Cancer Causing HPV

[Jamesja02]

Dear Doctors,
I am a British 31 yr old heterosexual  male living in the UK and am in a happy 13 year relationship. As a result of recent relationship difficulty there were a string of incidents between December 2011 & May 2012  and I have become very concerned about cancer causing strains of HPV to the point where I am refraining from performing cunnilingus on my partner. I understand that HPV is widespread and that most people clear it but my girlfriend only had 2 partners before myself between the ages of 18-20 ( 13 years ago) and  I am very worried and driving myself crazy about any additional risk my actions will have caused by passing on a cancer causing strain of HPV to my partner by performing oral sex on her. The specific incidents:

- performed cunnilingus on 4 different girls, 1 of which was a stripper
- Fingered  the above and an additional 2 girls, 1 of which was a stripper
-  French kissed all of the above and an additional 3 girls, one one of which on 3 separate occasions

Questions
What would your risk assessment be:
1. I've read that you now know that oral HPV can be acquired by performing cunnilingus - my concern is that I've contracted a cancer causing HPV strain that I could pass to my partner by performing cunnilingus on her - is this a real risk and something that I should be worried about?
2. Similar to the above I'm concerned that that I may have transferred HPV from my fingers into my mouth after fingering these girls that I could then pass to my partner
3. That I may have caught a cancer causing strain of HPV by kissing these girls that I could then pass to my partner?
4. Am I right in thinking that I'm not at risk of chlamydia or ghonnoreah if I touched the head of my penis or opening to my urethra immediately after fingering a girls vagina?

Thanks for your perspective Doctor.

[Edward W Hook, MD]

You are repeating yourself and asking questions which have been answerd in other posts.  our time and space it limited, thus my answers will be brief:

1) Re. the theoretical possibility of transmission from cunnilingus to my partner - can you say this with confidence or is it simply that no data exists / no research carried out so is assumption only and may well be incorrect? (ie. I've seen that in 2007 it was felt that oral sex didn't transmit HPV but now its known to.)

The observational data is that cunningus is such an inefficient means of STD transmission that is is quite difficult to formally study.  

2) I've read in one of your posts that the chance of HPV developing to cancer is 1% - do you mean invasive cancer only or does this 1% also include Carcinoma in Situ? And would this  1% figure be any higher for someone in their 30s?

Invasive Carcinoma.  Carcinoma in situ is part of the readily treatable, "pre-cancerous" lesions that are readily treated.  

3) I've read that HPV dna can get under the finger nails - would this be washed off easily when in the shower simply from contact with water rather than any scrubbing of nails (concerned that I may have passed something to my partner when using my fingers to stimulate her).

Sorry, this is one of those "what if", unrealistic scenarios which is simply not borne out by years of observation and care of patients.  

4) For general understanding, I've read that condom use is only 70% effective against aquiring HPV - I'm assuming the same goes for male partners - ie. a male may well still be infected with HPV strains (higher risk or otherwise) even if a condom is used? Would HPV not be washed off as it would be if the HPV infection got on your fingers?

See no., 3 above.  

5) Finally, I've read various posts that state that if a female follows reguilar pap screening she is at no meaningful risk of developing cancer. However, all of the major UK Sites state that regular pap screening can only prevent 7/10 invasive cancers. This is based on a yearly audit of invasive cervical cancers (I've attahed the link for your reference). The audit found that of all women with invasive cervical cancer, 29% had followed regular screening guidelines. This would suggest that in the UK if you have an HPV infection that persists there's a 30% chance of developing invasive cancer? Why would this differ from your 'no measurable risk' assessment do you think - is there any notable differences in the effectiveness of screening in the UK & US?

I am not familiar with the data you mention. The fact is that HPV progresses to invasive cervical cancer over a period of years or even decades.  Thus person who get regular, repeated PAP smear screening are detected, if not on their first screening, on their second or third.  Here in the U.S. nearly all invasive cervical cancer occurs in women who do not follow screening guidelines.

That will be it for this thread.  Try to relax.  EWH

[Jamesja02]

Thanks a lot Doctor, this is really useful and has definitely put my mind at ease. Sorry to be a pest as I greatly appreciate the detail you've gone into above but just for my understanding/clarification as I've read other posts on the site and would like to assure myself that I'm not misinterpreting things on some specifics:
1) Re. the theoretical possibility of transmission from cunnilingus to my partner - can you say this with confidence or is it simply that no data exists / no research carried out so is assumption only and may well be incorrect? (ie. I've seen that in 2007 it was felt that oral sex didn't transmit HPV but now its known to.)
2) I've read in one of your posts that the chance of HPV developing to cancer is 1% - do you mean invasive cancer only or does this 1% also include Carcinoma in Situ? And would this  1% figure be any higher for someone in their 30s?
3) I've read that HPV dna can get under the finger nails - would this be washed off easily when in the shower simply from contact with water rather than any scrubbing of nails (concerned that I may have passed something to my partner when using my fingers to stimulate her).
4) For general understanding, I've read that condom use is only 70% effective against aquiring HPV - I'm assuming the same goes for male partners - ie. a male may well still be infected with HPV strains (higher risk or otherwise) even if a condom is used? Would HPV not be washed off as it would be if the HPV infection got on your fingers?
5) Finally, I've read various posts that state that if a female follows reguilar pap screening she is at no meaningful risk of developing cancer. However, all of the major UK Sites state that regular pap screening can only prevent 7/10 invasive cancers. This is based on a yearly audit of invasive cervical cancers (I've attahed the link for your reference). The audit found that of all women with invasive cervical cancer, 29% had followed regular screening guidelines. This would suggest that in the UK if you have an HPV infection that persists there's a 30% chance of developing invasive cancer? Why would this differ from your 'no measurable risk' assessment do you think - is there any notable differences in the effectiveness of screening in the UK & US?

(http://www.cancerscreening.nhs.uk/cervical/publications/nhscsp-audit-invasive-cervical-cancer-201107.pdf)

Thanks for your clarification on these final points Doctor, you have no idea how useful it is having the service you provde available to people.

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help. To preview where I'm going here, my sense is that your risk is quite low and that your worries may be more of a reflection of your concern about your partner, magnified by your guilt over what you refer to as "relationship difficulties".  The questions you raise are asked regularly on this forum and have been answered many time, thus you can search the site to see what both Dr. Handsfield and I have said in the past about the issues of HPV, oral sex and HPV and cancer risks.  Further, let me point out that if your partner had two partners in the years before you met, there is still a more than 50% chance that she had acquired, and cleared HPV before you met.  Further. let me point out that the news that is so prominent about HPV and its relationship to cancer is by no means new, it is new UNDERSTANDING of something that has been present but not completely understood for years.  With these background statements, let's work through your questions:


1. I've read that you now know that oral HPV can be acquired by performing cunnilingus - my concern is that I've contracted a cancer causing HPV strain that I could pass to my partner by performing cunnilingus on her - is this a real risk and something that I should be worried about?
While there is a theoretical possibility of this occurring, the risk is quite small and not something to worry about.  Of all penetrative sex acts, cunnilingus is the one least likely to lead to infection of any sort, for anatomical reasons and because STDs are less likely to occur through cunnilingus than other sex acts for anatomical and microbiological (the microbes that cause STDs have less affinity for causing  oral infections than genital infections) reasons.  


2. Similar to the above I'm concerned that that I may have transferred HPV from my fingers into my mouth after fingering these girls that I could then pass to my partner
Again, this is a theoretical rather than biological concern.  Masturbation is an even less risky sexual activity than oral sex.

3. That I may have caught a cancer causing strain of HPV by kissing these girls that I could then pass to my partner?
No realistic concern about this.  If there were, think of all the babies kissed by politicians who would now have cancers :)
.  
4. Am I right in thinking that I'm not at risk of chlamydia or ghonnoreah if I touched the head of my penis or opening to my urethra immediately after fingering a girls vagina?
You are correct- this is not a concern.

I hope these comments and perspectives are helpful It is most doubtful that the exposure you mention above have put your GF at any risk.  She, like all women, should follow the recommendations for regular PAP smear and cancer screening and she will be fine.  I hope my comments are helpful to you. EWH