[Question #4081] Oral HPV DNA Test Reliablity

30 months ago
I had a French kiss with a woman, and went down for a sec -- licked her genitals twice. I stopped out of scare. 

I went to a dentist and he offered Oral HPV DNA test.  It came back negative.

I spoke to the Oral HPV DNA expert. They said the test has a sensitivity of 100% and Specitiy of  97%.  Overall, accuracy is 98%

3% less specificity because of sample collection from Oral Rinse.  They said the result is very reliable both for the positive and negative result.

I read that genital to Oral transmission is quite rare. Can I move forward assuming I do not have HPV orally?


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Welcome to the forum. Thanks for your question.

I would have strongly recommended against having the oral HPV test. The available tests are not nearly as reliable as the manufacturer of your test or your "oral HPV DNA expert" claim. As you suggest, there is uncertainty about how samples are best collected, and no consensus that oral rinse is best. Even with oral rinse, there is no standardization about whether only the mouth is rinsed, whether the fluid should be gargled, and how long the fluid should be retained in the mouth. All these things probably make a difference. Some researchers believe swabbing the tongue, cheeks, and throat gives a better sample.

Second, you are correct that genital to oral HPV transmission is uncommon. It probably occurs, but we really don't know the risks for any single exposure. Also, if you had indeed acquired HPV during the exposure described, you may have been tested to soon. It takes weeks or months for new HPV infections to be detected. (If done very soon after exposure, a positive result might mean that the specimen actually sampled leftover genital fluid from the partner, and infection had not yet taken hold.) Or a positive test could go back to a distant past sexual exposure, or perhaps even kissing. Even without oral sex, many sexually active people acquire HPV in the mouth or throat.

For all these reasons, all true STD and HPV experts would agree your negative test results is NOT reliable; you could still have HPV. Had it been positive, most experts would consider it reliable. But in that case, what would you do about it? There are no treatments or exams that can change it, and none that can reduce the very low risk of future complications, such as oral warts or throat cancer. The very large majority of oral or throat HPV infections are cleared by the immune system, never cause symptoms, and do not lead to cancer or any other serious health problem.

By the way, I'm curious where your are? What country, city, and/or lab was used?

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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30 months ago
I am in the US. 


This is the lab tested me.



I called the experts number there.  They gave sensitivity and specificity values.


Also, I took the test more than 6 months post exposure.  I gargled the liquid for nearly  30 second.  I swished all over my mouth.


30 months ago
Also,  can HPV transmit  in a second  like fleeting exposure with genitals? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Thanks for the additional information. Unfortunately, the uncertainties about HPV testing also apply to whatever gold standard a manufacturer chooses to determine their own test performance. FDA does not always have rigid requirements for such gold standards, especially for new and rapidly evolving tests like those for HPV. Many tests are FDA approved with excellent reported sensitivity and specificity which experts know to be more or less meaningless. Blood tests for HSV2 are another case in point:  the FDA approved data on sensitivity and specificity are nonsense and ignored by herpes and STD experts. For HPV testing, oral or any other site, I believe that all the new test manufacturer must do is pick some reasonable, previously used test as their baseline, then report sensitivity and specificity in comparison with that test. Some test manufacturers might go further, such as comparing to multiple test types or a combination of them, but many do not. I have no way to judge this for the specific test you had. Once FDA approval is secured, even highly reliable labs (e.g. Quest, LabCorp) can and often do start offering it, regardless of ipotential flaws in interpretation.

Trust me on this:  There are good reasons why the large majority of experts in HPV, infectious disease, public health, and STDs do not currently recommend any sort of routine oral HPV testing. That may come in the future, and maybe someday there will be standardization of collection methods, data on which tests work best, and guidance on what to do about a positive result. But these do not exist at this time, regardless of what you can find online.

Having said all that, with 6 months since the oral sex exposure described, the negative result strongly suggests you did not acquire an oral HPV infection at that time. But I would not consider it proof. Of course it is almost certain you'll have HPV genitally someday, and a good chance of oral infection as well. But apparently you have no oral infection at this time.

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30 months ago
Having said all that, with 6 months since the oral sex exposure described, the negative result strongly suggests you did not acquire an oral HPV infection at that time. But I would not consider it proof. Of course it is almost certain you'll have HPV genitally someday, and a good chance of oral infection as well. But apparently you have no oral infection at this time.


I just checked my calendar. The exposure was actually 11 months ago.  Does your statement still stand, or the test result is invalid?
30 months ago
Side note: My dentist ordered this test https://www.oraldna.com/oral-hpv-testing.html through Quest only.   Quest Diagnostics own this test--the expert said to me on the phone call.
30 months ago
Side note 2: My doc ordered this test. http://www.questdiagnostics.com/testcenter/BUOrderInfo.action?tc=90562&labCode=DLO    The expert on the phone said both are the same. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
"Does your statement still stand"?  Yes. At the time you were tested, it is unlikely you were infected with any HPV type detectable by the DNA test used. The test cannot detect previous HPV infections that then cleared up. For the reasons discussed (and more reasons below), there are no guarantees you don't have HPV and never will be.

Further to my comments above about test reliability:  To my knowledge, there are no FDA approved oral tests for HPV. In addition to FDA approval, labs have the option of conducting their own studies to determine test performance. That probably is what Quest did with this text. Whether it will prove to be a reliable test remains to be seen.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful.
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