I am wondering if you could tell me the risk of a man contracting HPV from the following scenario.

1) If the following was a man's only lifetime sexual experience and occurred more than 5 years ago and he has been completely celibate since:  condom protected intercourse and condom protected fellatio with several different female sex workers on several different occasions (about 5-10). In these scenarios what is the risk of contracting genital HPV infection?  If HPV was deposited only on genital areas not covered by a condom, could it then be spread to the rest of the genitals when one is washing oneself afterwards (through rubbing the entire area with soap and water), or through any type of touching of oneself afterward? 

2)  What is the risk of a man acquiring oral HPV through one time unprotected oral sex on a sex worker?  If it was acquired, what are the chances that it is still active and contagious 5+ years later?

3) If genital HPV was contracted in scenario 1, what are the odds that the infection is still active and contagious 5 years later (if the person has been entirely celibate since these experiences)?

4) I have read that HPV clears for most people within 2 years.  Does that mean they are no longer contagious for life? 

5) In cases of " reactivation" could the virus be passed on to someone else, or is it only a risk for the person infected?

6) Basically, what are the odds that a man with the above experiences would have contracted HPV and can spread it to future partners more than 5 years later?

Unfortunately, there are few precise data on the details of HIV acquisition, persistence, reactivation and transmission implied by your questions. My replies are based on my professional estimates and experiences, along with educated guesses. The answers could change in the future if new data become available.

1. Condoms are poor in preventing HPV. They lower the risk for any single exposure, but over time consistent condom users acquire HPV at pretty much the same frequency as non-users. With 5-10 such exposures, it is likely you were infected with HPV. It is entirely speculation about the mechanisms of infection when condoms are used, but it might include contact with genital fluids are skin not covered by the condom; or vaginal fluids on the penile shaft may be worked under the condom surface. (During sex, the penis often slides inside the condom, perhaps carrying fluids under the edge. These sorts of things probably help explain why condoms work less well for all STDs transmitted skin to skin, i.e. herpes and syphilis in addition to HPV. But they remain nearly 100% effective in preventing gonorrhea, chlamydia, trichomonas and HIV.)

2. Oral HPV is a lot less common than genital, and a single oral exposure is very unlikely to result in oral HPV infection. Most oral HPV infections probably clear rapidly and rarely reactivate, but nobody can say the risk is zero.

3. Few HPV infections remain active or reactivate and are transmissible after 5 years. But it sometimes happens, with no knowledge as to exact frequency.

4. The two year clearance figure is only an estimate. It is fairly accurate for high risk (cancer causing) HPV infection of the cervix in women; for external genital infections no data are available. Two years probably is a pretty good estimate, and once resolved most cases do not reactivate and become contagious again.

5. "Reactivation" means reappearance of previously undetectable HPV. Presumably it is equally transmissible as a persistent infection that was never cleared.

6. I cannot give you an accurate numerical estimate of the odds. As an educated guess, the chance is low in this situation -- but I suppose there could be a 10% chance of a future partner being infected in this way.

Sorry that exact data aren't available:  these are difficult topics for research studies, but I hope these answers are somewhat helpful. Let me know if anything isn't clear.

HHH, MD

1) When you say that condoms lower the risk for any single exposure, but not with consistent use, does it make a difference if a man sleeps with a different women each time (thus there are many "single" exposures) versus many times with the same partner?

2) Would you say that data suggest that HPV clears faster and is less likely to persist or reactivate in men due to the fact that penile cancer is so rare (much rarer than cervical), despite the fact that men probably acquire HPV at the same rate as women?  Do you think persistence and reactivation is more common in the cervix?  Therefore, after many years, a man is not likely to pass on HPV infection, even if he had it at one point?

3) Finally, I know there are no commercial HPV tests for men, yet there are testing methods used in studies.  If a man really wants to know his status, is there any way he can get such a test?

Thank you!

2) I didn't say HPV clears more rapidly in men than women. True that penile cancer is less common than cervical, but I suspect that's due mostly to differences in cervical tissues compared with the skin of the penis, and not to duration of HPV.

3) Actually, some labs offer commercial tests for HPV that they will do in males. However, no such tests are approved by the US Food and Drug Administration and their reliability is often unknown or at least highly variable. Among other things, there is no clarity on exactly what specimen(s) to collect:  urine, penile swabs of shaft, under foreskin, etc; abrasive methods versus wet wash; and so on. If a particular HPV type is found, that's probably reliable, but negative results are not reliable evidence HPV is absent. And it is difficult to counsel the patient about what to do about the result. So the answer is that such testing often can be done, but most experts agree there isn't much point and don't recommend it.

I believe this is my last follow-up, so I would just like to ask:

1) Do you suspect that even if a man may still acquire HPV with a condom, the viral load would be less (due to less skin to skin contact), so therefore the HPV would clear faster or be less likely to persist?

2) If a man wanted to get one of the tests you described, though not recommended, where can he go or who can he ask? Could you provide contact information for particular labs?

3) But finally, my overall understanding from all of this is that even if a man has contracted HPV, if he has been completely celibate for 5+ years, the chance of him infecting a future partner is low, correct? Because I have read other responses from you and Dr. Hook telling people with genital warts that after their warts are removed and have not returned for a certain length of time, they can safely resume unprotect sex with a partner without worry of passing on the virus, which makes me believe that HPV of any type is not usually contagious for life.

Thank you for your time!

In most cultures around the world, any woman you eventually settle down with probably will already have had HPV and might still be infected -- since 90% of all people acquire HPV. In that event, sex with you will not materially raise her risk of being infected or of having a health problem from HPV.

That concludes this thread. I hope the discussion has been helpful.