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Putting HPV to rest.
Hello Doctor,
My following questions relate to HPV transmission. I've found similar questions posted before, but they were around 6 years old, and I would like an updated answer regarding risk-assessment, as the medical literature and consensus on the manner of transmission has likely changed some in the past few years.
I just began a relationship with a man who was allegedly diagnosed with a genital wart 2 years prior. It was treated, and currently we believe he has no visible warts, though I am aware of alleged "micro infections." We are trying to be as careful as possible to avoid transmission. Currently, we have not engaged in any penetrative sex (be it oral or otherwise) and no genital apposition has occurred. I have also completed the full Gardasil series, receiving the third injection prior to any contact of any kind.
1) I understand that HPV DNA can be found under the fingernails of those infected with genital strains. Would thorough handwashing prior to any genital contact (i.e. before my boyfriend fingers me) be sufficient to avoid hand-genital transmission of HPV?
2) Touching his penis, then potentially touching myself. How likely is this to transmit the virus?
My following questions relate to HPV transmission. I've found similar questions posted before, but they were around 6 years old, and I would like an updated answer regarding risk-assessment, as the medical literature and consensus on the manner of transmission has likely changed some in the past few years.
I just began a relationship with a man who was allegedly diagnosed with a genital wart 2 years prior. It was treated, and currently we believe he has no visible warts, though I am aware of alleged "micro infections." We are trying to be as careful as possible to avoid transmission. Currently, we have not engaged in any penetrative sex (be it oral or otherwise) and no genital apposition has occurred. I have also completed the full Gardasil series, receiving the third injection prior to any contact of any kind.
1) I understand that HPV DNA can be found under the fingernails of those infected with genital strains. Would thorough handwashing prior to any genital contact (i.e. before my boyfriend fingers me) be sufficient to avoid hand-genital transmission of HPV?
2) Touching his penis, then potentially touching myself. How likely is this to transmit the virus?
MEDICAL PROFESSIONAL
This will need to be the final answer. If you continue to search the internet on this I can promise you that you will get conflicting information. This is because of a combination of facts including the fact that our understanding or HPV and HPV infections is still growing and unwarranted fears about HPV and its consequences. You have had the HPV vaccine and this dramatically reduces any risk you have for getting HPV or its rare consequences. The idea that your paranoia would cause you to end a relationship that you otherwise value saddens me.
HPV is transmitted by DIRECT contact and is not know to be transmitted in semen. Oral HPV is quite rare, even following known contact and you do not know that you were even exposed. Your partner was treated before your single oral contact - the chance that he was infectious in any way, much less that if he was you acquired infection is vanishingly low.
To build on this, I have provide two links below to other comments my colleague, Dr. Handsfield has writtin in the past summarizing our perspectives on oral HPV.
http://www.medhelp.org/posts/STDs/HPV-and-oral-sex/show/1515473
http://www.medhelp.org/posts/STDs/Oral-HPV-Cancer-Risk/show/1512873
With future partners there is no reason whatsoever for disclosure regarding the events that you are worried about. EWH
HPV is transmitted by DIRECT contact and is not know to be transmitted in semen. Oral HPV is quite rare, even following known contact and you do not know that you were even exposed. Your partner was treated before your single oral contact - the chance that he was infectious in any way, much less that if he was you acquired infection is vanishingly low.
To build on this, I have provide two links below to other comments my colleague, Dr. Handsfield has writtin in the past summarizing our perspectives on oral HPV.
http://www.medhelp.org/posts/STDs/HPV-and-oral-sex/show/1515473
http://www.medhelp.org/posts/STDs/Oral-HPV-Cancer-Risk/show/1512873
With future partners there is no reason whatsoever for disclosure regarding the events that you are worried about. EWH
Hi Dr. Hook,
If you could provide some brief commentary on the transmission of oral HPV, I'd be very much appreciative.
It is my understanding that HPV is spread mostly by direct skin to skin contact, however, is semen a likely vector for transmission? As discussed before, I have a partner who had an active case of genital warts that was treated. About 2 months after treatment, I performed protected oral sex on him, but afterward semen came into contact with my mouth (sorry to be graphic). I've been vaccinated with Gardasil. I know that oral warts are extremely rare, but I'm concerned about disclosure to future partners if my relationship does not work out. How likely is it that semen could have transmitted HPV to me orally, or transmission from the single act of protected fellatio alone?
If you could provide some brief commentary on the transmission of oral HPV, I'd be very much appreciative.
It is my understanding that HPV is spread mostly by direct skin to skin contact, however, is semen a likely vector for transmission? As discussed before, I have a partner who had an active case of genital warts that was treated. About 2 months after treatment, I performed protected oral sex on him, but afterward semen came into contact with my mouth (sorry to be graphic). I've been vaccinated with Gardasil. I know that oral warts are extremely rare, but I'm concerned about disclosure to future partners if my relationship does not work out. How likely is it that semen could have transmitted HPV to me orally, or transmission from the single act of protected fellatio alone?
Thank you again for your additional commentary. I really do not mean for this thread to drag on and on, but I keep finding conflicting information on this forum from other experts, and am just trying to obtain an understanding of what the consensus is on the matter. Dr. HHH stated in a previous thread that, concerning HPV, "the chance of transmission to your partner by hand-to-genital contact are very low. They will be lowered to zero if you wash your hands." You seem to think that it wouldn't really make much of a difference. I don't know what to believe, and I'm not sure where to go from here. I know my questions reek of anxiety, but it really is a more of a matter of knowing what is safe and what not is safe. Now, I fear that I might as well just terminate the relationship because, apparently with HPV, no amount of contact, even with substantial handwashing, is considered "safe."
MEDICAL PROFESSIONAL
Thanks for your thoughtful reply and clarification. I note that you assume that your BF has HPV and I am confident that you can find experts who will both agree and disagree with this assumption. I think most would agree however that if he has not experienced a recurrence in the two years since his treatment, that infection is no longer likely to lead to infection in you.
As for the hand washing issue, I have no doubt that if he had HPV on his hands or under his fingernails, washing them would somewhat reduce infectivity but precisely how much is unknown and whether the scenario you describe even puts you at risk, particularly after you we're vaccinated, is hard to know. On the other hand, I suspect that the concerns about hand washing, etc might hinder the spontaneity of you interactions- something that may not be good for the relationship.
My comments were not meant to sound glib but to provide a perspective which might help to keep fear of a widespread but manageable infection from deleterious lay impacting this or future relationships. You have done the right thing in getting the HPV vaccineEWH.
As for the hand washing issue, I have no doubt that if he had HPV on his hands or under his fingernails, washing them would somewhat reduce infectivity but precisely how much is unknown and whether the scenario you describe even puts you at risk, particularly after you we're vaccinated, is hard to know. On the other hand, I suspect that the concerns about hand washing, etc might hinder the spontaneity of you interactions- something that may not be good for the relationship.
My comments were not meant to sound glib but to provide a perspective which might help to keep fear of a widespread but manageable infection from deleterious lay impacting this or future relationships. You have done the right thing in getting the HPV vaccineEWH.
Also, I forgot to mention that I have not had any sexual contact prior to this partner. I'm a virgin, etc. So I highly doubt I've been previously infected with HPV. In short, given the previous degree of contact I've described, should I continue with these behaviors in the future, can I safely assume I will not contract genital warts from my boyfriend?
Thank you for your insightful commentary. I am aware the the vast majority of individuals have been or are currently infected with some strain of HPV.
That being said, while I understand that the transmission routes I have described are not common, I understand they are *possible*. Now, I understand the "well a meteor hitting you is also possible" scenario, but the fact is that my boyfriend does have HPV, and I am putting myself at risk by engaged in sexual behavior with him. I see no harm in trying to be precautious to avoid infection.
It seems like you feel that handwashing prior to contact would not reduce the risk of transmission much, if at all. Can I ask why? I'm now fairly nervous, and if you feel that this wouldn't help much, perhaps I should just avoid contact altogether.
That being said, while I understand that the transmission routes I have described are not common, I understand they are *possible*. Now, I understand the "well a meteor hitting you is also possible" scenario, but the fact is that my boyfriend does have HPV, and I am putting myself at risk by engaged in sexual behavior with him. I see no harm in trying to be precautious to avoid infection.
It seems like you feel that handwashing prior to contact would not reduce the risk of transmission much, if at all. Can I ask why? I'm now fairly nervous, and if you feel that this wouldn't help much, perhaps I should just avoid contact altogether.
MEDICAL PROFESSIONAL
Welcome to our Forum. I hope that I can help you accomplish what you refer to in the title of your questions and allow you put any concerns you have about HPV to rest. In doing so, I need to share with you the overall perspective that we take on HPV infections. In doing so, I am going to presume that you have had sex with at least one partner in the past. If so, you probably have or have had HPV in the past. Further, by taking the HPV vaccine you have done the best single thing you can do to prevent both further HPV infections and, more importantly, the consequence of HPV that we to prevent, cancer and pre-cancerous lesions. Further, if it has been two years since your partner was treated for his wart with no sign of recurrence, then it is safe to assume that he is not infectious to you related to that infection. I hope your concerns will not negatively impact your relationship.
With these background statements, let's address your questions:
1) I understand that HPV DNA can be found under the fingernails of those infected with genital strains. Would thorough hand washing prior to any genital contact (i.e. before my boyfriend fingers me) be sufficient to avoid hand-genital transmission of HPV?
Hand to genital transmission is not a major concern. HPV DNA has been found nearly everywhere is has been looked for. The presence of DNA does not mean that transmission will occur. As you might imagine, there are no studies of hand to genital transmission of HPV, much less the utility of hand washing to reduce this. I would urge you not to worry about things such as hand washing prior to masturbation by your BF but if that is the path you choose to take, hand washing, and use of a fingernail brush might theoretically help.
2) Touching his penis, then potentially touching myself. How likely is this to transmit the virus? .
Again, most experts agree that this is not a major route of HPV transmission.
I hope these comments are helpful. More importantly however, I hope that you can avoid having a fear of HPV negatively impact your relationships with others. As I tried to indicate above, virtually everyone has HPV and the two most important things a person can do at the present time to minimize the consequences of the infection are to take the HPV vaccine as you have done, and to get PAP smears at regular intervals. EWH
With these background statements, let's address your questions:
1) I understand that HPV DNA can be found under the fingernails of those infected with genital strains. Would thorough hand washing prior to any genital contact (i.e. before my boyfriend fingers me) be sufficient to avoid hand-genital transmission of HPV?
Hand to genital transmission is not a major concern. HPV DNA has been found nearly everywhere is has been looked for. The presence of DNA does not mean that transmission will occur. As you might imagine, there are no studies of hand to genital transmission of HPV, much less the utility of hand washing to reduce this. I would urge you not to worry about things such as hand washing prior to masturbation by your BF but if that is the path you choose to take, hand washing, and use of a fingernail brush might theoretically help.
2) Touching his penis, then potentially touching myself. How likely is this to transmit the virus? .
Again, most experts agree that this is not a major route of HPV transmission.
I hope these comments are helpful. More importantly however, I hope that you can avoid having a fear of HPV negatively impact your relationships with others. As I tried to indicate above, virtually everyone has HPV and the two most important things a person can do at the present time to minimize the consequences of the infection are to take the HPV vaccine as you have done, and to get PAP smears at regular intervals. EWH
You are reading content posted in the STDs Forum
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