[Question #3343] Follow-up Question

38 months ago
Dear Dr. HHH,

this thread is a follow-up for [#3332], which you've done a great deal in assuring my mind. I've gone through your reading suggestions and your HPV faq videos. Yet, I still had some doubts/questions I want to clear to release my axiety/guilt away, especially since you didn't answer some questions given it would take full thread.

facts:
* Encounter  described in prev. thread (summary: insertive oral with ejaculation in mouth/fingering/deep kissing with csw).
* I'm 28 and my wife is 22 and a 3 yrs. boy
* no sexual encounters before/during marriage (except this stupid time)

Q1: You've mentioned that HPV transmission possibility is (1 in 1000s) given it was only receiving oral. Why is it low 'in a nutshell'? Is the risk the same for deep/french kissing 'Oral HPV'?
Q2: Assuming the worst, that I'm infected, given my age '28' and hers '22', What are the chances high-risk HPV will 'cure?' by our body? and will this mean risk of HPV cancer is 'elevated'?
Q3: I read that 90% of HPV cases will clear away in 2 years, if not exposed to any further HPV 'through monogamous relationship', is it possible for HPV to come a later stages in life (I read the term latent HPV)?
Q4: If I'm infected and I infected her, will we be infecting each other back 'loop like scenario'? i.e. one of us cured HPV, the other is still not cured.
Q5: What age should she do pap/HPV test, if any?
Q6: is there danger for her to pregnant?
Q7: when to test for HSV-1/2?
Q8: Can Anxiety give STI Symptoms?
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Welcome back to the Forum. Today I will be answering your questions.  In reading through your earlier interaction with Dr. Handsfield, I think you may have missed some of his points of information and suggest you re-read his earlier replies. I agree with all that he has said to you in your earlier exchange.  I'm sorry that your guilt over the exposure you described in your earlier post continues to translate into poorly justified concerns about STIs that I suspect you cannot do anything about.  I'll go straight to your questions:

1.  His statement was that the risk is less than 1 in 1000.  The reason for his statement is first, the biological fact that transmission of STIs, including HPV is never 100% and typically far less.  In addition, with respect to oral vs genital risk for acquisition, the mechanics of contact (amount of friction involved in exposure) are different (less typically for oral) and that the cells lining the oral cavity are different (and thus less susceptible to HPV) than cells in the genital region. 
2.  As Dr. Handsfield told you, there are less data for oral HPV than for other sites of infection. That said, it is safe to assume that well over 95% (and probably considerably higher) of oral HPV infections will resolve on their own, reducing the already tiny risk for ultimate progression to cancer.
3.  This is discussed at length in other posts that can be seen on this site.  I endorse Dr. Handsfield's suggestion that you look at some of those exchanges.  After HPV can no longer be detected in infected persons as the result of the clearance process mentioned above, the virus does appear to remain latent and on rare occasions can be detected again.  The circumstances and mechanisms by which this occurs are not well understood.
4.  Possible but unlikely.
5.  Every woman should have regular sexual health checks which include either PAP smears and/or HPV tests.  In a woman of your wifes age these tests should be done every two years.  This recommendation is in no way related to the exposure you have described.
6.  No
7.  No need for HSV testing in the absence of symptoms. 
8.  Yes

EWH
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38 months ago

Dear Doctor EWH,


Many thanks for for your feedback and help in this thread. you’re expertise is definitely welcomed in here to help me. I guess I’m lucky to have two experts shedding light on me.


Realizing my situation, admittedly, besides the immense guilt that I’m having which is taking my sleep and my soul, I come from part of the world where it’s really hard, if not impossible, to discuss such things with people around me. You’re the only people i was able to find to discuss those topics with [plus you’re experts]. In fact I’m writing this while my tears are running like a river. what makes the matter worse is I love my wife to death and I don’t want to be in place where I might see her ‘or our children’ suffer because of a foolish mistake and a moment of stupidity that i’ve done. Sorry if I’m dragging the conversation into more of a personal feeling, but It’s our nature i guess.


Writing the above, I’m realizing that I need to resolve this as soon as possible as I’ve been drifting away from my wife and family for past 11 days and I don’t think I can let that go further. 


As such, I need your medical expertise and assessment to help me overcome this:


Note: sorry If I’m sounding like I’m repeating my questions/statements and yours. I hope you understand the immense pressure I’m under and my need to have clear picture of what I should know/do/assume.


1. My first question was related to both genital (receiving oral sex) and Oral (Deep Kissing). Given the exposure 'note: she is CSW, her exposure is very high', would you say that my risk was almost zero ‘i.e. less than 1 in 1000’? and that most probably I didn’t get HPV anyway, so no need to worry? 


2. related to question 1, but I deliberately wanted to separate them as I wanted an assessment for my case in Q1. Nevertheless, in CDC site, they use the work 'might' and not can when describing possibility of getting HPV through 'receiving/getting' oral sex. it is on purpose? they add a note that this hasn't been studied well 'unlike vaginal/anal'. Do they imply they have some studies, but not extensive? what are they outcomes if you know that?


3. even in worst case scenarios “I’m infected and Infected”, it’s not the end of the world. HPV will clear itself in 95% of times. it will go away by itself, Correct? statistically, how likely for dormant HPV to comeback? and for those ‘chronic’ HPV’s what are the chances (percentage) of turning chronic HPV into cervical/oral cancer?


4. is it possible to get multiple HPV strains at the same time/encounter? how likely?


5. Is it too late for my wife to get HPV Vaccine? will the vaccine help her fight HPV if she got infected already? I’m willing to pay everything I have if that helps.


6. HPV/PAP Test: Should she do both Pap Test AND HPV during her 20’s? or should she wait for later years? Could emotional stress affect our/her body capability to clear HPV (in case it was there?) At least that’s what I understood from suggested resources online to not get HPV test before 30’s or maybe I’m mistaken.


7. Does frequent (e.g. yearly) PAP test affects ability to be pregnant or increase chance of early delivery/labor? I heard that if HPV exists in body, C-Section is required?


8. Your answer regarding ‘loop infection’ scenario. how much unlikely?


Hoping getting answer to those question will put my mind to rest and let me focus on getting back to my family.


I really cannot thank you enough for the time and effort you spend in helping me and others. it is those things that really stick to mind and heart. Thank you very much doctor.

38 months ago
Sorry,
* Re-Formatting for easier read
* Added question [9]
* modified question [6].

Dear Doctor EWH,

Many thanks for for your feedback and help in this thread. you’re expertise is definitely welcomed in here to help me. I guess I’m lucky to have two experts shedding light on me.

Realizing my situation, admittedly, besides the immense guilt that I’m having which is taking my sleep and my soul, I come from part of the world where it’s really hard, if not impossible, to discuss such things with people around me. You’re the only people i was able to find to discuss those topics with [plus you’re experts]. In fact I’m writing this while my tears are running like a river. what makes the matter worse is I love my wife to death and I don’t want to be in place where I might see her ‘or our children’ suffer because of a foolish mistake and a moment of stupidity that i’ve done. Sorry if I’m dragging the conversation into more of a personal feeling, but It’s our nature i guess.

Writing the above, I’m realizing that I need to resolve this as soon as possible as I’ve been drifting away from my wife and family for past 11 days and I don’t think I can let that go further. 

As such, I need your medical expertise and assessment to help me overcome this (Note: sorry If I’m sounding like I’m repeating my questions/statements and yours. I hope you understand the immense pressure I’m under and my need to have clear picture of what I should know/do/assume)

1. My first question was related to both genital (receiving oral sex) and Oral (Deep Kissing). Given the exposure 'note: she is CSW, her exposure is very high', would you say that my risk was almost zero ‘i.e. less than 1 in 1000’? and that most probably I didn’t get HPV anyway, so no need to worry? 

2. related to question 1, but I deliberately wanted to separate them as I wanted an assessment for my case in Q1. Nevertheless, in CDC site, they use the work 'might' and not can when describing possibility of getting HPV through 'receiving/getting' oral sex. it is on purpose? they add a note that this hasn't been studied well 'unlike vaginal/anal'. Do they imply they have some studies, but not extensive? what are they outcomes if you know that?

3. even in worst case scenarios “I’m infected and Infected”, it’s not the end of the world. HPV will clear itself in 95% of times. it will go away by itself, Correct? statistically, how likely for dormant HPV to comeback? and for those ‘chronic’ HPV’s what are the chances (percentage) of turning chronic HPV into cervical/oral cancer?

4. is it possible to get multiple HPV strains at the same time/encounter? how likely?

5. Is it too late for my wife to get HPV Vaccine? will the vaccine help her fight HPV if she got infected already? I’m willing to pay everything I have if that helps.

6. HPV/PAP Test: Should she do both Pap Test AND HPV during her 20’s? or should she wait for later years? Could emotional stress affect our/her body capability to clear HPV (in case it was there?) At least that’s what I understood from suggested resources online to not get HPV test before 30’s or maybe I’m mistaken. Do you recommend me to check her HPV in 3 years given my exposure? (my non-expert analogy, might be infected and it might take 2-3 years to get transmitted and cleared by body)

7. Does frequent (e.g. yearly) PAP test affects ability to be pregnant or increase chance of early delivery/labor? I heard that if HPV exists in body, C-Section is required?

8. Your answer regarding ‘loop infection’ scenario. how much unlikely?

9. Should I go  back having sex with my wife normally (not only regarding HPV, but overall, given the previous thread)?

Hoping getting answer to those question will put my mind to rest and let me focus on getting back to my family once and for all. I'm really tired of thinking.

I really cannot thank you enough for the time and effort you spend in helping me and others. it is those things that really stick to mind and heart. Thank you very much doctor.
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
I'm sorry for the mental pressure you are experiencing.  At the same time, we must limit what we can do on this site to science-based comments and information.  Your posts are well beyond the acceptable word/character count for submissions.  I will be providing brief follow-up information.  Many of these questions are "what if" questions which serve no practical purpose:

1.  My response did consider your partner's occupation and the sorts of exposures you mentioned.  Still very low risk.
2.  I cannot tell you why the CDC used the wording it used.  As Dr. Handsfield has told you, the data for HPV and oral sex are not nearly as good as the data for HPV at other sites.  .
3.  Correct.  The rates of reactivation of dormant infections is unknown.
4.  You are asking questions for which there are not good answers.  is it possible- sure.  How common- unknown.
5.  HPV vaccination is recommended for all women.  It would not impact any current infections but if exposed in the future, is very effective for preventing infection.
6.  You should follow her doctors recommendations.  HPV testing is not recommend under the age of 30 here in the U.S.
7.  No
8.  Sigh, another "what if" question without good data to inform the answer.
9.  You should not worry about having normal, unprotected sex with your wife.

Please keep any further follow-up questions brief.  EWH.

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38 months ago
Hello Doctor Hook,

Apologies on my previous long response. I'm under severe pressure and trying to cover as much of the worry/anxiety provoking concerns as I can.

I'll try to keep them short.

- in summary:
* my risk is almost zero for both my genital and oral area given the exposure? most likely no transmission occurred.
* there is no basis for worry/anxiety given the exposure (very low risk a transmission occurred).
* I should get back to my wife having our normal (unprotected sex) without worry of HPV.
* In most people (95%) HPV will be cleared totally. in other words, if tested after 2 years, no HPV is detected.
* PAP test should be done every 2 years. no HPV test before 30, unless pap is abnormal?.

is my summary above correct?

* Do you suggest getting her vaccine before getting back to sex together 'didn't have sex with her since the exposure'? Or given the very low risk, it doesn't warrant stopping having sex?
* if yes, can we have sex during the 6 months vaccine period? or will it affect the vaccine?
* can I kiss my children? share food, utensils or bath with them?
* do you have any suggestions for me to release my worry, if any?

suggestions for the forum:
* Better Search function: search question content and by question #. Currently, it only searches for titles.
* Mechanism to report test result after question is closed (good for references)

Sorry if I annoyed you with my questions or long responses. I thank you doctor for your patience with me.
38 months ago
One thing I re-call, when i was young (7-12 Yrs.) i had warts on my hands (are they hpv?) and they all gone away (after a while when i was a child). does that change anything?
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Final responses.

Your summary is correct although I should point out that your final statement ("PAP test should be done every 2 years. no HPV test before 30, unless pap is abnormal) may vary according to where you live.

Vaccination is a good idea but need not delay sexual contact.
Of course you can kiss, share utensils and touch your children.
Regarding your guilt and anxiety, this is something to work out with a counselor or mental health professional.  Such interactions are confidential. 
Your childhood warts in no way change my assessment or advice.

This thread will now close.  Further anxiety driven, repetitive questions will be deleted without response and without refund of your fee.  EWH

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