Terrified mother - tested positive for HPV-16

[VMJ85]

I hope that you can help allay my fears - I just tested positive for HPV-16 after a series of abnormal pap smears and follow up tests.  

I'm absolutely terrified right now - both my husband and I have frequently performed oral sex on each other and I'm scared to death that we both could have the infection in our oral cavities.  

In addition, I'm scared for my two young children.  We frequently share food and drinks and I'm in a panic wondering if HPV viruses in my saliva could have been transferred to them - in addition to normal kissing.  I've also kissed nieces and nephews on many occasions.

So, my questions are:
(1) Is it a plausible scenario for HPV to be present in saliva in high levels if there is an oral cavity infection?
(3) If the virus enters the oral cavity, does it always take hold and cause infection?
(2) Is there any type of oral swab test that can be done to detect HPV?
(3) Do I need to inform my sisters/brothers that I may have infected their children?
(4) Am I over-reacting?

I'm in tears right now thinking about this and the information on the net is scary.  

Your advice will be greatly appreciated.

[H. Hunter Handsfield, M.D.]

Whoa, slow down!  To answer your last question first, yes, you are badly overreacting.

There has been a lot of media attention recently about oral HPV and oral HPV-related cancers.  HPV-16 is the main type that has been implicated.  But some other facts:  There are only about roughly 6,000 HPV-16 related oral/throat cancers per year in the entire US; that number probably is higher than it used to be, but it still is a rare disease.  Second, almost all of those are in people age 50 and up, especially 60 and over.  And there is a strong male predominance in these cases, for reasons unknown.  It isn't clear that any of these oral HPV-16 infections was sexually acquired, or when the person became infected.  Also, fewer than 5% of people with genital HPV have oral infection with the same type, even when they have performed oral sex on the partner who infected them.  Finally, genital HPV (of any type) is not transmitted to children of infected parents.  Absent inappropriate sexual activity, it's simply not a risk.

To the questions, using your own numbering system (your anxiety is showing!):  

1) I know nothing about oral fluids HPV levels.  But it can be assumed they are not high.  Nobody is known to catch HPV-16 by contact with anyone's oral secretions.  Trnamission appears to be exclusively by vaginal or anal intercourse.

3) As best we know, genital HPV does not usually take hold in the mouth, even after oral exposure to someone's genital infection.

2)  There is no generally available test for oral HPV infection.  Even the tests used in research studies aren't validated as yet; and the researchers don't even know how best to collect an oral specimen.  (Swab the throat?  The lips?  Tongue?  Cheeks?  Collect saliva?  Gargle and spit?)

3) You do not need to inform anybody about your HPV infection.  You absolutely should not tell your inlaws.  (Several million women, many of them with kids in the house, get new genital HPV infections every year in the US alone.  How many of your friends have told you about their infections?  Nobody does that and it would be inappropriate both for you and them.)

4) Yes, big-time.

Don't take my word for it. Speak with the gynecologist managing your cervical HPV infection.  And believe what he says.  And stop searching the internet for bad news -- or if you are compelled to keep looking, pay attention to the professionalism of the site. And totally ignore sites that are dominated by scare stories from infected persons, especially if they are not moderated by health professionals.

Best wishes--  HHH, MD

[VMJ85]

Many, many thanks for your sincere answer - you certainly helped calm me down.

What is frustrating is reading articles on the net that seem to make this out to be the next plague.  For example, in an article by Bernadette Healey that I read, she states that "HPV is a particularly scurrilous threat, since it incubates silently in the back of the mouth " and that "this rise in oropharyngeal cancer is linked to changing sexual practices and, in particular, ones that involve bathing the throat with HPV-infected fluid".

Those are some strong words - "scurrilous", "bathing", "infected fluid".   It sounds like your mouth is crawling with viruses if you are indeed infected or have had contact with someone who is.

I'm getting from you - very loudly - that this type of rhetoric is inaccurate.  

So, I'll assume that I'm not going to infect my children by letting them sip from my coke can or offering them a piece of my food.  I guess that if that was plausible, we'd all be infected - right?

Thanks for your help on this.

[H. Hunter Handsfield, M.D.]

Yes, the Healey piece is certainly having its adverse impact, owing to her name recognition and the credibility of her former work at NIH.  But she is not an STD, or infectious diseases expert, and authorities in those field believe she overstepped in making assumptions based on a not very sophisticated understanding of the issues -- not to mention the dramatic wording.  I have to wonder whether the article was ghost written and that she didn't think it through before signing off on it.  Whatever happened, in my opinion it is an embarrassment to her.

Your last paragraph (before the thanks) is exactly right.  STDs evolved as STDs precisely because they cannot be transmitted by casual exposures, or only with great difficulty or in special, infrequent circumstances.

[VMJ85]

Again, thanks.  Hopefully this commentary will be useful to other users of the board.