[Question #2049] HPV risk from kissing sex worker/unprotected oral

88 months ago

Dear Doctors,

This is the second question that I have asked so it will be my last for this year and is related to an earlier question. My apologies in advance for asking these supplemental questions, I truly mean no disrespect with regards to the earlier advice I have been given.

I am still worried about Oral HPV (mainly type 16) from deep open mouth kissing which I did several times one night with a commercial sex worker. I am not meaning to be judgemental but am aware that she provides unprotected oral sex to her male clients. My thinking is that she would have had multiple exposures to HPV and therefore may be carrying active HPV 16 in her throat. She also performed unprotected oral sex on me.

Could you kindly elaborate on my risk of particularly HPV type 16 and subsequent risk of oral cancer and transmission to my female partner. I am a 47 year old male and my partner is the same age. The incident occurred just over 3 weeks ago. My concerns are that literature/studies that I have read on-line suggest that HPV may be transmitted by open mouth kissing (although not certain), that HPV 16 can cause cancer in 25-30% of cases of infection within 10 years (some studies), and that there is no way to test or adequately surveil the oral cavity and throat.

I am reassured that regular pap smears will protect my partner(wh from a cervical cancer point of view and I am aware penile cancer is rare (I am circumcised) but this is playing on my mind with regards to oral/throat cancer risk .

I would greatly appreciate your advice on what my actual risk would be from getting HPV 16 from this exposure, and if I did get it what the likelihood is that either me or my partner will get an oral/throat cancer down the track. We are healthy but work really long hours and don't get much sleep - I'm concerned our immunity isn't what it once was. Is there anything I should do? I haven't told my partner about this mistake which I do not intend to repeat.

Your advice is greatly appreciated.

Edward W. Hook M.D.

88 months ago

Welcome back to the Forum. I'll try to help. Before I do, let me suggest that you are worrying about a very rare event and that were it to occur, routine health and dental care would most likely detect and address the problem before it occurs. There is still much to be learned about HPV and this includes oral infections, their detection, and management. While the partner that you refer to, as a CSW is more likely to have HPV than most people, please remember that most exposures to persons with infection do not lead to infection and certain sorts of exposure are more biologically "efficient" for transmission of infection than others. Thus oral sex is less efficient for HPV (and other STI) transmission than genital sex and kissing is still less efficient than oral sex. Let me list some of the reason why I would urge you not to worry:

1. Oral HPV is not all that common- current estimates are that about 7% of American adults have oral HPV, of which 1% is HPV 16, the virus associated with oral cancers.

2. Like other sites of infection, in most persons oral infections are probably cleared by the body's immune system over a period of months to years (these data are not well characterized for oral HPV as they are for genital infection)

3. Only a very small fraction of HPV infections persist and progress to oral cancer (again, data are as yet imprecise)

4. Cancer risk is much greater if there are co-factors, tobacco exposure being the most well described. If you do not smoke or chew tobacco regularly, your risk if far lower.

5. As I alluded to above, dentist are now expected to look for signs of oral HPV and pre-cancerous lesions and do so regularly.

Finally, to be realistic, not only is oral HPV-related cancer rare but there is not too much we can do as yet but take care of ourselves and see our dentists regularly. There are no currently recommended tests for oral HPV and even if discovered, in the absence of obvious pathology, there is no recommended treatment. Thus, my suggestion is that this is similar to the situation we deal with when we cross the street or go out in a rain storm. While we certainly could be hit by a care or struck by lightening, the odds are very low and other than taking common sense precautions, there is not a lot we can do. With this perspective, I would urge you not to worry about your misstep. I hope my comments will help you to do this. EWH

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