Oral HPV concern

[TyFor]

Dear Doctor,

I recently started a monogamous relationship with a girl I'm very interested in.  Last night we had our first sexual encounter where we each gave each other oral sex.  I asked her this morning whether or not she has any STDs and she told me she has genital HPV.  I am currently unaware of the strain but plan to ask tonight.  I understand that many people have one strain of the disease or another, but I am wondering if there was a high-risk of transmission from this one act.  Coincidentally I learned from my dentist a few weeks ago that there is a correlation with oral HPV infections and cancer of the mouth and throat.  She said that there is a test that can be taken to verify whether or not you have oral HPV and what strain it is.  I was wondering if it is known what the incubation time is for this disease.  I would definitely go in ASAP and get tested if I knew that it was detectable.  I plan to have the test done every six months for the sake of trying to avoid oral cancer, but if it's possible to go this coming week from a reassurance standpoint it would be nice.  Beyond that I realize that it's very possible I already have oral HPV, or have had it at some point, and even genital HPV for that matter.  Are there any other tests that can determine genital HPV in men beyond visual inspection of warts? My main goal here is to find out how to be as safe as possible with a partner with this disease, as well as prevent transmission to myself, or other regions on her.  As a closing I have a couple of questions towards prevention of transmission.  Are there strains that affect only the genitals and not the mouth? If I have HPV orally will kissing her with tongue give her HPV orally?  What is the likelihood of transmission from a single night of oral sex from genitals to mouth?  There is still more information that I would like to get from her (strain, when she found out, most recent test results).

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

There has been a lot of research in recent years on oral HPV and the association of a single genital HPV type (HPV-16) with throat cancer. Although a lot is to be learned, the important facts are that oral HPV is a lot less common than genital; and that the vast majority of people with oral HPV-16 infections (probably under 1 in several thousand) actually develop cancer.

There are indeed tests that can attempt to diagnose oral HPV and even determine the type, and you can find them on line.  However, they have not been certified or approved by the Food and Drug Administration and are not recommended by most experts, even in people possibly exposed orally to the virus.  In any case, the ONLY type you need be concerned about is HPV-16, and even that really shouldn't be a worry.  At this point, I do not recommend that people in your situation take any precautions at all.  Certainly the details of how you kiss, or the mechanical details of oral sex, are not likely to make any difference; indeed, I doubt we'll ever know whether, for example, more or less tongue contact has any effect on HIV transmission risk -- this would be almost impossible to study.  There also are no data on genital to roal transmission risk for any single exposure.

Bottom line:  If I were in your situation, I would do nothing at all.  I would not be tested for HIV, would not use a condom, and would continue oral sex any and all other sexual practices that I and my partner both found enjoyable.  And I would not seek to learn my partner's HPV type (which likely isn't known anyway -- most tests associated with pap smears simply group HPV as "high" or "low" risk, without information on the specific type.

Here are three other threads that go into greater detail on all these issues.

http://www.medhelp.org/posts/STDs/HPV-and-oral-sex/show/1515473
http://www.medhelp.org/posts/STDs/HPV-and-oral-cancer-risk-in-male/show/1181303
http://www.medhelp.org/posts/STDs/Oral-HPV-Cancer-Risk/show/1512873

Best wishes--  HHH, MD