[Question #2360] HPV in gay men

46 months ago
Hi. I recently committed my first and only infidelity and had sex with my husband after. Then I found out I had chlamydia. My husband is understandably devastated and wanted a full STD Panel. We both had the panel done, everything did come back negative except chlamydia but it turned out HPV wasn't included. I looked online and found out HPV isn't tested for in men. Given our situation, I really want to ease his concerns on this but I can't find anything that didn't scream anal/penile/oral cancer before providing some unclear statistics on the likelihood of these things happening. From what I read online, it would appear the chances of HPV related complications are very very small and that is why men's testing hasn't been a major priority. And given our experience before our relationship, it looks like we likely even acquired it before we got together. But I want to be sure from an expert. How likely is it I caught HPV from a single session of oral sex giving/receiving? How likely is it we already had HPV? How likely is it to develop complications from HPV? Is there any way to test for it that websites may not have listed? 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Welcome to the Forum.  I'll be glad to comment. 

First, as sexually active men who have had other sex partners in the past, the chances that you both have HPV is high from your past sexual activities. .  On average over 80% of American adults will have or have had HPV.  Rates are likely a bit higher among men with other male sexual partners than hetrosexual men and women.  Having said that, there is also a huge amount of mis-understanding about HPV an its relationship to cancer.  Less than 1% of HPV infections go on to cancer and when it does, the process is slow, typically taking years.  As a result, we, like most experts recommend against testing for HPV in men and instead, would tell men to get regular sexual health checks and have new or unusual skin lesions which appear and persist.

As for your risk of having gotten HPV from giving and receiving oral sex, the risk is low.  Oral HPV infections do occur but rates are far lower than at ano-genital sites and transmission through either giving or receiving oral sex is a biologically "inefficient" process.  Certainly most exposures to infected partners (and you do not know that your partner was infected) do NOT lead to infection.

I hope these comments are helpful.  I really would not worry about having gotten HPV from the oral exposures you describe.  EWH
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45 months ago
Thanks for the earlier response. I do have a follow up question. About 1.5 weeks after finishing treatment for Chlamydia, the penile discharge returned and worse than before. I retested and the rest results came back negative for Chlamydia and gonorrhea. My doctor asked if it hurts to urinate, and I told him it doesn't. He said if it was an STD  related NSU it would burn given I'm having discharge. He gave me ciproflaxacin and told me I should be fine for sex. My questions are as follows:

1) is my doctor correct that it's probably not STD related NSU given there is no burning?
2) should I ask for azithromycin given everything I'm reading says cipro isn't good for treating STD related NSUs?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome back.  I need to ask a few questions to round things out to provide some advice.  Did you have a penile discharge when you were initially diagnosed with chlamydia and does this discharge look similar?  Also, you did not mention what medication you were treated with initially when you found you had chlamydia nor did you mention if your husband had been treated for chlamydia as well and, if he was, was he treated before you had both resumed sexual activity.  I ask because he if not treated he may have become infected and then re-infected you.  Recommended treatment for chlamydia is quite good but there are both occasional treatment failures and reinfections can occurred if partners are not treated before sexual activity is resumed.  In addition, there are other organisms which can sometimes cause urethral discharge.  In answer to your questions:

1.  Recurrent discharge is highly suggestive of treatment failure and/or re-infection.  Your penile discharge should be evaluated and checked for white blood cells as well as possible infecting organisms (gonorrhea, chlamydia, and Mycoplasma genitalium).  You can certainly have NSU without painful urination, in fact in a recent study we performed (as yet unpublished) about 40% of men with NSU did not complain of burning on urination.
2.  You are correct that Cipro is not recommended for STI-related NSU.  Azithromycin or doxycycline are the preferred medications, at least to start with.

In addition, I think you would do well to seek evaluation ad a sexual health clinic which is accustomed to dealing with such issues.  I hope these comments are helpful.  I may have additional comments when I hear more details from you.  EWH
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45 months ago
Thanks for the information. 

To answer your questions:
1) Yes I did have discharge when I was initially diagnosed with chlamydia.
2) They discharge started out looking similar, however it is much more pronounced now and more white than before. It was more of a cloudy white previously. And I don't find myself having to run to the bathroom nearly as much as I did the first time around. 
3) My husband and I were treated with doxycycline initially and the symptoms went away, then returned. 
4) You say I should be retested, but as I said before, I've been retested (twice). Both times have come back for chlamydia/gonorrhea. One was a swab after I completed treatment, and the other was a urinalysis when the symptoms came back.  My doctor said nothing about mycoplasma; which is my next concern. 

So here's a couple more questions: 
1) Is there a timeframe in which I could falsely test negative for chlamydia after antibiotics treatment? I finished treatment June 30th and my most recent retest was on July 11th. 
2) Given I've tested negative for chlamydia/gonorrhea twice, is it likely I have mycoplasma?
3) Is there a resource where I could look up a clinic that actually tests for mycoplasma? 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Thanks for the additional information.  Sorry if I overlooked that you were re-tested.  At this point I would suggest that both you and your husband be tested for Mycoplasma genitalium which is a major cause of urethritis that recurs or does not respond to doxycycline or azithromycin therapy.  It is rather commonly resistant to these antibiotics and is treated with another medication, moxifloxacin. typically for 7-10 days.  Most commercial laboratories can provide testing on a urine specimen. 

In answer to your follow-up questions:
1) Is there a timeframe in which I could falsely test negative for chlamydia after antibiotics treatment? I finished treatment June 30th and my most recent retest was on July 11th. 
It would be unusual for you to have symptoms and negative tests for chlamydia if that was the cause of your recurring symptoms.  I would believe your test results. 

2) Given I've tested negative for chlamydia/gonorrhea twice, is it likely I have mycoplasma?
As I mentioned above. M. genitalium is a recently appreciated pathogen which is an important cause of persistent or recurring symptoms after treatment for non-gonococcal urethritis or chlamydia with doxycycline or azithromycin.  When it is present, white blood cells are typically also seen on a stained specimen of the urethral secretions.    In addition, there are some persons who may have NGU and negative tests for gonorrhea, chlamydia and mycoplasma.  Our experience is that such persons are not infectious and not a danger to sexual partners.  What causes this latter phenomenon is not well known.

3) Is there a resource where I could look up a clinic that actually tests for mycoplasma? 
Depending on where you are, your local STD Clinic may have access to M. genitalium tests.  that is certainly where I would start.   In addition, large commercial labs like Lab Corp have there own M. genitalium tests. 

As you may know, we typically close question threads after three responses.  I will be able to provide another response if what I have said is unclear but after that the thread will be closed and you will need to have to start a new question if there are further questions.  EWH
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