[Question #4383] CSW std risks

28 months ago
Hello experts

Sorry I’m back, mainly due to not asking all the questions I needed at first. I had an encounter with a CSW where I gave and received unprotected oral (very stupid I know) and had protected vaginal sex. This was a one time lapse in judgment. I have been in a monogamous relations for over ten years and I’m ready to move forward but I’m afraid this episode is going to end everything I’ve worked for.  I wanted to get your opinion as to the risks I put myself at for all std’s. At first I was obsessed with herpes but now my focus has shifted to hpv. With hpv being so common and prevalent what do you think the chances I got hpv from this encounter? I’m very concerned about oral hpv, considering the contact was unprotected. I understand hpv is very complex and not fully understood, which is probably what scares me most. Because I’ve been in a mongomous relationship for so long any new infection or virus would mean the end for me. I really just want to move forward and put this behind me but I’m finding it difficult. I tested negative for bacterial std’s eight days post exposure and negative for hiv and herpes five weeks post exposure. I understand the herpes test was a little early.  Please give me some insight as to my chances for hpv both genital and oral. Given my situation and circumstances do you think I need to remain concerned or can I move forward and put this behind me?
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Welcome to our Forum. Part of my response is an effort to validate what you have already said.  Much about HPV remains unknown although the infection is widespread.  Based on available data including studies of the prevalence of oral HPV infections we can say that HPV infections from receipt of oral sex are rare although just how rare is hard to say.  This is really something I would not worry about.

Even less is known about your risk for HPV from a single episode of performing unprotected oral sex on a female sex partner who may or may not have the infection.  Cunnilingus is, from a biological perspective, one of the most inefficient ways to acquire STIs. The tongue is not particularly susceptible to infections, including HPV, which tend to be more likely to infect mucosal surfaces such as the posterior pharynx than the tongue.  The prevalence of oral HPV is substantially less than the prevalence of genital infections as well.  Further, most experts do not recommend testing for oral HPV and when tests are available, their performance characteristics are unknown. 

Based on these observations and what limited data there are, my advice is to put this problem behind you and to move forward without continuing concern.  I hope my comments will help you to do this.  EWH
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28 months ago
Thanks for the response Dr. Hook. 
I have had common warts on my hand, I just got them frozen off last week. I understand this is caused by a strain of hpv. In your opinion would having hpv that causes hand warts offer me any type of protection against acquiring different types of hpv, like genital and oral?  I believe I have read multiple times that Dr. Hansfield has never seen a case of an oral std caused exclusively by cunnilngus. I cannot cite the specific post but I’ve seen him say that a few times. Do you know if he was also referring to oral hpv or just other types of STD’s?  How often do you see oral HPV yourself? In your experience what is the time frame I would expect to see symptoms after the exposure if I acquired hpv either genitally or orally?  Also how do you assess my risk of acquiring genital hpv from condom protected vaginal sex? I know this is just a numbers game about a virus that is not well understood. I’m trying to determine if there is enough of a risk to continue constantly worrying this. Thank you in advance for your help. 
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
I'm going to answer your last question first.  You are seriously overthinking this.  Acquisition of STIs from conniving us, or for that matter, condom-protected sex is excruciatingly rare.  I have seen just one such case in which gonorrhea was acquired from performance on cunnilingus in nearly 40 years of STI,focused practice and no other STIs.

We do not test for oral HPV as even if we diagnosed it, the diagnosis would be of no consequence.  Most such infections resolve spontaneously and when they progress to cancer there are co-factors such as smoking present.  Even then we would simply observe that patient as the risk for progression is vanishingly low.

The question of whether one type of HPV protects from others is still a subject of study.  If thre is protection, it is quite modest.

Again, as I said above, you are greatly overthinking this.  I urge you to put your misstep behind you and move without concern.  EWH
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28 months ago
Thanks again for your reply Dr. 
If I can clarify a bit I’m more concerned with hpv that would cause warts. I understand hpv is common and most people clear the virus without showing symptoms. Given my situation if I show up with warts either genitally or orally my life will change drastically. I’m not trying to get overly anxious, I’m simply trying to asses my risk. I’m now noticing every bump and mark in and around my mouth. Which I know is bad.
In your opinion/experience how common is it get the strain of hpv that causes genital/oral warts?  Also how long after an exposure would someone develop genital/oral warts? Any other insight into my dilemma would be appreciated. Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Your risk for HPV from the exposure is very, very low. I will say again, as I said above, you are overthinking this.  Most exposures to HPV (wart) infected partners do not lead to infection.  Further, you used a condom for genital sex, reducing your risk for infection.  Oral sex rarely leads to genital wart infections.  If you were to develop a wart, it would occur in the next 3-6 months and would be unlikely to occur in less than 6-8 weeks.  Worrying about this is not a fruitful use of your time - your risk is tiny and there is nothing you could do about it.  My advice remains that you should move ahead without concern.

In this forum we provide up to 3 responses to each thread.  This is my 3rd response.  Thus this thread will be closed in a few hours without further comment.  Take care and please don't worry.  EWH
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