[Question #3101] HPV exposure and cancer risk

38 months ago
Hi, about 4 years ago a girl performed oral sex on me whom I discovered had tested positive for HPV. According to my text exchange with her at the time, she said that she "didn't know until my female exam came back with abnormal results" but that her last one (ie, most recent one before our encounter) "was completely normal." That was the only such sexual encounter that I had with this person.  I had pretty much put it out of mind until this article popped up on facebook: https://www.thedailybeast.com/young-men-should-be-required-to-get-the-hpv-vaccine-it-would-have-saved-me-from-cancer?source=TDB&via=FB_Page. 

I'm a worrier and so of course that article scared me. What is my risk of contracting HPV from that encounter? Does the fact that her most recent pap smear had come back normal mean she had cleared the infection by the time of our encounter, or is there still a risk of transmission? Would her initial abnormal test indicate what strain she had, and if so, would it be worth contacting her to find this out?

Thank you in advance for your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question.

Just yesterday I wrote a detailed reply to a question about oral HPV and resultant cancer risk. Rather than repeating all that now, I'll ask you to read that question and my reply; look for question 3098 by username Jennifer. You should find it very reassuring, just as intended for her -- both about the inherent risk of oral HPV and the low frequency of oral cancer as a result. Riffing on the data I gave there, even with this exposure event (and others you don't know about), the chance you will someday have oral cancer due to HPV is 1.6% of the risk of all cancers (in males in the US, 14,000 pharyngeal per year versus total 850,000 for all cancers). In other words, the chance you'll have an HPV related oral cancer is about 60 times less than the risk of all other cancers combined. (That other question also contains the URL to the American Cancer Society data on cancer in the US.)

As for the article you cite, such cases can seem alarming, and certainly the advice for everyone to be immunized against HPV is valid and would save lives. Still, it's just one case among a kind of cancer that isn't exactly rare, but quite uncommon compared with prostate, colon, lung, breast, and many others. The broader risk, as cited above, is far more important than alarmist stories about any one case!

And anyway, getting to your particular situation:  First, 4 years later, your partner's genital HPV infection probably is long gone and no longer transmissible. Second, even if she has a persistent infection, it isn't necessarily with the single type (HPV16) that causes oral (pharyngeal) cancer. Third, this undoubtedly isn't your only likely exposure to HPV, either genitally or orally. For every woman you know had HIV, there are at least 10 others who are infected and don't know it, or don't tell their partners about it. At any point in time, somewhere around 50% of sexually active people have genital HPV -- so if you have had sex with, say, 10 women in the past several years, you have been exposed to HPV 5 times -- multiplied by the number of exposures with those partners. So this particular event doesn't elevate your risk of pharyngeal cancer, or any other important outcome from HPV, any more than it was before you knew about it (or before you read the Daily Beast story).

Accordingly, I recommend against any further communication about HPV with your former partner. It is irrelevant to your health, or your subsequent partners' health, now or any time in the future.

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

HHH, MD

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