[Question #1340] HPV at 55?

47 months ago
In a previous answer you said it is rare to get hpv at 55.  Why would that be?  What if during the last 30 year I was in a monogamous relationship.
Is saw a study about oral cancer from hpv and that it is getting more common and implies that is not uncommon to get hpv from oral sex.  In a previous answer you said hpv is rare from oral sex.  What explains what seems to be a contradiction?
What kinds of having show up in a Pap smear and can it be explained by anything other than an STI?  If there is cervical cancer can it be determined that it came from hpv?  

I hope this is not too many question.  If it is let me know and I will pay more.

Thank you for your good information. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Welcome back. Thanks for your kind words and for your confidence in our services.

I mentioned the main reason for the infrequency of HPV in older persons in my reply to one of your earlier questions last year -- that prior infections increase the chance of immunity in case of exposure. Also, older persons tend to have older partners, hence lower risk of exposure to HPV. Beyond that, we just don't know. Whatever the reasons, new HPV infections are sufficiently infrequent after age 26 that the effectiveness of the vaccines has not even been studied in people older than that. This doesn't mean all older persons are at low risk; we're speaking of averages and trends, with plenty of exceptions to the norm. With multiple sexual contacts with escorts, most of whom probably are substantially younger than you are, you could be at risk. However, the large majority of HPV infections never cause symptoms, do not cause cancer, and are cleared by the immune system without ever knowing they were there. There are plenty of risks from the sort of sexual lifestyle you asked about in your earlier questions, but HPV is not very high on the list.

There certainly has been a lot of media attention in recent years to oral cancers from HPV. But it's still uncommon. The media often speak generally of "oral cancer" or "head and neck cancer", in fact only a single cancer -- of the pharynx (back of the throat) -- is regularly due to HPV. And pharyngeal cancer is caused almost entirely to only one of the 100+ HPV types, HPV16. Those cancers indeed have increased, in fact almost doubled in frequency in the past 20 years. But it's still a rare kind of cancer; the increase means it has gone from very rare to somewhat less rare. Also, most HPV16 infections don't lead to cancer. (It's like smoking and lung cancer:  smoking is by far the main cause of lung cancer, but most smokers don't get cancer.)  Since you're 55, there's a pretty good chance you'll get cancer someday and a good chance you will die of it. We all die of something, and cancer accounts for about half of all deaths at your age and older. But it's much more likely to be cancer of the colon, prostate, lung, etc than it is pharyngeal cancer due to HPV, no matter how much oral sex you perform. 

Perhaps you can now understand there is no contradiction: oral sex accounts for some pharyngeal cancers, but oral sex uncommonly transmits HPV, and oral HPV rarely results in cancer.

Having said all that, the HPV vaccine probably is effective at your age (although likely expensive and not covered by insurance). If you haven't previously been infected with HPV16, it would prevent it, and thus probably drop your risk of pharyngeal cancer to nearly zero. So perhaps something to consider.

Virtually all cervical cancer and the large majority of abnormal pap smears of all kinds are caused by HPV.

Lots of information there -- let me know if anything isn't clear.

HHH, MD

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47 months ago
What are the plenty of risks you refer to. From earlier answers ist seems like most STI are  low risk. 

About the Pap smear testing. I'll be more explicit. Like I said my partner and I have been monogamous since early 20s. So it is unlikely that we ever had HPV.  So I worry that if it turns up in a Pap smear test it will be hard to explain.   So how do you asses my risk of that and is there any other explainarion. Mi understand that even the non dangerous hpv shows up in a Pap smear test. Is that correct.  Could it have come from sex 35 years ago from another woman. How long ago could I have gotten it and it remained dormant til now?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Yes, you're at low risk. But not zero risk. Anybody choosing to have non-monogamous sex, or sex with commercial sex workers, are at some risk of STD, no matter how safe they are. Condoms break and rare atypical transmissions occur. 

If indeed you and your partner never had other partners before you were with each other, or during your relationship, it may be unlikely you ever had HPV. However, 80% of people acquire HPV after only 3 lifetime sex partners. So if you or your partner had sex with others, either before or during your relationship, you can assume you have had HPV. And some HPV infections are lifelong.  It is true that non-high risk HPV infections explain many abnormal pap smears. However, a negative pap smear does not prove HPV isn't present, or that it never was. There is no test to tell that.

Having HPV is a normal, expected consequence of being a sexually active human. Happily, most people never have a serious consequence of it. There is no reason you should assume that you have or that you will. As I said above, whatever low risk there is that you will acquire a future HPV related health problem, getting vaccinated may lower it still further. Other than that, this really isn't something that should concern you at all.

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