I have tested (cervical screening) 3+ years negative for 16 and 18/45 HPV; positive for high risk HPV from 11 other types. Negative cytology (Pap smear). (I have had HSV2 since teens.)

New HPV infections are generally believed to be rare beyond age 40-50. Beyond those years, the likelihood of transmissible infection is low, so any new partner is not likely to be a source of HPV. Second, one's own prior infections make them immune to new infection with the HPV types (and related types) they have had earlier. These are the basic reasons, for example, that the HPV vaccine is not recommended (and generally not covered by health insurance) beyond age 45. Regardless of your past HPV history and that of any potential partners, neither of you is likely to be at risk of infecting the other.

Those comments largely cover your specific questions, but to address them explicitly:  First, your current potential partner is overreacting; there is no good reason for him to be "very wary of HPV exposure" -- and especially on account of kissing, which is believed to very rarely transmit HPV. As for discussing this with your gyn, be aware that the knowledge level of many of most gyns about the details of HPV isn't great -- although of course there are exceptions. In any case, I would expect your gyn to echo my comments above and to reassure you (and through you, your potential partner).

There are no standard, generally approved tests for oral HPV. Even the best methods for specimen collection are uncertain:  swish, gargle and spit? Swab specimen(s)? If so, exactly from where (lips, throat, inner cheeks, tongue, maybe all of them)? Equally importnat, negative results only mean that HPV is not detectable at that moment, which does not rule out the possibility of undetected but intermittenly active infections. The same is true of Pap smears and other genital testing as well. The fact that pap smears are no longer advised after age 50 also reflects the rarity of positive HPV tests and other abnormalities due to HPV beyond that age.

Why not vaccinate? See my comments above. As for Dr. Hook's comments, I have said the same many times. However, the actual effect of vaccination on preexisting infections is very small, compared with high effectiveness in preventing new infections.

You're several years younger than I am, and I wasn't in your situation at your age -- but if I had been, I wouldn't have given HPV a thought either in terms of my own risks and health or that of my potential partners --  unless maybe I had a partner under age 30 or so. Even then, the risk would not concern me at all. The large majority of newly detected HPV (i.e. newly positive tests) beyond age 30 are from reactivation of preexisting infeciton, not newly acquired HPV. The chance anyone in your age group would ever have a significant health problem (e.g. genital or throat cancers) from a new HPV infection is nearly zero.

For all those reasons, I honest believe HPV should be a non-issue for you and your current or future (i.e. potential or actual) sex partners.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

My heightened concern about HPV transmission is largely based on my experience with my husband's HPV oral cancer and death.  As you pointed out, there are few data on HPV risks and transmission in older adults.  And data in general about HPV transmission can be alarming (I know, stay off Google).  I am working on not being alarmist, using what science there is and do what's right to get and share information as appropriate.  The last thing I want to do is share an STD that has no cure and can cause cancer.  So maybe I'm the one overreacting.

Just to be clear:  Are you saying that my current diagnosis via pap smear is incorrect, unreliable, or irrelevant due to the unlikelihood of transmission?

My diagnosis of "positive for high risk HPV" has been persistent for 3+ years. So I am in the "rarity of positive HPV test" category.

Not to belabor your points, but you're saying that essentially at our ages, it's unlikely that I will give my partner a new (to them) HPV infection and even if I did, it is unlikely that they would develop significant health problems from it. No guarantees, but this is what science can tell us at this time.

Do you recommend any recent HPV studies?

Again, thanks

I'm not at all saying your Pap smear diagnosis is incorrect or unreliable, and of course it is relevant to your concerns. But the second part of that statement is correct:  a low likelihood of transmission, partly on the assumption that your potential partner has had a reasonably normal sex life up til now and therefore is likely to have been infected previously with some of the HPV types you have and therefore immune to new infections with those types. In addition, there appears to be something about aging that may reduce susceptibility to HPV:  in my original reply I commented on the low frequency of new HPV infections after age 30-40, which is not fully understood but probably is not due entirely to previous exposure and immunity.

Another factor is that the overall rate of serious outcomes of HPV is males is very low:  the large majority of infections never cause visible problems like warts or cancer; most infections remain entirely asymptomatic. In other words, I agree exactly with "at our ages, it's unlikely that I will give my partner a new (to them) HPV infection and even if I did, it is unlikely that they would develop significant health problems from it. No guarantees, but this is what science can tell us at this time."

If by "recommend any recent HPV studies" you mean newer research, the answer is no; but in all honesty I make no attempts to monitor the research literature on HPV complications, epidemiology in older persons, etc. However, probably I would have heard through the various public or academic grape vines if important new information had recently become available.

In view of your PP's apparent lack of understanding and exaggerated fear of HPV, please advise him of the truths above and the reasons he really shouldn't be fearful. You can also tell him that no particular strains of HPV are more likely than others to cause cancer or other serious problems. That is, even if you are carrying and he were infected with the one that caused your husband's pharyngeal cancer, he would not be likely to have the same outcome. (In addition to which, it seems you know that HPV16 is virtually the only type that causes throat cancer, and that you have tested negative for it. Make sure he is aware. Finally, he could consider HPV vaccination. Although not generally recommended it his age, almost certainly his doctor would prescribe it (and his insurance cover it) once they understand that he is likely to be exposed to your infection(s). Immunity is nearly maximum just 2-3 weeks after the second dose, so it might mean a delay in first sex by perhaps 6-7 weeks, no longer. It likely would further reduce the chance he would be infected from you.

Please accept my apology again for my lapses last time. I hope these additional comments are helpful.