[Question #4925] GW and Oral Sex

25 months ago
Hi Dr's,

I am a male- I was diagnosed with genital warts in July of 2018. I had 1 small wart, got it biopsied off (positive for 6/11). and then another one came in Augus/re-appeared in September and got them cryo'd and re-cryo'd. I'm diligent about seeing my dermatologist monthly for routine checks. We haven't seen anything since September so it has been 4.5mos since I have not shown any warts.

I have recently been going on a couple early dates with a women-nothing serious and not a current long term partner. As we were making out- I disclosed that I have had HPV in the past year and asked her if she was vaccinated - she said yes. I also asked her if she "understands HPV and if she has any questions" and she mentioned she has an abstract understanding but not super detailed. I didn't get into the specific details of "I have had warts" and "the treatment I had" and if "I'm not showing symptoms, I can still transmit".
She said she felt fine about it and then performed unprotected oral sex on me.

- Did I do proper job to disclose all the details of my situation to her as a good partner/person? I just feel like I should have actually said the word "wart" and educate her more- let her know even though I am not showing symptoms, there is still possibility of transmission. 

- Is there any risk of her getting oral warts/hpv 6/11 even though she is vaccinated? She mentioned she got vaccinated as a teenager (maybe 11+ years ago). Is the vaccine still effective?

- Since it has been 4.5mos, did I start a little too early getting back in sexual relationships. Should I wait longer for this to "clear"? I feel guilty here that I should be waiting 6mos-1 year to have sexual activities with other people.

I just want to make sure I am being a good partner and I am much more educated on HPV than most people since I have to be. My worry is did I say enough, explain HPV well and the risks.

Thanks

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

With no visible wart recurrence 4+ months after treatment, probably they're gone for good and the underlying HPV infection likely is gone as well. In addition, asymptomatic (invisible) HPV infections may have lower virus levels than active warts and thus be less transmissible. In any case, my 6 month advice is arbitrary; there are no solid data on exactly how quickly HPV becomes non-transmissible after warts are treated. It probably ranges from a few weeks to a year or more. In any case, it sounds like your current partner has an appropriate attitude about HPV and transmission potential. You and she should participate in any and all sexual practices that give you mutual pleasure.

"Did I do a proper job...?" Yes, I think so. I doubt it makes much difference whether you mentioned warts per se.

"Is there any risk...?" No, probably not. 90% of genital warts are caused by HPV 6 or 11, and the vaccine is 100% protective against those types. Even if you were among the 10% whose warts were caused by other HPV types, the risk would be very low for the reasons discussed above.

I would say your responsibilties regarding HPV and informing partners is not signficiantly higher than average. You're obviosuly a kind and caring person, but don't overdo it. For example, I don't see it as your responsibility to educate your partner(s) about HPV in any detail. Once they know about your past infection, the rest is up to them. I would also say that once you get to ~6 months with no recurrence of the warts, you don't need to mention it at all to future partners.

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

HHH, MD 
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25 months ago
Thanks Dr. Handsfield. Appreciate the note back.

Is the vaccine effective for both 6/11 HPV warts orally as well? How long does the vaccine keep immunity for?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
The vaccine is effective against 9 HPV types, including 6 and 11, anywhere on the body, including oral. Indeed, one reason for immunization is to prevent pharyngeal (throat) cancer, a rare but dangerous outcome of oral infection with HPV type 16. It appears to provide lifelong protection against all 9 types -- for sure 10+ years.---
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