[Question #3098] Oral HPV

39 months ago
How likely is it to transmit oral HPV?  What if a former lover comes up with an HPV related cancer diagnosis of the oral cavity?  Does that mean I have oral HPV and can transmit the virus to others?  I've read some things about HPV being the new "kissing disease" and that it's dangerous to kiss others now.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome back to the forum.

There are no data to answer your question precisely. But several statistics should be reassuring. Among adults in the US, at any point in time roughly 50% have HPV DNA in the genital or anal area, and (if I correctly recall the data) about 7-8% have oral HPV, i.e. about one seventh as common as genital infection. So I would characterize oral HPV as common, but not as frequent as genital infection. Performing oral sex on a partner with genital HPV undoubtedly explains many of these infections, but others probably result from auto-inoculation, i.e. self-transfer from a genital infection (e.g. by finger contact genital to mouth). Kissing probably is a very uncommon mode of transmission, and I have never heard of HPV being called "the new kissing disease".

There are several types of oral cancer, but only one, pharyngeal cancer, is regularly caused by HPV; and almost all these are caused by a single type, HPV16. The frequency of pharyngeal cancer is rising (and has been the subject of a lot of media attention), but it remains uncommon. There are around 17,000 new cases per year in the US, roughly only 1% of all cancers. (It's even rarer in women, accounting for about 3,200 cases, about 0.4% of cancers.) So while pharyngeal cancer due to HPV isn't to be ignored, you are far higher risk of someday getting other cancers. For example, the 3,200 cases of pharyngeal cancer in women compares with over 250,000 new breast cancers each year; i.e. the chance you'll have breast cancer is nearly 100 times higher than pharyngeal. See the American Cancer Association website:  https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf

The roughly 17,000 cases of HPV related pharyngeal cancer compare with many more (probably hundreds of thousands) of oral HPV16 infections each year. In other words, the vast majority of infections do not progress to cancer; most HPV infections of the oral cavity, just as genital, are cleared by the immune system (as discussed in your previous threads). As for a former partner with pharyngeal cancer due to HPV, it for sure does not necessarily that that person's partners are at increased risk either of HPV or cancer. Because a particular infection leads to cancer in one person does not indicate an increased risk of cancer in partners infected with the same strain.

Finally, HPV immunization is highly effective against HPV16, whether genital, anal, or oral, and therefore highly protective against pharyngeal cancer (but of course only for persons not previously infected with HPV16).

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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39 months ago
Is the strain of HPV 16 and 18 the most common kind of HPV out there?  In other words, are most HPV infections of the high risk type?
The situation with my ex boyfriend and current girlfriend has had another development.
She has had high risk HPV and now has gotten biopsies to see how to proceed because her HPV has progressed.  As previously mentioned, I had a LEEP in 2001.  I'm worried that I might be the source of her HPV.  I've had clear for a long time (at least 10 years). Feeling very guilty.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
HPV16 is among the most common HPV types; 18 is quite a bit less common. However, most HPV infections are not with high risk types. There are roughly 100 HPV types regularly sexually transmitted; 30-40 account for the large majority of genital infections, and about 10-15 of those are considered high risk.

It is almost impossible to know when and from whom any particular HPV infection was acquired. And there certainly is no way to know if you were the indirect source (through your partner) of the HPV infection diagnosed in your former partner's current girlfriend. Health experts don't even recommend telling one's own partners about past HPV infections, let alone their partners' other partners. That situation with her health is none of your business. (Your past partner probably was well meaning, but he needn't have told you and probably shouldn't have done it.) In any case, her risk of actual cancer is close to zero:  once in treatment and follow-up of the sort she apparently is getting, progression to actual cancer is very rare, and easily treated even if it happens.

So my advice is to cut off any further discussion with your former partner about his partner's or his HPV situation, and do your best to stop worrying about HPV in general. Follow routine pap smear guidelines, and if under age 26, speak with your doctor about HPV vaccination. Other than that, move on with your life without worry about it.

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39 months ago
Finally, do you stand by your previous statements that distant past HPV is unlikely to be transmitted to future partners especially if it has been a long time (say 10 or more years?)  Is it more likely that she acquired the HPV from a past relationship or from her ex-husbands extramarital affairs which were more recent history?  Do I need to tell my future partners about this?  Does current data indicate that distant past HPV is probably not contagious?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Because no new data become available about delayed HPV transmission, my advice on it has not changed much in recent years. In a nutshell, that advice it usually is unnecessary to tell partners about distant past HPV infections. (Of course many couples discuss past sexual experiences, including STDs they may have had. But for the most part, this is a relationship issue, not one of disease prevention.)

 In any case, I don't see this as relevant to your health. You obviously didn't believe, or perhaps didn't carefully read, my reply above. You can never know when and where your former boyfriend's new partner was infected. It's none of your business and I won't help you speculate about it.  Try to move on.

That concludes the two follow-up comments and replies included with each question, and so concludes this thread. Do your best to accept HPV as a normal, expected consequence of being human and sexual. Good luck with it.

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