 11 from, you wonder IF you might have HPV 16 in your mouth which you could then pass on by kissing (presumably not French) your daughter or sharing eating implements with her.  While I do appreciate and understand your commitment to your daughter's health, I think you are over reacting and I fear that this sort of overreaction might impair your relationship with he, introducing a barrier to the contact and spontaneity which is part of what is so fulfilling form a parental relationship.

Sure we are still learning about HPV and its manifestations but this is simply not a reason to worry about transmission to your daughter through the activities you describe.  The thing you are worried about, oral cancer only occurs in a fraction of persons who get oral HPV and is more likely in persons who have co-factors (tobacco use or chronic immune suppression) and is something that dentists regularly exam their clients for as a preventative measure.  

I urge you not to worry about this- both for you and your daughters sake.  Answers to your specific questions below (space limitations).  EWH

[concerned1889]

I appreciate the additional information. After reading Dr. Hook's feedback, and earlier threads between other users and Dr. Handsfield, I am confident that there would be no possible transmition via sharing untensils between my daughter and I (if I actually did have oral hpv, which I cannot sit and stress about).

Dr. Gillison, who is the doctor who carried a study claiming that 7 percent of americans have oral hpv, made a statement that it could be spread through kissing. This study was in 2009. In 2012, she then made this statement based on additional study. Fewer than 1% of people without sexual experience had an oral HPV infection.

For parents worried that teenagers might spread HPV through kissing, "this is reassuring," Gillison says

This is in response to the less than 1 percent of people studied that claim to have no prior sexual interation. It is to be noted that in this less than one percent, oral hpv was found, but it wasn't made clear if this was type-16.

Also, http://www.cancer.org/index states that "It’s not spread through blood or body fluids."

Dr. Handsfield also states that there is no medical evidence of hpv-16 ever being transmitted non sexually.

Again, you can never say never...for anything. But I am very confident not that my interction with sharing utensils is safe.

[alahue]

Infections with high-risk HPVs cause more than 99% of all cervical cancers, 80 – 90% of anal cancers, 70% of vaginal cancer, and 40% of vulvar and penile cancers.  HPV also causes 25% of oral and oralpharyngeal cancers with HPV-16 present in 90% of oral HPV-positive tissues. Oral infections with low-risk HPVs can cause Recurrent Respiratory Papillomatosis (RRP), when children develop warts in their throat during birth which lead to persistent health problems throughout their lives. In the United States nearly 2,000 children are diagnosed with RRP every year.

Most sexually active people will be infected with at least one type of HPV at some point in their lives. Having just one sex or oral sex partner can expose you to HPV. Although the immune system generally clears an HPV infection within several months to a few years, some infected people may not resolve the infection. The virus can remain in the skin layer and gradually alter cells so that they become abnormal and cancerous usually after a period of years or decades after the initial infection. If one has an HPV infection on their skin and experience a trauma such as a cut, the HPV can cause cell abnormalities deeper in the skin.

Men and women infected with HPV can unknowingly spread the virus as the infection may present no symptoms and infected individuals may not realize that they carry it.  Though a condom may help reduce transmission, HPV is spread via skin-to-skin contact through the moist layer of skin and can therefore be passed onto a partner even when a condom is used. Nevertheless, safe sex practices including the use of condoms should still be utilized as a method to reduce the likelihood of transmission.

[alahue]

Human papillomavirus (HPV)

Human papillomavirus (HPV) is a virus transmitted through contact with the skin and mucosal membranes found in the mouth, throat, vagina, cervix, anus and penis. There are over 200 HPV strains that can affect the human body. The vast majority of these viruses affect the skin and cause benign warts. About 40 HPV types are sexually transmitted and about 15 of those strains cause lesions that can progress to cancer. A person can be infected with multiple HPV strains simultaneously.

HPVs can be classified into high-risk and low-risk groups according to the likelihood that an infection by the HPV type can lead to a cancer. The most common high-risk strains are HPV-16 and HPV-18, although types HPV-31, HPV-35, HPV-39, HPV-45, HPV-51, HPV-52 and HPV-58 are also high-risk.  Low-risk strains, such as HPV-6 and HPV-11, cause 90% of genital warts; these strains rarely develop into HPV-related cancer and may be linked with benign lesions and/or mild dysplasia.A study described in the 2008 British Journal of Medicine showed that 72% of anal cancer is caused by HPV-16 and HPV-18, the HPV types which cause most HPV-related cancers in the United States. Other studies have shown that though HPV-16 is the most common link to anal cancer followed by HPV-18, other types of HPV such as HPV-33 and HPV-73 infections have led to anal cancer.

[alahue]

from analcancerfoundation

The HPV Connection

80%-90% of anal cancers are caused by the human papillomavirus (HPV). There are many types of HPV. Some HPV types cause benign warts, but some cause lesions (also called dysplasia) that can progress to invasive cancer. HPV-16 and HPV-18 are the high-risk strains responsible for the majority of HPV-associated cancers. Nearly 75% of sexually active people in the United States will have a genital HPV infection at some point in their lives.

HPV causes cervical, anal, vulvar, vaginal, penile and head and neck cancers, as well as recurrent respiratory papillomatosis. Most people fight off HPV infections with the body’s natural defenses. Yet over 30,000 people will be diagnosed with an HPV-related cancer this year in the United States. Researchers do not know why some people get cancer from HPV and others do not. However, some people are at higher risk for developing anal cancer than others.

Intercourse is not necessary to transmit the HPVs that ultimately can cause anal cancer or cervical, vulvar, oral or penile cancers, although it is a common route of transmission. HPV can also be transmitted from person to person by deep kissing, manual stimulation of the genitalia, rubbing, sex toys or multi-site use of any fomite use (i.e. an inanimate object with the potential of being contaminated with a pathogen such as HPV). A person can also spread an HPV infection from one site on his/her own body to another site (e.g. hand-to-genitalia).

[Edward W Hook, MD]

Glad I could help.  Take care. EWH

[concerned1889]

Thank you for the quick repsonse. I am reassured now regarding my daughter. I came across an earlier thread where Dr. Handsfield stated that HPV-16 is only transmitted sexually. I know is medicine, you can never say never. But from your response, and his thoughts in other threads, I am confident now that transmission through spoon or straw is little if not no concern. Thank you again!

[Edward W Hook, MD]

1. I you are receiving therapy for your Crohn’s this may be moderately immunosuppressive and could impair resolution of genital warts.  Steroids and other immunosuppressive agents can do this.
2. As I pointed out above, you are asking about HPV 16 based on the fact that you have warts most likely due to HPV 6 or 11.  I think your concerns about HPV 16 are a bit excessive.
3. Please do not let these fears inhibit your interactions with your daughter.  If the infection was in your mouth and easily transmitted (neither of which is particularly likely) it could have happened years ago.  To be worried about this now serves no good purpose.
4. I do not know specifically of Dr. Gillison’s work.  The sort of news clip you refer too is over 3 years old and an example of the sort of media sensationalism that leads people to over react.  Certainly it is conceivable that the direct contact involved in French kissing could transmit HPV but that does not mean transmission is common.  Her research was done in the group (teen agers and young adults) who have the highest HPV rates due to their high rates of partner change.  Most infections in this age group are transient

I hope these comments are helpful.  EWH

[concerned1889]

For section 2) I realize hpv-16 is not what caused my genital warts. However, from what I read, hpv-16 is so common, I am assuming I could have contracted that as well. As since my body has had issues clearing the wart type, I am concerned about oral infection hpv-16 and transmitting it in non-sexual matter (if the infection is active).