hpv infection in the operating room

[lulu6210]

Hi- I had a question about hpv in the operating room.  Recently, I was involved in a case where it was scheduled as a biopsy of an oropharyngeal lesion.  Into the case, I asked why the surgeon was using a coblator for the biopsy.  He said it was already known that it was a squamous cell ca with hpv positive component.  There was some smoke at the beginning.  We did not have n95 masks on, just regular ones, which they say can let vaporized particles in still.  The surgeon was not concerned obviously, but the anesthesiologist would not even enter the room at the end of the case.  I know there has been a documented case where a surgeon was infected this way, and other cases have been suggested.  I can't seem to find what the conditions were.  Of course,several weeks later, my throat feels dry, like something in it, and awful taste.  I am concerned over the exposure, knowing for certain i have not had other exposure.    I know I tend to worry, but there is much confusion out there, with some concerned and some not.  I am wondering what the true likelihood of infection could be by this exposure.  I know some particles that are viable have been isolated from smoke, and that n95 masks are recommended, but have viable particles been found in coblator smoke, and how infectious would they be, and could a regular mask help at all?  Are my current throat symptoms typical of initial infection?  or is it just allergy/drainage coincidence?  thank you.

[lulu6210]

thank you.. I know if positive its a watch thing, which i am not good at, but wondered about the throat, if like with another virus infection, the symptoms would be indicative of infection( different in throat?)   thanks again for your responses....

[Edward W Hook, MD]

Th 6 monthfigure refers to the time required for a lesion to appear.  Again, to my knowledge, there are no data on how long it would take for an exposure of the sort you describe to become apparent.  

With regard to your concerns. what would you do if it were positive?  I think the only recommendation most clinicians would make is observation over time.  EWH

[lulu6210]

Thank you.  I did not mean this was not helpful.  It was in a way.  I do however need more info.  I also went to have the orarisk dna swish and spit test done.  the lab there said it would need to be at least a week after for the dna to show in saliva-- does the 6 months mean for an actual lesion to appear or just for the dna in a test such as the orarisk salivary test?  I took the test about 2 weeks after exposure thinking that would be an adequate incubation period.  is it not?  should i repeat the test at about 6 months?  thank you so much.  I need to discuss, and I appreciate your help

[Edward W Hook, MD]

Welcome to the Forum.  Your question deals with a nuance of HPV that I am not expert in so my answers will be based on my knowledge of HPV as it related to genital infections and their management.  I do have some suggestions however.

You are partially correct regarding the possibility of HPV DNA being aerosolized  when tissue containing the virus are destroyed using laser or electrocautery however to my knowledge there are no data proving that such DNA represents VIABLE virus. The heat generated during laser or electrical cautery would be expected to kill most microbes, including HPV.  You are also correct that because DNA aerosols have been demonstrated, n95 articles are recommended based on theoretical information however to my knowledge, there have any clinical trials which DEMONSTRATE that one mask is more effective than another.  

My comments and assessment:
1.  The surgeon who did this case sounds to have not followed appropriate precautions. I suggest that you mention this to supervisory personnel at your hospital.
2.  Overall, the risk of HPV infection from this exposure is low and not something to worry about.
3.  Your current scratchy throat in certainly not due to HPV.  It takes, on average 6 months for HPV infection to become apparent following an exposure.  

I hope these comments were helpful. EWH