[Question #1283] HPV Oral Transmission Risk

48 months ago
About 3 and a half months ago, I had brief receptive oral sex with a woman I went on a date with.  She performed the oral sex for about 2 minutes. 

About a month ago, I went through a scare about warts, and was told by 2 doctors that the bumps I was concerned about were not warts. Despite their diagnosis, I began excessively inspecting myself, looking in folds of my penis that I had never previously expected, and pulling the skin very tight while erect and examining for any minuscule bump. I noticed a subtle little red patch, and possible bumps on the ridge on the underside of my penis where I was circumcised as a baby. The area is so small it's hard to really tell. I did not notice this and have it checked out when the other bumps were examined. Over the past month, it has not changed in size or appearance, and does not hurt, itch, etc. The first time I noticed it would have been about 2.5 months after contact. 

I doubt highly this is an old infection, as I haven't had other partners in the past 5 years.

1. What are the odds that I contracted warts from this one time brief oral encounter?
2. Are warts usually noticeable enough that if a trained STI clinician was inspecting one area of my penis, he/she would notice warts on another area?
3. What amount of self inspection is appropriate? I'm very neurotic and I'm pretty sure I could find 1000 normal variations in skin texture to worry about.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome to the forum. Your question arrived while I was logged in; most users shouldn't expect nearly real-time replies!

Based on both the exposure and your symptoms, you needn't be worried at all about genital warts. HPV is rarely transmitted by oral sex, so you really weren't at risk. Second, two doctors' opinions that your penile bumps are not warts is very reliable. There are plenty of other causes of bumps and other irregularities of the penile skin. Third, HPV doesn't causes inflamed (reddened) patches. And anything that is "so small it's hard to really tell" probably is not abnormal. To your specirci questions:

1) Almost zero risk of catching HPV from this event.

2) As I said above, your doctors probably would have recognized and accurately diagnosed genital warts if they had been present. Certainly so if one or both were expeineced STI clinicians.

3) I recommend against any and all self inspection in this situation. I'm pretty sure your anxieties about warts, and perhaps about a sexual decision you regret, are altering your objectivity and perception -- i.e. that nothing is wrong with your penis. But if you feel strongly something is there that shouldn't be, get checked again -- maybe this time by a dermatologist.

All things considered, I strongly doubt you caught HPV or have genital warts from that event.

I hope this has helped. Let me know if anything isn't clear. Best wishes--  HHH, MD

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48 months ago
Thanks so much for your reassuring reply. 

Just to be clear, the little spot I'm now worried about is not the one I originally pointed out to the clinicians. I only noticed it afterwards when I was over-inspecting.  Does that change your opinion?

Another random question: how does infection risk vary with age? I am 27, and I know that the vaccine is only covered up to age 26. Why is that? I plan on getting it anyway (out of pocket).
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
I assumed the spot appeared after you were examined and was your own observation, not the doctors'. It doesn't sound like HPV and doesn't change my assessment.

Feel free to get vaccinated against HPV if you wish. But I don't recommend it, no matter how sexually active you expect to be in the coming few years. But it won't hurt and it's your money! But new HPV is uncommon at your age and older, which is why the vaccine hasn't been studied and therefore isn't approved or recommended over age 26. But it won't harm anything and it's your money!

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48 months ago
Final questions. 

When a potential wart is biopsied, will the biopsy show non-wary causing hpv? In other words, if I had a strain that was asymptomatic in men, and a non-wart was biopsied, would that biopsy come back negative or positive?

After having the original bumps examined by Planned parenthood, I followed up with a dermatologist. He said he didn't think they were warts but ordered a biopsy to be sure. I am terrified of the prospect that they could be warts, and don't want a false positive for warts because of a non wart causing strain which would not bother me. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
If the dermtologist genuinely thought the penile lesion might be a wart or other HIV problem, or anything else that would best be diagnosed by biopsy, then you should follow his or her advice. OTOH, if you talked them into it because of your worry, i.e. they would not have otherwise done a biopsy, then discuss it further with the doctor before going forward. Biopsy tissue can be tested for non-wart HPV infection, but it's not usually done. This also is something to ask the dermatologist.

But why in heaven's name are you "terrified of the prosptect that they could be warts"? Genital warts are an unpleasant inconvenience and easily treated. They're not a significant health risk. This really shouldn't be such a big deal.

That completes the two follow-ups and replies included with each question and so ends this thread. Really, do your best to just move on. You're making far too much out of this exposure and your penile skin. But I do hope the discussion has been helpful.

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