[Question #13038] Risk of HPV and Genital Wart

2 months ago

Dear Doctor,

I have read many questions related to HPV and genital wart in the forum, but I feel a bit confused, so I post again to ask.

Is there a significant risk of infection with genital wart in a single protected sex? Because I know condom doesn't provide complete protection against HPV, but many posts emphasize that "if you don' t have unprotected sex, there's no need to worry about STIs including HPV/genital wart."
Do saliva and genital fluids pose a risk of transmitting HPV and genital wart (such as through masturbation)?
I saw that the main point in the forum was "no penetration, no risk for STIs." Does it include HPV and genital wart? Is there a risk of HPV infection and genital wart if frottage (e.g., genital-genital contact) is with using condom?

Thank you very much for providing many educational responses on this forum!

H. Hunter Handsfield, MD

2 months ago

Welcome back, but I really don't understand the need or why you "feel a bit confused."

1. There are no data by which to know the risk of genital warts from a single exposure like yours, but my estimate is under one chance in many thousand.

2. Saliva is little or no risk; and genital fluids contact intact skin (above the condom, for example) is little or no risk as well.

3. Yes, that statement includes HPV and genital warts. Nobody can say the risk is truly zero, but it is low enough to be ignored.

I hope these comments are helpful. Let me know if anything isn't clear -- but do understand that there probably is nothing you can say that would alter these replies.

HHH, MD

---

2 months ago

Thank you for your kindly response my confusion, Dr. Handsfield.

According to aforementioned content and previous response from Dr. Hook, is my following understanding correct:

1. For all STIs (including HIV, syphilis, HSV, genital wart), protected sex is certainly no risk. This does not mean zero risk, but rather that the risk is extremely small and close to zero (e.g., Some of these potential infection conditions exist in theory, but are actually very rare or virtually non-existent in clinical practice), so small that it can be ignored. Is my understanding correct?

2. Furthermore, are the risk levels of different STIs different? For instance, in the case of using condoms, the infection risk of HIV is one in a million, while that of syphilis may be relatively higher (possibly one in 100,000 or one in ten thousand). But in general, they are all small enough that we can ignore these risk.

3. Same as (1), no penetration (e.g., genital-genital frottage and contacting with genital fluids and saliva) further reduce the risk of all STIs, especially using condom during this activities. Am I correct?

I can understand what you mention when you say that no one can guarantee zero, but there is no risk. It's just like no one can guarantee that they won't be struck by lightning when going out, or suddenly win the lottery and become a billionaire, but the probability of such events happening is extremely extremely small. Is my summary like this accurate?

Thank you again for your patience!

H. Hunter Handsfield, MD

2 months ago

I agree with all these statements, except the numerical odds are not at all precise. We quote things like "one in a million" simply as examples to give a general sense of very low but not zero risk. For all three statements, the actual risk -- including the numerical values -- vary widely depending on the type of partner and other factors. For example, risks for syphilis and HIV are far higher for sex between men than for most male-female events. Geography also is important, with higher risks for some STIs in (say) much of Africa than in most of North America. Anal vs vaginal sex also makes a difference not reflected in your summaries. You understand our advice very clearly, but don't rely on the specific numerical risks in all situations.

---

2 months ago

Thank you for your reply, Dr. Handsfield.

I understand your meaning. There are many factors (as you mentioned) and also confounding variables (e.g., people not being fully honest about their encounters) that can affect the actual probability estimates.

This is my last question. As mentioned in Question (1), while many risks exist in theory, they are virtually non-existent in practice and many doctors have not encountered them in their career. I also consulted my doctor previously, who told me that he actually never encountered a case of STI transmission from either protected vaginal intercourse, or frottage (genital-to-genital contact) with or without condoms. I would like to know if you and Dr. Hook have encountered any such unexpected cases in your work or among your clients?

Finally, thank you for your detailed explanation. I think the significance of this forum is great for popularizing the risks, transmission, and prevention of STIs. It could be due to design issues that it is difficult for the people to obtain relevant information in this platform through Google, which leads to the dissemination of some outdated, inaccurate, ambiguous and over-conservative information. If this forum could be improved to enable more people to search through Google, it might help more panicked people.

H. Hunter Handsfield, MD

2 months ago

Dr. Hook's and my experiences with patients over our careers are irrelevant. What would it mean I said I had seen none, five, or a hundred of such patients? I've never cared for a patient struck by lightning, but some people die of it. My experience has no bearing on your chance of being struck. Have there been patients in our clinics who had STDs despite saying they only had condom protected exposures? I'm sure there have, but that can mean lying, forgetting, or misunderstanding the question more often than actual STD infection while using a condom -- and I and the clinicians on my staff generally wouldn't know which of these was most likely.

I don't understand your closing sentences -- which seem to both denigrate and support google searching. Our main advice isn't related to google per se, but the sites it leads so. We advise limiting STI/HIV info searching to professional and professionally moderated sites, and pretty much avoiding those run by and for people with the problem or at risk -- like Reddit, for example.

That concludes this thread. Best wishes and stay safe.

---