Hi Dr. Handsfield - 

Male patient had a single 1mm genital wart removed (HPV strain unknown) on mid-shaft of penis by dermatologist.

Wart was removed 3 days after initial appearance on penis. 

7-days post-excision, the male patient received oral sex on only 1) the head (glans) of the penis for <15 seconds as well, as licking on rear-side of shaft (opposite side of the penile shaft where the excised wart was present; NOT on the front of the shaft where the wart was present). Male patient said his none of his partner's mouth, tongue, or any part of her oral cavity, including her hands, came in contact with the area where the excised wart was healing. At the time of the oral sex, the site was 80% healed, with a small scabbed area of the cratered excised area where the wart was (<1mm). 

This was also the male patient's first and only genital wart.

What is the risk of transmission in this scenario?

Thanks

A few comments to start, then to your specific questions. First, the HPV type causing the wart does't matter. I would not ever advise learning the HPV strain that causes a genital wart. Second, the visible wart is not the only infected area. Think of it like an iceberg:  the wart is the 10% above the water, but the surrounding skin usually has the same HPV. Therefore, sexual contact with nearby surfaces probably also has a risk of transmission. On the other hand, the AMOUNT of virus in the surrounding areas probably is lower than in the wart itself, so transmission chance might be lower. But yet another warning:  all that I just said is general belief, without much science. I don't really know -- and neither does anyone -- whether contact with a wart is more risky than contact with nearby tissues.

For those reasons, I have no way to estimate the risk for a partner who performed oral sex and had oral contact near but not directly at the site of the recently treated wart. Oral sex in general is low risk for HPV. The risk isn't zero, but the oral partner probably was not at high risk of oral HPV infection. But whatever the risk, whether that person had direct contact with the spot where the wart was probably makes no difference.

All things considered, probably the oral partner is at little risk of oral HPV infection from the events you have described.

I hope this information is helpful. 

HHH, MD

4. Does this being a one-off encounter change any of your advice?

2. No.

3. Even with the highest risk types of HPV -- i.e. those most likely to late result in cancer -- that still happens very rarely. Knowing the HPV type does not help prevent serious outcomes of HPV infection.

4. No.

You wrote:

It's true I wasn't entirely certain whether the new partner was male or female, so I wrote my reply to cover either one. The sex of the exposed person make any difference?

1. Informing partners of possible HPV exposures is controversial; there is no right or wrong answer. My usual advice is that it isn't necessary, which explains my reply above. Sorry I used the wrong pronoun, but you say your female partner has had many oral sex experiences. So once again I advise that she probably has been repeatedly exposed to HPV and this particular event has no bearing on her chance of someday having an oral HPV infection or a health problem from it. You could inform her, but I don't see what good it would do. Even if she wanted to pursue it as a medical issue, no wart or other problem will show up before 2-3 months; and even testing for HPV would not be useful until then, if ever. That said, some people advise informing partner anyway -- you'll need to make your own decision.

2. And as I said above, and for the same reasons, I do not advise any medical evaluation of the partner, whether male or female.