[Question #12039] Oral Exposure

10 months ago

I’m a 30 y/o F s/p Gardasil vaccine in past, hx of CIN 1 “other-high-risk” cervical HPV, but recent Pap in 08/2024 was normal and neg HPV. Met new partner, got tested together b4 anything with STI screening (HIV, syphilis, C/G), both of us all negative. I gave him unprotected fellatio for 1st time and found a bump on penis. Next day Urgent Care physician clinically diagnosed the bump as “likely folliculitis,” but also said could be HPV wart. Sent viral culture, which was negative. No sexual contact after that, we broke up. Never had intercourse, only deep kissing, dry humping, hand jobs, fingering, and the 1 time oral sex. Ex refuses to see Derm for biopsy to confirm dx. Been 1.5 months and I haven’t had any oral or vaginal lesions appear, but I’m so anxious and scared. Should I tell my future partners about this exposure? Am I now a carrier of warts for life/could I infect my future partners? Is there a certain period after if I remain asymptomatic that I’d be deemed “in the clear”?

H. Hunter Handsfield, MD

10 months ago

Welcome to the forum. Thanks for your question and your confidence in our services.

Congratulations for your practical approach toward sexual safety, including HPV. I'm glad to hear your previous CIN and cervical HPV have resolved; apparently you were infected with a type not covered by the vaccine. Did you receive Gardisil 4 or 9? Just curious -- although both are equally effective in preventing the two HPV types that cause 90% of genital and oral warts, HPV 6 and 11.

More to the point of your question, folliculitis and warts are entirely different, so it's slightly difficult to understand an experienced physician being uncertain between the two. And for what it's worth, single genital warts are uncommon; most cases have several warts visible. But even if it's a wart, having been immunized against HPV 6/11, you are not at risk of oral infection. Second, assuming you have been sexually active over the years and other relationships included oral sex, undoubtedly you have previously been at potential risk of oral HPV, and this event does not materially elevate that chance any higher than it was. There will be little or no risk of you transmitted HPV to other oral sex partners on account of this event.

Warts can develop anywhere from a couple of months to years after acquitting the causative HPV infection. But the chance you will ever have such a problem is exceedingly low -- and no more than it was before this event or in almost all sexually active persons. I really don't think you need worry at all about this.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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10 months ago

Thanks for the response! I got the Gardasil 4 in 2013. Yeah, initially UC doc said could be HPV wart, but then when he looked closer he said likely folliculitis bc saw a dimple in center c/w follicle? l just reread the clinical note- it states “Penile Lesion. Appears more like folliculitis, however we did swab will send out for virus culture. Treat accordingly”. No mention of HPV in note, only verbally in visit, so idk if I’m being irrational, but since not able to get confirmed dx it remains uncertain. Just to clarify, if it was a wart, since I’m vaccinated, does that mean I have a 10% chance of developing warts and passing on, or is oral risk lower than that? Also he briefly gave me cunnilingus right before fellatio event, no lesions on/around mouth observed, but not sure if I’m at risk there too. To clarify, do you think this event should be disclosed to future partners or should I just move on since no confirmed exposure/low risk? Any benefit to getting Gardasil 9 now? Thank you!

H. Hunter Handsfield, MD

10 months ago

Thanks for the expanded description. With this information, molluscum contagiosum is a possibility -- a minor and harmless saliva-transmitted viral infection in toddlers, but once in a while sexually transmitted genital infection, typically in young persons (teens, early twenties). Classic description is pink and shiny with a central dimple. (You can google it for photos.) Moreover, because MC is relatively uncommon, even experienced clinicians like dermatologists often fail to recognize it at first. If indeed it's MC, you likely are at little risk -- having had Gardasil 12 years ago, presumably you're beyond your mid twenties and likely immune from past childhood infection, often asymptomatic and not diagnosed.

If it is a wart after all, your chance of catching it is well under 10%: even if it's a wart due to an HPV type other than 6 or 11, there is vaccine cross-protection to other types; and even with no immune protection at all, the chance of virus transmission from a single exposure is nowhere near certain, probably under 50% chance. Considering all these factors, the chance you'll ever have it is very low. I really wouldn't worry about it -- and especially not if it's not a wart.

The chance your partner also had oral HPV is low regardless of all else; and STDs in general are rare by oral to vaginal exposure.

No matter what the outcome -- wart, folliculitis, molluscum -- you definitely have no obligation to discuss any of this with future partners. For almost all STD, partners of infected persons, but not known to be infected themselves, have no such obligation. Maybe for some of the biggies, like HIV or syphilis -- but certainly not a virus that everybody has or is going to get anyway, i.e. HPV.

If you're under age 45, and if likely to continue dating before perhaps entering a long term, mutually committed relationship, it would be reasonable to get Gardasil 9 (and owing to CDC advice in the US, 45 is a common age cut-off for insurance coverage). It will protect you from 5 additional HPV types, and the booster effect against the original four types (6, 11, 16, 18) wouldn't hurt.

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10 months ago

I looked up MC and I agree it could also be that, since correlates with the Urgent Care findings and would explain the unclear diagnosis. Frustrating that ex refuses to see Derm to confirm. You say MC is saliva spread, not direct skin to skin? After reading about MC, I remembered I recently saw a new tiny bump on my right hand. Today I looked closer at my hand and idk if I’m just paranoid, but now I notice multiple, tiny, smooth flesh/pink colored papules that I think are new. Palms spared. I gave ex hand jobs before I found the lesion orally. I haven’t seen any oral lesions on me. Idk if I had MC as a kid. I made a Derm appt for myself, which is in 2 days. I put bandages on the lesions and am avoiding using same towels. I know my thread will close after this, but if I have a spare $25 I will write back in 6 months and let you know what Derm said. Thank you so much for all your help! No matter the outcome, this thread has been helpful and I appreciate all your time and insight!

H. Hunter Handsfield, MD

10 months ago

Saliva is the transmission route in young kids, which is all I said. In adults with genital area infection it's genital fluids. Saliva may sometimes have a role in sexual transmission. Good plan to see a dermatologist, but I've never heard of MC involving the hands in adults. Maybe you're paying too much attention to nothing. ("Paranoid" is your word, but maybe it gets to your anxieties about it.)

As you apparently know, threads normally are closed after two follow-up exchanges, but I'm leaving this open to hear what your dermatologist says. But nothing more until then -- OK? In the meantime, don't overreact; note my characterization of MC above as "minor and harmless".

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