[Question #4721] HPV from Oral Sex

28 months ago
Dear Drs,

Recently I had an encounter with a CSW in South East Asia where I performed unprotected oral sex that has left me extremely anxious about the risk of STIs - and in particular oral HPV.  I'm a mid-30s aged male and I have received the Gardasil 9 vaccination - with the final dose around 1 year ago.  I understand this is quite late in life   though saw recent press material that the vaccine is now approved by the FDA for use in men and women upto age 45. 

My main concern is that I may have contracted oral HPV from the CSW that I'm now at risk of passing on to future partners - which is making me extremely anxious about engaging in future sexual activity.  I also wanted to ask the following questions which I'm not particularly clear on:

a) Does Gardasil 9 prevent oral hpv infections? 
b) Can you be re-infected with the same strain of HPV?  As I had the vaccine late I appreciate it's highly likely in my youth I would have been exposed to some strains already.  Once the body clear these though can you be re-infected with the same strain or would you have immunity?  And if it is possible to be reinfected would the vaccine provide protection against re-infection?
c) Is there high risk of contracting oral HPV from performing cunnilingus?  And is there high risk or possibility of then passing this to a future partner through cunnilingus or even kissing?

I would be very grateful for your guidance on the above as it's causing me a lot of anxiety.

Many thanks,
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Welcome back to the forum. Thanks for your continued confidence in our services.

As we discussed a year and a half ago, everybody gets HPV. Based on quick scan of that discussion, I believe we didn't discuss oral infection. Some baisc information:  Oral HPV is a lot less common than genital:  prevalence studies show that at any point in time, the number of people with oral HPV is around 15% of the rate of genital HPV. Most oral infections probably are acquired by oral sex, but oral HPV isn't rare in people who deny such exposures. Oral HPV rarely causes symptoms and appears to be rapidly cleared by the immune system, perhaps more rapidly than genital HPV. And although there has been a lot of media attention to "oral cancer" from HPV, in fact of the many kinds of oral cancer, only one (pharyngeal cancer) is due to HPV; and that is caused only by a single HPV type, HPV16. Finally, the large majority of oral HPV16 infections do not progress to cancer.

To your specific questions:

a) Yes, the vaccine is effective against the 9 covered HPV types for all anatomic sites, including oral infeciton.

b) The potential for reinfection with previous HPV types is a subject of active research. This has been believed to be rare or not to occur at all. However, this is changing: reinfection might sometimes be possible. However, it is a difficult kind of research:  if someone has had, say, HPV16 in the past and HPV16 is detected (maybe on a pap smear) 10 years later, it is very difficult to know whether it is due to reactivation of the previous infection or to a more recent exposure with a new infeciton. It is hoped that ongoing research will help answer these issues. However, it is important to note that this only applies to reinfeciton, not to vaccine protection. The vaccine is believed to provide solid lifelong protection against the 9 types covered by the vaccine. That includes HPV16, which means you probably are not at risk for the one type of oral infection that might be dangerous in regard to cancer (assuming you had not been infected with HPV16 before you were vaccinated).

c) Cunnlingus is a potential source of oral HPV. Probably transmission from mouth to genitals (either cunnilingus or fellatio) is low, but we can't say it never happens. Kissing in general is very low risk, but might transmit the occasional HPV infection.

Don't overreact to any of this. The bottome line is that oral HPV is rarely an improtant health threat and not something to be worried about. 

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