Oral?

[sleeplessinseattle425]

Hello Doctors,

I am a 35 year old male.  Spouse is 34.  Last year I had unprotected oral with a woman I did not know.  She briefly licked my penis (head and shaft) to provide saliva for a HJ.  Not sure if this makes any difference, but my penis was never physically inside her mouth.  This is my only exposure in 10 years with my spouse.  February, my spouse tested positive for High Risk HPV.  From everything I have read on the forums I can surmise the following.

1.  My unprotected oral sex/HJ had a low, but possible chance of infecting me with High Risk HPV.

2.  My spouse could have had a dormant HPV infection for the last 10 years.  

Both events seem to be uncommon, but yet one of the two HAD to occur.  In your opinion which of the two is more likely?  If you had to put a percentage on it.  50/50?  70/30?  80/20?  90/10?  

I have read that oral HPV transmission can occur, but in my case the woman would had to have had an active Oral High Risk HPV infection correct?  From everything I have read High Risk Oral infections are not very common.  Or after 10 years my wife had a dormant HPV infection flare up.  She is very healthy and has never had any female problems.  We have no kids.  She had 5 partners prior to me and I had 3 prior to her.  

I know this question can never be answered with 100% certainty.  I would like to think my actions had nothing to do with this, but the timing of everything is highly suspect and I feel certain that my exposure infected her.  

Thanks in advance.

[Edward W Hook, MD]

Playing "what if" games is not a good use of your time.  

The answer to your what if question however is that my answer would not change.

There is no way to determine how long your wife has been infected and how her  infection evolves will not provide clues to the duration of infection.  

This will end this thread. EWH

[sleeplessinseattle425]

One more follow up if I may please.

Even IF the woman had a High Risk Oral Infection would you still rate my exposure as a low chance of transmission?  The act that was performed on me doesn't seem much different than french kissing other than location of course.

Also, can we make any assumptions on how my wife responds to this infection over time?  For example, if she clears it quickly it was possibly a new infection (or strain) or if it lingers for a few years it was most likely longstanding?

Yes, you are probably correct about me over reacting, but unfortunately this lapse in judgment is something that will sit in the back of my mind for some time.

Thank you for your help.  

[Edward W Hook, MD]

HPV can be present without an abonormal PAP smear for years and then manifest itself as an abnormality. It is for that reason that annual PAP smears are recommended regularly for long periods of time.  Her findings don't trouble me a bit or strike me as unusal.  As I said before, I think they are a great validation of the value of regualr PAP smears.  

My sense is that you may be over reacting a bit.  EWH

[sleeplessinseattle425]

Thanks for the quick reply.  

Her pap came back as abnormal so her Dr. had it tested for HPV.  To my knowledge, she was never previously tested for HPV as she has never had an abnormal pap prior to this one.

Are these dormant infections really all that common?  1 in 1000?  1 in 100?

10+ years just seems really hard to believe.  Her Dr. didn't really make her feel like "this is something I see everyday".  

Thank you.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be happy to weigh in, as well as to ask a few clarifying questions.  First my assessment- I would put the odds at 90/10 that this is a longstanding infection in your spouse which has only recently been detected.  The events you describe, the "inefficiency" of oral to genital transmission, and the rather low prevalence of high risk oral HPV all lead me to this conclusion.  

Now to my clarifying questions which might change my thoughts.  Do you know if your wife has had prior tests for HPV?  Routine HPV testing is still not recommended inmost settings unless there is a reason to do it such as an abnormal PAP smear. While this may change in the future, for the moment I find myself wondering why she was tested to start with.  all too often we find that long standing infections are detected by clinicians who have just started HPV testing on their established patients, raising just the sort of questions you mention.

I'll look forward to further information from you. In the meantime, let me point out that this is good-helpful knowledge. the purpose of both PAP smears and HPV testing is to permit early detection of an infection which MAY (but usually doesn't) lead to future problems such as cancer so that they can be addressed before they do serious harm to those with infection.  Knowledge is power- feel good about the result but please don't beat yourself up over your miss-step as the source of this infection.

I hope this helps.  EWH