[Question #1296] Oral Sex HPV Risk

83 months ago
Three years ago, I received oral sex ONCE from a man who had 7 previous sex partners. Two and a half years ago, I received oral sex TWICE and performed fellatio (deep throat) ONCE on another man who had 10 previous sex partners (he told me he had not had sex in 6 months before I engaged in oral with him). I am incredibly worried that I have HPV in my throat and also that I could have been infected at my vulva. I have had no manifestations of warts and my pap smears have come back normal two years in a row, my most recent testing negative for HPV. I married a virgin (we lost our virginity to one another on our wedding night, about ten months after my last oral sex encounter) and the only sexual encounters I had before marrying my husband were the oral sex listed above, other than French kissing.
  1.  What are the odds of me having HPV in my throat, or at my vulva? I am sick with worry, thinking that I infected my husband.
  2. I know that most sexually active people get HPV, but in my situation, as only having vaginal sex with a virgin and only having had oral sex before, what are the odds of having it?
  3. I am afraid to have children because I am afraid to infect them with HPV.  Will this affect them?
  4. If I had HPV in my throat and then had oral sex with my virgin husband, could he have then transferred the HPV to my cervix?
  5. Should I be tested for Gonorrhea or Chlamydia in my throat?
Thank you for you time, I truly appreciate you expertise and patience.

H. Hunter Handsfield, MD
83 months ago
Welcome to the forum. Thanks for your question.

As you seem to know, getting and having HPV is normal and expected in all sexually active persons. However, you are somewhat overreacting to your very low risk situation. Also, some genital area (and probably oral) HPV infections occur in people without apparent sexual risks. Some HPV infections are unexplained. One other comment, before addressing your specific questions, is that I will take you at your word that your husband and you both were "virgins" before your wedding night. But if he, like you, had oral or other non-penile-vaginal sex, he (and you) could now have HIV unrelated to your own sexual experiences. To your questions:

1) There are no data, but I think the chance you have oral HPV from a single episode of performing fellatio is extremely low. And who cares? If you had it, it will have gone away by now; and oral sex does not frequently transmit HPV.

2) Assuming the facts about past sexual exposures are correct as you state them, I would say the chance you have genital HPV is very low, nearly zero.

3) Up to half of all pregnant women have HPV. And how often have you heard of people not having children because of it? Or of kids having an HPV problem? On rare occasions, moms' genital HPV is transmitted to their babies during vaginal delivery, resulting in laryngeal papillomatosis, i.e. warts in the baby's throat. But it is a rare problem and exceedingly unlikely in someone with your and your husband's sexual history. This is nothing to worry about.

4) Probably not. Once someone has already been infected with HPV, s/he is at much lower risk -- probably completely immune -- to ever catching the same HPV strain again.

5) The chance you acquired gonorrhea or chlamydia of the throat from your very limited sexual experiences is very, very low. And both those infections would be gone by now anyway; the immune system clears gonorrhea or chlamydia within a few weeks or months. This also isn't something to be worried about.

All in all, you have had an extremely low risk sexual lifestyle and shouldn't be worried about HPV or any other STDs. I hope this information has helped lower your concerns. But let me know if anything isn't clear.

Best wishes--  HHH, MD

83 months ago
Thank you so much for your reply. I have been researching yours and Dr. Hook's forums for a few months now. Honestly I feel like I am over reacting, but to be answered by you directly means a lot. 
1. Is it safe for me to go through my life with the belief that I do not have HPV? I know nothing is certain, but is the risk so low that I can just assume that I do not have it?
2. Is it crazy for me to think that I could have "hidden" warts or an infection in my vagina that I do not know about?
3. Does the fact that the men had multiple partners make me more at risk? I worry because 7 and 10 partners each seems like an awful lot to me.
4. So if I had an infection in my throat, my cervix would be immune to that type of HPV infection? Is it a systematic immunity?
5. Have you ever seen cases of virginal women having cervical HPV? or having cervical HPV from only oral sex?

Thanks for bearing with my annoying anxiety. If it is any consolation, I truly admire your work and value your opinion.
H. Hunter Handsfield, MD
83 months ago
I'm glad to have helped and appreciate your thanks. But these additional questions do indicate HPV is more worrisome to you than it should be.

1) HPV is so common, and some infections unexplained by know sexual activity risks, that I would never tell anyone they can assume they do not have HPV. Probably you do not, but there are no guarantees. For example, you should follow standard recommendations for pap smear regardless of your probable low likelihood of having had HPV.

2) This isn't "crazy", but based on your exposure history it is a somewhat irrational worry.

3) 7-10 lifetime partners is roughly average, although of course this depends a lot on his age and other factors. (7-10 would be a lot at age 18, but not at age 25, for example.)

4) Yes, you correctly understand. The immunity is systemic. (That's why the HPV vaccine is so successful -- systemic immunity.)

5) Every gynecologist and STD expert has seen, or heard of, women with genital HPV (cervical e.g. abnormal pap, or genital warts) who gave apparently honest histories of not have had intercourse. Some such persons, but not all, have had oral sex despite being virgins as defined by penile insertion. Some such sexual histories are false, either intentionally or unintentionally (e.g. repressed memories, deep denial of childhood sexual abuse, etc, etc). But some HPV infections may be acquired through unknown, nonsexual routes. It's uncommon, but there are enough such stories to raise legitimate doubt about 100% sexual transmission.

My final thought is to ask "So what?" Since HPV is normal, with at least 90% of all people having it at one time or another, and the large majority of cases don't cause symptoms or lead to disease, what's the big deal? Why is this so much on your mind? Think of it the way you may understand other bacteria and viruses:  all humans are covered in bacteria and viruses that fill every body cavity and pore. Some of those bacteria, although entirely normal, sometimes cause serious disease, like staph infections, E. coli intestinal or urinary tract infections, and so on. If you had chickenpox, you carry the virus. You probably carry Epstein Barr virus, the cause of mononucleosis -- we all have it. And hundreds of others. HPV is simply another in this same category. That most cases are acquired sexually doesn't change the fact that having it is a normal, expected consequence of being a living human. Everyone should take common sense precautions to prevent uncommon but serious outcomes, such as being vaccinated and following pap smear guidelines. But otherwise, do your best to just forget it and move on with your life.

Thanks again for your kind words. Take care.

83 months ago
Thanks, again, doctor. I feel that I have not forgiven myself for having oral sexual relations before marriage and the guilt I feel is being projected into my overwhelming worry of HPV. I have two further question, if you do not mind:

1. Theoretically, if I gave my husband HPV on his penis from Oral sex, would his penis clear the virus? Should we worry about penile cancer?
2. I read a report that said HPV can be passed to a baby through being in the sperm DNA. Is that true? Just curious, because it seems far fetched.

Thank you for the perspective on the other diseases that we carry. It makes sense. I suppose it is just shame of my sexuality that makes HPV seem more sinister. 
H. Hunter Handsfield, MD
83 months ago
These comments made me smile. The large majority of users on this forum are highly resistant to any suggestion that their main problem is psychological, usually related to unresolved conflicts over sexual decisions they regret. But here you are not only recognizing it, but stating it forthrightly. That takes courage and fortitude just to recognize it in oneself, let alone express it for others to read.

1) Almost all HPV infections clear up on their own, and that certainly would include any infection your husband acquired from you. Penile cancer is very rare, even with HPV, and almost always easily curable without drastic treatment. It's really nothing to be worried about.

2) There is no scientific evidence of what you say. HPV isn't known to be transmitted by sperm. Perhaps someone dreamed up that theory to try to explain occasional cases of HPV in young children, or in young adults without apparent sexual risks, as discussed above. But it's nonsense as far as we know.

That completes the two follow-up comments and replies included with each question, and so ends this thread. In closing, I won't try to talk you out of the guilt and shame you are feeling, but I hope you find a way to move beyond them. Try to understand and believe -- at a gut level, not just intellectually -- that sex and sexuality are natural, and you didn't do anything unusual, abnormal, or particularly unhealthy. I have to suspect you had a restricted upbringing about sex. I hope you can translate the inner strength displayed above into broadened understanding that helps you move beyond your negative feelings about sex. I also wish for you a healthy, rewarding, romantic, sexually satisfying marriage.

Best wishes to you, your husband, and your future growing family.