unprotected oral sex with prior known hpv infection

[entropy_boy]

Thanks so much for reading my questions, Dr. Handsfield. I have struggled with an hpv diagnosis for the past ten or so years. I do realize that I have a tendency to overreact because I also have obsessive-compulsive disorder. I’ve read most of the posts and your responses on this site and have often referred to the ASHA, CDC and American Society of Colposcopy and Cervical Pathology sites for accurate numbers. Recently I have been reading more and more about oral hpv transmission and I have become very concerned that I was not ‘honest and forthcoming’ with my hpv status and let my ex-girlfriends perform unprotected oral sex on me without disclosure of my infection over the past years. I feel like a jerk, but I also know that many expert opinions don’t feel it necessary to inform partners due to the ubiquitous nature of the virus and that the chance of them contracting oral cancer due to hpv exposure is somewhere along the lines of 1 or 2 in a million. Anyway, doctor, I was wondering if you could give me a hand and some peace of mind and reassurance by replying to the following questions:

1) Is it my ethical responsibility to retrace through my sexual past and inform my ex-girlfriends who performed unprotected oral sex on my of my hpv status?

2) Although I used condoms about 98% of the time (I had a couple girlfriends for over 1 year and didn’t use a condom for vaginal intercourse one time with each of them), I feel like a sleazeball that I didn’t inform them of my prior hpv infection. Do I need to contact them?

Thank you so much, doctor! You’ve helped so many people and we all very much appreciate your expert opinion and your dedication to public health education. Take care. S.

[H. Hunter Handsfield, M.D.]

It seems you are overreacting.  However, I don't know what you mean by "have struggled with an HPV diagnosis" for 10 years.  But your closing comment suggests that you're actually talking about a "prior" diagnosis (warts?).  If you haven't had visible evidence of warts or a professional HPV diagnosis for 10 years, it is long past time to forget it.

Although definitive data are not available on the frequency of oral HPV infection from performing oral sex, the available information suggests low risk.  Among young women followed to determine the frequency of new HPV infection, only about 5% of those who acquired genital HPV also had positive oral tests for the virus, even though most performed oral sex on the partners from whom they acquired their genital infections.  Second, almost all oral HPV infections are asymptomatic and undoubtedly the large majority clear up spontaneously -- that is, they aren't an important health issue.  Although the frequency of oral cancer is rising, not all cases (around 60-70%) are associated with HPV -- and even for those, it isn't clear that HPV is the main cause.  Smoking and heavy drinking may remain more important triggers.  In any case, if you compare the overall frequency of oral cancers (I have heard figures ranging from only 15,000 to 30,000 per year in the entire US) with the overall frequency of genital HPV and of oral sex, obviously the risk is trivial.

With that as background, my replies to your specific questions are:

1) People with known (i.e., currently active) genital HPV infection, such as warts or abnormal pap smear, should inform their partners, either for genital or oral sex.  But once the infection has cleared up -- and especially once a 3-6 months have passed without recurrence of warts or pap smear abnormalities -- in my opinion nobody has an ethical obligation to inform their partners, regardless of what sexual practices are likely.  Some disagree with this and would suggest that all people have an indefinite obligation to inform partners.  But most STD experts don't feel that way and I certainly do not.

2)  As I said above, if your prior HPV infection was more than a few months ago and you have no visible evidence of continuing warts or other problem, you can consider yourself cured. There is no reason to mention it, regardless of condom use or whether the contact is vaginal, anal, or oral.

Thanks for the thanks about the forum.  Best wishes--  HHH, MD