Dear Doctor,

Thank you for your previous replies. I recently started psychotherapy because my anxiety about HPV became excessive. My therapist suggested that I ask a few final questions so I can use your answers as an "anchor" instead of continuing to search online.

1. I have read many HPV-16 discussions on this forum. You and your colleagues have generally been optimistic about the natural history of oral HPV-16. Has this view changed with newer evidence, or do you still believe it applies to my situation?

2. If HPV-16 is so common, why is oral HPV-16 much less common than genital HPV-16? Can someone with multiple lifetime oral exposures still never acquire oral HPV-16?

3. I have read that future cancer risk may not depend only on whether oral HPV-16 is detected at one point in time. Did I understand this correctly?

4. In Question #9279, Dr. Edward Hook suggested HPV vaccination may still provide benefit after prior exposure. Based on my situation, would you recommend Gardasil 9?

Thank you very much.