HPV, Oral Cancer, Vaccines, and (unnecessary?) Anxiety

[elagabalus]

I am a virgin and will be married in the near future.  My (future) wife has had one sexual partner in her life, who gave her both high and low-risk HPV.  This happened nearly 2 years ago, when she was 30.

Her genital warts have not returned after her initial infection, but she still tests positive for high-risk HPV. She is currently CIN-1.

I have received the HPV vaccination (Gardasil).  I was 30 and 31 years old when I took the course of shots.

My questions:

1. The literature out there that I have read speaks about the dangers of HPV for a person who is over 30, but In her case, she knows she has had it for about two years.  Is getting HPV later in life more dangerous and does it mean that the body is less likely to clear the infection, or to clear it rapidly? How serious is her diagnosis of CIN-1, roughly two years after initial infection?  

2. In terms of oral sex: do you have any sense of what the dangers of oral HPV infection are if a man performs oral sex on a person who is known to have high-risk HPV?  And do you have any sense of how great (or small) the odds are of going from an oral HPV infection to throat cancer?  

3. Also, do you have any sense of the efficacy of Gardasil on a man who received it after the age of 26, as well as its efficacy in preventing oral infection with HPV 16, which seems to be the culprit in these cases of HPV-related oral cancers?

4. If she has HPV, I presume that she will eventually give me HPV as well, even if we are careful to use condoms.  It’s just the nature of the (highly-contagious) beast.  Is there a chance that I could give her oral HPV if she were to perform unprotected oral sex on me?  Would having her vaccinated offer her protection from oral infection, even though she already has been infected vaginally/cervically?  

I know the research for some of these questions is simply not there, so I have asked for your sense, based on your experience dealing with HPV and HPV-related questions.  Thanks!

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.

Even with a possible rising rate of HPV 16-related throat cancer in men in their 30s and 40s, it remains a rare disease, with around 10,000 cases per year in a country of 307 million people.  In any case, you are protected, so it's not an issue for you.  

[elagabalus]

thanks a lot, Dr. Handsfield!  My original post was too long, so I had to delete things.  What I wrote originally included the fact that I had read through the recent article in the Journal of Oncology which dealt with oral cancer and HPV.  It got a lot of attention and in the newspapers, researchers were saying that men in their 30s and 40s were getting HPV-related oral cancers; if I understood the study correctly, however, something like 80% of their data was based on men who were over the age of 50.  What is more, and perhaps very importantly, the researchers did not know whether the throat cancer samples they were testing came from men who were, in addition to being infected with HPV, smokers, or drinkers, if they were gay or straight, or a variety of other potentially important factors. Researchers were working with historical data and could not go back and ask questions of their samples.  They were also studying people in a few places only—Hawaii and Los Angeles, as I recall.  

I have read extensively on HPV and my sense is that there is a lot of fear and a lot of misinformation and misunderstandings out there about it.  In the case of studies like the one that just came out, there is also a dynamic where researchers will tout their results in order to bring attention to their work and hope to get more funding for it.  The results in terms of anxiety among people who are dealing with these issues, first-hand, are often not very salutary.  I appreciate all the work you have done in this forum to educate people.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Just yesterday there was a question about oral HPV, throat cancer, etc, which also containst linke to two other thread.  They answers many of your questions, perhaps all of them.  Take a look:

http://www.medhelp.org/posts/STDs/HPV-Oral-Cancer/show/1624567

Perhaps most important, your immunization against HPV protects you from the single HPV type associated with throat cancer (HPV-16) -- so even if your partner has HPV-16, you are not at risk of catching it from her, either orally or genitally.  Her HPV/CIN should have absolutely no bearing on your sexual activities together -- no need to avoid any contact of any kind, no need for condoms.  To your specific questions:

1) The danger isn't in catching HIV at age 30 and up.  Being age 30 and HPV positive is just a marker of possible prolonged infection.  Most such women have been sexually active many years, and postive results at age 30 usally mean an infection has persisted for a long time.  It is long term persistence that carries the higher risk of progression to pre-cancer or cancer, not age per se.

2) HPV can be acquired orally, but even with high risk types, the large majority of the time nothing bad happens.  In your case, you are protected agains the single type that could cause problems someday.  So no worries at all; if oral sex is pleasurable for you and your wife, follow through with no concern at all.

3) The vaccines are believed to be equally effective regardless of age.

4) You will not catch HPV of any of the 4 types covered by Gardasil.  And any other types will remain asymptomatic and never cause you any problem.

So all is well, no risk to you.  Your wife needs to follow her doctor's advice and plan about managing her pap abnormalities.  Other than that, there is nothing you need to be concerned about.

I hope this helps.  Best wishes--  HHH, MD