[Question #3786] Follow up question to #3578

35 months ago
Dear experts,

I recently left a question about giving and receiving oral sex from the man I dated in January (Question #3578). I got tested for HIV, Gonorrhea, and Chlamydia in April and all the tests are negative. I have no other previous sexual experience. The man in question recently told me that he had genital warts. I guess he got it a few years ago, and got treatment for it and it recently came back. When we were together, I don't  believe seeing a wart and he said that it had receded and was gone when we are together. However, I am still quite distressed as he never disclosed this to me. Is it true that I would need to get a pap smear to test for HPV? Also, what are the chances of getting Genital warts/HPV solely through oral sex? Also since I havent had any sexual contact  since January, I could assume that my recent tests are 100% conclusive since I took them in April?  Thank you so much for your help. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Welcome back to the Forum.  I'll try to help.  First, regarding your tests for other STIs, the results are conclusive and you should not be concerned.

The topic of oral HPV is more complex.  Research has shown that the same sorts of HPV that cause genital infections can also cause infections in the oral cavity although they are less common.  Like genital HPV, a small proportion of certain types can go on to cause cancer years after they are acquired.  It appears that most of these infections, again like genital infections resolve on their own and cause no problems.  Oral HPV is considerably less common than genital infection.  Unlike genital infections in women, there are currently no approved tests for oral HPV infection.  Most dentists now incorporate careful evaluation of the oral cavity to look for signs of oral pathology, including both warts and abnormalities. On average about 5% of adults have the infection.  Oral HPV is, on average, three times more common in men than women.  The risk for oral cancer is greatly amplified by smoking and infections are effectively prevented by the HPV vaccine. 

In your specific case, with just three exposures, one of which was condom protected, your risk for infection is low even if your partner had active infection at the time you had sex with him.  Further, the type of HPV that causes warts is not the one of the types associated with cancer.  I presume you have been vaccinated for HPV.  If not, you should be since while it will not reduce the risk for infection from past exposure, it will prevent future infection.  Otherwise, my advice is not to worry about it and to see your dentist regularly as you should.

I hope this information is helpful.  If there are further questions, please use your up to 2 follow-up questions to seek clarification.  EWH
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35 months ago
Thank you so much for your response. I am very grateful for your service since there are many conflicting information on the internet. And I am glad to hear that my other test results are conclusive. And thank you for providing the information about oral HPV. Since I received oral sex from him, would I be at risk for genital warts? or is genital warts mainly passed through vaginal/anal sex (which we did not have)?  Unfortunately, I did not receive the vaccine, however I am still within the recommended ages, so I plan on getting the vaccination. Would you recommend a pap smear? Thanks for the info again. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
I would not worry about a meaningful risk of getting warts from receipt of oral sex from him.  His infection was on the penis, not the throat, as I understand it.  Further, were it to occur, your own immune system would likely control the infection.  Thus the major risk would be from penile contact. 

I would urge you to get the vaccine ASAP. It is a good way to remove one sexual health worry.  The vaccine is safe and highly effective.  I recommend it for all of my patients in the age range.

I suspect you are of an age where there is not need for a PAP smear. Even if you get HPV, the infection would not be apparent for months.  Just follow recommended women's sexual health screening recommendations.  EWH
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35 months ago
thank you for your response. I am of age  where they recommend PAP smears, so I thought this might be the right time to get my first one. In general, how long would it take for HPV to become apparent (I read some sources saying that it could take years)? It seems like the most risk is from penile contact rather than oral contact, did I understand that correctly? And I read on another question that stated oral sex, even unprotected, was still considered safe sex, with virtually zero chances for HPV , would that be fairly correct as well? Thank you for easing my anxiety with this question and the first one. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
I'm glad my comments have been helpful to you.  I think a first PAP smear is a fine idea.  typ9ically when HPV-related changes are found on PAP smear they have taken several months (3-6 in the majority of cases) to appear. 

I agree that the risk for HPV is far greater from penile contact than from oral sex.  I would not say that oral sex is "no risk" for HPV.  Some people do get HPV from oral sex but it is not nearly as common or as "efficiently" transmitted as it is through penile-vaginal sexual contact. 

This is my third reply to your questions so, as per Forum Guidelines, this thread will be closed later today.  In closing however, my major and most important advice to you is to go and get started on your HPV vaccine sooner than later. it is the best single way to prevent HPV and its consequences.  EWH
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