[Question #10459] HPV

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22 months ago
Hello Doctors, 

I am a gay male on Prep. I have one sexual partner but he has others besides me. After about two months of not seeing each other, we engaged in oral-genital, oral-anal, and anal intercourse today. Both of us gave and received for all activites. Afterward, I noticed a single small white bump on his anus that seemed to have grown ON the skin (not under the skin like a Fordyce spot or hair follicle). I am worried this was a wart. Assuming it was indeed a wart, I have some questions. Am I correct that exposure to a physical wart can easily lead to HPV infection but will not necessarily lead to me also getting a physical wart myself? Or am I almost guaranteed to get physical warts if I was exposed to his physical wart. Basically, I'm not clear on how often infection with HPV results in a wart you can see, especially if the person you got it from infected you with the kind of strain that causes visible warts in the first place. And should I be worried about my performing analingus or is that an unlikely route to infection?
Thanks Doctors! 
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Edward W. Hook M.D.
22 months ago
Welcome to the Forum. Thanks for your questions. Thanks as well for being on PrEP, this is a great thing for you and a step towards ending the epidemic of HIV.  I'll be glad to provide some comments.

Let's start with his lesion.  On one hand, you do not know that this is a wart.  What you describe does not sound classic for a wart and there are many other processes (cysts, etc.) which occur near the anus that might be mistaken for a wart.  On the other hand, as a sexually active man who has had other partners and may not be vaccinated, it is more likely than not that he has one of several different HPV infections.  The best way to prevent HPV and its relatively rare complications is to be vaccinated.  We recommend HPV vaccination for almost all of our clients.

If the lesion was HPV-related, your exposures do not guarantee that you will have been infected.  There are no infections, including HPV, for which transmission following a single exposure is 100%.  There are no good estimates on the per exposure risk of infection with HPV and that risk, is likely to vary with the site of exposure (it appears that the penis and anus/rectum are more easily infected with HPV than the mouth for instance).   Obviously, with more exposures, the likelihood of infection goes up  however.  

Warts and lesions.  Two HPV types, types 6 and 11 cause around 95% of visible warts but not all HPV 6 or 11 infections are manifested as warts.  In fact, inapparent HPV 6 and 11 infections are relatively common although I am not aware of data on precisely what proportion of HPV 6 or 11 infections cause visible lesions.  Thus, IF the lesion you noted was due to HPV and IF you became infected, that does not necessarily mean that the infection would also appear as a visible wart.  

I think these comments address your questions.  I hope that the information I have provided is helpful.  EWH
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