Risk To Wife

[UKPete01]

Hello Doctors,
I've been married for 15 years and stupidly strayed 3 months ago. I have had a full sexual health screen and tested negative but have become anxious about the risk of passing a cancer causing strain of hpv to my partner. I understand that everyone is likely to have had hpv at some point anyway but my concern is any additional risk I've put my wife at. It would be appreciated I you could respond to the following:
1. Is there any risk of catching a cancer causing strain of hpv from receiving fellatio that I could then pass to my wife through unprotected intercourse?
2. Is there any risk of catching a cancer causing train of hpv orally from performing cunnilingus and could I then pass this to my wife by performing cunnilingus on her?
3. Can you confirm that there is no risk of Hep B or Hep C from putting my fingers in my mouth immediately after inserting them in this females vagina?

4. Can you confirm that based on my negative results for HIV, chlamydia, ghonnoreah and syphilis and depending on your responses to the above that i am now safe to continue unprotected sex with my wife with no risk to her?
Many thanks

[Edward W Hook, MD]

I will take you at your word that this is your last question- this will be my last answer.  My sense however is that you are re-thinking this again and again as a manifestation of your guilt.  Working throough that is what I would recommend you focus on.

The duration of your oral exposure does not change my assessment or advice.

Take care. EWH

[UKPete01]

Thanks doctor, whilst I think the 4th cunnilingus exposure with the stripper was brief, I was extremely drunk so can't be sure of how long it was. I'm assuming that the length of time is irrelevant anyway? This final clarification would put my anxieties at ease. Thanks again

[Edward W Hook, MD]

You are correct, the 4th exposure in no way changes my assessment or advice.  I hope my comments ahve been helpful.  Try to move forward, not to worry so much about the past- its behind you and fortunately, you did not get an STD or otherwise adverse effect from your mis-step.  EWH

[UKPete01]

Thanks doctor, this has helped. To end this thread and I suspect I know the answer but want to finish this conversation clear, ive realised there were actually 4 exposures as I also visited a strip bar on a stag weekend and when drunk performed brief cunnilingus on a stripper. I'm assuming that a 4th incident is the same as your opinion on 3, there is no increased risk of hpv to my partner and so I should just put this to bed and move on. This final clarification would be hugely appreciated. Thanks for your help.

[Edward W Hook, MD]

Thanks for the clarification- it in no way changes my opinion or advice however.  Directly to your follow-up questions:

1. No, that there were 3 incidents does not change my opinion.  

2.  In 2007 whether HIV could be acquired in the oral cavity was unknown.  We now know that it occurs but is not common. As I also said above, knowledge about HPV is increasing but what to do about it has not (other than to encourage vaccination of young persons, before they are at risk)

3.  The risk of gettting HPV from cunnilingus is lower than if your exposure had been fellatio.  Oral infections are (I'll repeat it again) rare however.  Whetehr or not and how effeciently oral HPV is transmitted through performing oral sex is not well understood at this time.  

4.  As I also said, it takes years and years for HPV to cause problems,.  As a result screening 3 years later will detect about 75% of infections missed at the previous screeing, and so forth. This system of repeated screening works VERY well and is the reason that your wife will not be at risk if she follows screeing guidelines.  

Try to relax.  Work through your guilt- don't dwell on unealistic risks that you  have nothing that you can do about.  EWH

[UKPete01]

Thanks doctor, I need to clarify that I had three separate exposures to different women, one o these was unprotected sex, another was receiving fellatio and performing cunnlingus and another was performing cunnilingus only. These were all in a short space of time and at a difficult point in my marriage which we are now thankfully over. A couple of things:
1) does the fact that there was actually 3 separate incidents change your view about any increased hpv risk to my wife?
2) I've read ablest post from dr handsfield from 2007 that states that there is no link between oral sex and hpv and that it's not been known to be transmitted fhrogh oral to genital contact. Does this and what you say about it being 'now known' to cause oral hpv demonstrate it's rarity or was the lack of knowledge previously due to something else?
3) just to clarify on one of your points do you mean that It's now known that hpv can be transmitted orally ie, I could catch oral hpv by performing cunnilingus but it's not known if I could then transmit this to my partner by performing cunnilingus on her? And to clarify could I catch genital hpv by having fellatio performed on me?
4) finally, you mention that in those rare cases where hpv does persist it can take years to develop. In the uk women have pap smears every 3 years, a nurses I spoke to said that it can prrogess at different rates in different women.
Also the nhs site stats that pap screening only detects 75% of cancers which makes me concerned that a) hpv could progress in my wife to a point of it being advanced cancer within three years and also that there is a 25% chance that any cancer might be missed?
Thank you doctor, I appreciate your guidance

[Edward W Hook, MD]

Welcome to the Forum. I'll try to help.  Your wife is not at serious risk from the events you describe.   Let me elaborate.

As you already know, HPV infections are very widespread and most people have acquired infection with multiple strains of the virus within a few years of beginning sexual activity.  These infections most often go undetected until they resolve spontaneously as the result of individuals' own immune response.  In the very small fraction (1% or less) of persons in who the HPV persists and progresses, it does so over a period of years and even decades allowing any resulting abnormality to be detected and therefore to be managed long before cancer occurs.  For all practical purposes, women who follow reproductive health guidelines and obtain periodic PAP smears are at no meaningful risk for developing a cancer which cannot be detected early and easily managed.  Our recent and increasing knowledge of HPV, its biology and how it is spread and progresses have not changed what is appropriate management of the low risk of cancer if persons following guidelines which were established long before the links between HPV and cancer occurred.  On the othe hand, this relatively new understanding has fueled epidemic guilt and concern over the possiblity of the process. Since there are no recommended HPV tests for men and the risk is so very low, I would urge you not to worry that your actions have placed your wife at meaningful increased risk.

As to your risks.  We now know that oral sex (cunnilinglus or fellatio) can result in acquistion of HPV (the role of oral sex is transmitting HPV is less clear) but that risk remains quite low, far lower than for genital exposures.  

Regarding your other questions.  Neither hepatitis B or hepatitis C is known to be transmitted through oral sex or ingestion of infected material. There is no reason for concern from putting fingers potentially carrying genital secretions or from oral sex.  .


Finally, currently available tests for HIV, gonorrhea and chlamydia are some of the most reliable diagnostic tests the medical profession has ever had access to.  When you consider negative test results in the context of exposures to a partner who is unlikely to bve infected in the first place, to that most unprotected exposures of any sort to infected partners do not result in infection and that your tests are negative, you have no reason whatsoever for concern about these STDs and need to stop punishing yourself for your mistep by worrying that you have acquired them or have given them to your wife.  

I hope my comment and perspective is helpful to you.  You need to stop beating yourself up.   Given the information you have provided, there is no eason for you to abstain from unprotected sex with your wife.  EWH