Questions about HPV transmission

Doctors, I've looked this up a bit on the forums so hopefully I'm not repeating too much territory..
Here's the situation:

I've been concerned with HPV for a while now. (I'm a 30 year old male.) Dermatologist diagnosed a case of flat warts on backs of my hands and on my feet that he has been treating. As a result I have had him inspect my genital area several times now--no warts there, luckily.
Now I just spoke with a woman I had been intimate with a few months ago. She says she learned she has genital HPV (she found out via a pap smear.) We did not have intercourse, and I did not go down on her, but she went down on me (i.e. performed oral sex on my penis.)

1.) Just because she has genital HPV doesn't mean she would have any more of a chance of having ORAL HPV than anyone else in the population, right? Is there any reason I should be concerned about receiving oral sex from her, in terms of MY getting genital HPV?

2a.) My big worry: I also manually masturbated/'fingered' her. Is it possible that I could have contracted genital HPV on my hand, either in the form of visible warts or in non-wart producing virus on my hand?? I have anxiety issues and now Im concerned that I should tell future partners that I might have latent HPV virus on my hand, which would be an issue if I masturbated them...I hope this is not the case and I do not need to worry about this/bring it up with anyone (??).

2b.) I'm guessing that the flat warts on my hands/feet are totally unrelated to this fingering incident, most likely? I know a bit about how HPV 'works' in the sense of sites of preference...

3.) My anxiety issues also push me to get tested for STDs whenever tests exist. As I can tell there are no tests for men for genital HPV in the US, correct?? I have seen some stuff about PCR tests online but would rather not go down that route if it's unadvisable. Is this the same for testing for oral HPV--should I be getting an oral HPV test to make 'sure' I'm not carrying anything?

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help. My sense however is that you are over reacting.  The FACT is that if you have had unprotected sex with others you probably already have HPV, as does your partner. So what?  Most people (over 85% of sexually active persons) not only have HPV but have infection with multiple strains.  This is by no means the end of the world and should not be a matter of concern since only a small proportion of HPV infections go on to cause cancers or pre-cancerous lesions (particularly for men) and when it does, these can readily be detected if persons are seeing their health care professionals as is recommended.  At this time all you can realistically do to reduce your risk for HPV is to use condoms and get the HPV vaccine.  Both help.  then see your health care professionals regularly for check-up and for assessment of any unusual skin lesions which occur and persist.  That's it.

As for your specific questions:

1.) Just because she has genital HPV doesn't mean she would have any more of a chance of having ORAL HPV than anyone else in the population, right? Is there any reason I should be concerned about receiving oral sex from her, in terms of MY getting genital HPV?

Sexually active persons who perform oral sex are more likely to have oral HPV than persons who do not.   There are no data on whether persons with genital HPV (i.e. just about everyone) are more likely to have oral HPV than others. Either way, oral HPV is far less common than genital HPV.

2a.) My big worry: I also manually masturbated/'fingered' her. Is it possible that I could have contracted genital HPV on my hand, either in the form of visible warts or in non-wart producing virus on my hand?? I have anxiety issues and now Im concerned that I should tell future partners that I might have latent HPV virus on my hand, which would be an issue if I masturbated them...I hope this is not the case and I do not need to worry about this/bring it up with anyone (??).

Your anxiety issues are getting the best of you. The types of HPV that infect the genitals rarely infect the hands and feet and vis versa.,

Further, we do not urge clients to notify partners even if they have HPV since virtually everyone has the infection, they are of little consequence and there is little to do if one has infection unless they have troublesome visible genital warts.  

2b.) I'm guessing that the flat warts on my hands/feet are totally unrelated to this fingering incident, most likely? I know a bit about how HPV 'works' in the sense of sites of preference...

Correct- see above.

3.) My anxiety issues also push me to get tested for STDs whenever tests exist. As I can tell there are no tests for men for genital HPV in the US, correct??

Correct and if there were we would not recommend them since treatment of warts which are most likely to resolve on their own would be more likely to cause consequences than letting the HPV run its course.

4) While I did not perform oral sex on my partner in this case...hypothetically, for the future, what if I had? Would I have to be concerned about her genital HPV being transmitted to my mouth, and would I then have to inform future partners that I 'might have' oral HPV before I kissed them, performed oral sex, etc?

Oral sex appears to lead to HPV infection less often that genital/genital contact.  Even if you got it, as I said above, we do not urge discussion with sex partners since such knowledge so often leads to the sorts of over reactions that you are manifesting.

And you have mis-read my earlier post.

I hope this helps.  If there are further questions I will accept a limited follow-up but will not engage in a prolonged, repetitive exchange.  EWH

[anxiousinantwerp]

And I forgot a (4)--
4) While I did not perform oral sex on my partner in this case...hypothetically, for the future, what if I had? Would I have to be concerned about her genital HPV being transmitted to my mouth, and would I then have to inform future partners that I 'might have' oral HPV before I kissed them, performed oral sex, etc?

[anxiousinantwerp]

And my concern about the contracting HPV on my finger by touching her HPV infected genitals is from a comment made here by Dr Hook:

http://www.medhelp.org/posts/STDs/hpv-confirmed/show/438766

Where he says that getting HPV on the hand from fingering could happen 'but rarely,' and it would be visible. Can you clarify??

[anxiousinantwerp]

Thank you doctor. I will keep this to one follow-up comment, thank you.

1)*Can you clarify what you did mean in that post I included so I am not misreading?

2) *And just to be 100% clear--even if I 'fingered' someone with genital HPV or visible warts (not sure which strain she has), I shouldn't worry about having visible or invisible HPV on my hand, and should definitely not mention this to future partners, etc?

[anxiousinantwerp]

Oy, and forgot one more thing. I am 31 years old, and male (obviously.) Is it possible for me to still get the HPV vaccine, or even worthwhile? I thought there was a cut-off at 26 or so...

[Edward W Hook, MD]

I suspectd you would resond quickly and am not suprised that you "0ne follow-up" has become several:

1)*Can you clarify what you did mean in that post I included so I am not misreading?

You quoted a nearly 5 year old repsonse regarding getting HPV form masturbation in which I repsonded "rarely" when I now would have said "almost never" in a world where scientifically one can never say never.  This is not something to worry aobut.

2) *And just to be 100% clear--even if I 'fingered' someone with genital HPV or visible warts (not sure which strain she has), I shouldn't worry about having visible or invisible HPV on my hand, and should definitely not mention this to future partners, etc? .

Correct


The cut-off of recomemndation for HPV vaccine is based upon risk calculations as to when person are most likely to acquire HPV.  Getting the vaccine at this time wil not harm you and if you have not been infected with the vaccine types of HPV, would provide protection from it.  EWH

[anxiousinantwerp]

Thank you Dr. Hook.

Do you have any links/info on how to go about getting the HPV vaccine for men over the age of 26? Is it just the case that insurance won't pay for it over the age of 26? Everything I'm finding makes it sound more like a solid rule, not a reccomendation, including the CDC site. Sorry if I'm being dense, just want something to show my GP if i request the shots and am told that I'm 'too old' for them.

[Edward W Hook, MD]

It is not a solid rule.  You should just be able to ask your doctor.  EWH

[anxiousinantwerp]

The only thing I remain confused about is the issue of NOT counseling people to divulge HPV? Are you differentiating between wart-causing and otherwise? Because from reading the forum previously it seemed that both you and Dr. Handsfeld suggest informing partners if you have HPV, but if you've been wart-free (or abnormal pap free?) for 3 months, or 6 months, depending, then AFTER that point you can keep mum about it.

[anxiousinantwerp]

And you're also saying that even if I did perform oral sex on someone who ended up having genital HPV, I should not inform future partners in any case that I might have oral HPV?

This will really be the end of my follow-ups, 110%. Thank you for your time.

[Edward W Hook, MD]

The time has come for this thread to end.  This will be the final answers.

Once again, you have mis-read or have taken out of context our prior statements about HPV.  We have repeatedly discussed the nuances of talking to partners about HPV.  Because the vast majority of persons have HPV and are unaware of it, because there is nothing that needs to be done for most cases of HPV, and because of the tendency for persons to over-react to the possibility/knowledge of infection, we do not routinely recommend disclosure and suggest that it be carefully considered and if infection is KNOWN to be present, to discuss it with partners who are able to discuss the possibility without over reacting.  

Take care.  EWH