I have some questions. 

1. Knowing that it is almost impossible for a guy to get tested for HPV, I want to ask this question. At least in 4-5 occasions I have had unprotected oral (both giving and receiving) with female CSWs in the last 10 years. I am worried if I can get oral cancer and transmit the HPV to my SO by kissing or via oral sex (giving and receiving). How often do people get oral or throat cancer from HPV infections? How likely do you think I am exposed to this virus (statistically speaking)?

2. My second question is that I had protected oral and vaginal sex with an escort less than 24 hours ago. The sex was intense, and the condom was mostly intact except the bottom part of my penis which was exposed to her vaginal fluids. I have had itching around my genitals (penis, testicles and pubic hair), pain in penis and testicles and even some dull pain in my legs. What are the chances of getting any STI from this exposure?

Thank you dearly

You have basic misunderstandings about HPV. Getting it and having it is a normal, expected, unavoidable aspect of human sexuality. Around 90% of all people are infected at least once within their first 3-4 lifetime ex partners. The vast majority of infections never cause symptoms or disease. Cancer is possible but rare. Your own sexual history is on the low risk side for HPV, which is infrequently transmitted by oral sex. And because HPV is so common, CCSs are no more likely to have active, transmissible infection than anyone else.

1) You are at low risk for HPV from kissing or oral sex, but can assume you have been infected assuming you have had other sex partners over the years. You can look at the American Cancer Society webisite (www.cancer.org) for statistics on throat cancer from HPV, but I'd in the neighborhood of 16,000 cases per year -- a tiny number compared with the millions and millions who have performed oral sex and potentially exposed to the single HPV type that causes almost all such cancers (HPV 16).

2) Congratulations for having safe sex in this situation. It protected you from the STIs that matter.I Still, you could have acquired HPV (again) during the exposure described:  condoms are only fair protection against HPV, since they allow for lots of skin contact and exposure to genital fluids above the condom. But since it is so likely you have been infected previously. this particular event probably did not raise your risk for being infected or having a future HPV health problem. In any case, genital itching is not a symptom of HPV or any other STI -- you might be having a nonspecific irritation effect. "Pain in penis and testicles and...dull pain in [your] legs" also is not due to any STD; almost certainly it is just the result of anxiety over the exposure (or a sexual decision you regret).

In summary, I see nothing for you too be worried about. Let me know if anything isn't clear.

HHH, MD

Follow up question. How likely is hepatatis B is transmitted via unprotected oral sex? Or is it close to zero?