What are the chances?

[scottie2006]

Hi Doctor,



Thank you for providing such a valuable service!  Here is my situation.  I am a 35 year old male and have had one partner for the past 3 years.  I recently met someone and had an encounter.  I do not know this girl well but she told me prior to engaging in any sexual activity that she had a past HPV genital warts outbreak and was treated about 7 months ago by her doctor.  She said she has had a previous outbreak a few years earlier and has no current signs or symptoms.  I didn't feel comfortable engaging in sexual intercourse given this information but we did engage in oral sex both giving and receiving and we mutually masturbated each other as well as kissing, touching, etc.  Here are my questions;



1.  What is the chance that I could get her prior HPV infection from performing oral sex both giving and recieving?



2.  Can the virus (if still present) be transferred from mutual masturbation?



3.  If the virus is still present, how long can it live on your hand or fingers?  Can it be transferred through genital secretions?



4.  If I do have condom protected sex with this girl, what is the chance of passing it along if the sex is protected?  



It has been about 3 weeks now and I don't show any signs.  How long would it take for symptoms to show up and when do you think I would be in the clear?



Thanks again, I have read the information on this website and others and to be honest, it is completely confusing.  Just looking for some guidance.



Thanks again doc.

[H. Hunter Handsfield, M.D.]

The information is confusing in part because much of what is "known" about HPV is based on incomplete and inadequate data.  In any case, my first and primary advice is to not worry or obscess about HPV.  You probably already have been infected, perhaps several times; 80% of all people acquire genital HPV at least once.  It is wheel-spinning to get worked up over any particular exposure when you don't even know whether your partner is infected.



1) There is no way to know whether your partner still is infected with HPV.  Assuming she had no visible warts, there's probably a 50:50 chance she still has detectable genital HPV, but even if she does, the transmission risk probably is low once visible warts have responded to treatment.  Oral sex is low risk.  Oral HPV occurs but is uncommon.



2, 3) Genital HPV is transmitted only through genital secretions.  There are conflicting data on whether it can be transmitted by hands and fingers that are moist with genital secretions.  It probably occurs, but not commonly.



4) Condoms are highly protective against HPV (despite what is often said by the relgious right), but some transmission occurs because condoms do not prevent all skin to skin contact.



Bottom line:  If you are otherwise attracted to this person and decide to have vaginal sex with her, condoms would reduce the otherwise fairly low risk, but otherwise I wouldn't worry about it.  Genital warts are a minor inconvenience, not a health threat--certainly not important enough to interfere with an otherwise promising sexual relationship.



Good luck-- HHH, MD

[Testfrequency]

Speaking of oral transmission, does HPV shed only from the affected area of the body (e.g. genitals if genital hpv) or can it shed through saliva or other secretions even if the infected person is only affected genitally? From your response to Scottie2006, is it correct to say that there is both symptomatic as well as asymptomatic shedding, but that once symptoms reside, the shedding and risk of transmission decrease?



I know from reading your forum that oral HPV infections are rare, and in your reply to Scottie2006, you stated that "oral sex is low risk." I guess the question is whether this is because of the infrequency of oral HPV infections or whether there is some other reason.



Thanks for enlightening us with your forum.

[scottie2006]

Thank you so much for your fast response doctor.  Just one point I would like to ask for clarification on.  You mention that HPV is only transmitted through genital secretions but then you mention that the condom only protects areas covered and not those where skin to skin contact occurs.  I just want to make sure I am clear on this.  So, it can be transferred by genital secretions as well as skin to skin contact.  The information I have read leads one to think it is acquired by skin to skin contact only and not by genital secretions.



Also, what would be a fair amount of time for symptoms to show after exposure?  Is there a general timeframe?



Thanks again.

[H. Hunter Handsfield, M.D.]

It doesn't matter.  It's probably impossible to have sex without both skin-skin contact and skin exposure to secretions.



No expert advice says skin-skin is the only route of HIV transmission.  The point is that some infections (chlamydia, HIV, gonorrhea) are only by secretions, not skin-skin (because intact skin is not susceptible).  HPV, syphilis, and herpes are transmitted either way.



HHH, MD

[HHH,MD]

That last comment is supposed to say HPV infection, not HIV.



And I forgot to answer the last question:  Visible warts