[Question #4979] Potential HPV transfer and transmission

24 months ago

I recently read an article (https://www.verywellhealth.com/hpv-and-toilet-seats-514137) from Very Well Heath where the author said that parents might be able to transmit HPV to their children by sharing wet towels and that people could transfer HPV from one area of their body to another by touching an area infected by HPV (the article gives the example of someone touching their genitals and then touching their mouth) and then touching another area of their body.

Based on other stuff I've read online, it sounds like many people who have had sexual experiences (assuming they have not received the HPV vaccination) either have HPV or have been exposed to it. To my knowledge, I have never had a genital wart, but let's say that hypothetically I have HPV. I try to practice good hygiene. I wash my hands after going to the bathroom. I use one towel for my face and another for my body after showering. Etc. Etc.

However, the Very Well article got me thinking about a few scenarios. The first is that after showering and drying myself off, I'm touching a wet towel that has touched my genitals. Also, when getting dressed or undressed or when gathering laundry, I am touching clothes that have sometimes touched my genitals. The clothes are not always wet, but sometimes they are if I have been exercising or something along those lines. To add to that, even though I do wash my hands after going to the bathroom, I'm sure there are times when I touch my penis and then touch my anus during the process of going to the bathroom. Beyond my own personal hygiene, it doesn't seem out of the question to think that someone would use the bathroom without washing afterward and then want to shake my hand.

Could the scenarios I outlined transfer HPV from one area of the body to another or from one person to another? I realize there are different strains and not all cause warts. If the type of HPV and the presence or absence of warts would affect your answer, please specify how and why.

H. Hunter Handsfield, MD

24 months ago

Welcome to the forum. Thanks for your confidence in our services.

Like many health releated articles in the general media, this one is quite misleading. It starts out with the accurate statement that HPV is not transmnitted by contact with toilet seats -- even though it uses fear of toilet seats in creating an attention-grabbing title. And while the article pays lip service to the difference between finding HPV on an object like a towel and actual transmission from towels (there's a big difference!), the overall tone of the article implies lots of risk from various nonsexual exposures. One example that caught my eye is "towels (at least wet towels) may be responsible for some cases of HPV in young children". As worded, this implies that there could be substantial numbers of HPV cases in young children. But there are not: young children almost never are diagnosed with genital area HPV, or HPV anywhere on the body caused by genital types of the virus. Of course young kids get common hand and foot warts all the time -- most children do, at one time or another -- but those are caused primarily by HPV1 and other types that rarely involve the genitals and are not sexually transmitted. (Probably transmitted mostly through skin-skin contact or saliva between children.)

Without reading the article in all its detail, I'll bet there are other examples. Basically, it warns readers that because HPV can be identified on towels, fingers, in bathrooms, etc, that there must be some potential for transmission from contact with these things. But the fact is that even the busiest STD clinics never see people with genital or anal warts or HPV who didn't have sex with potentially infected partners. There are rare exceptions, i.e. rare patients who give honest histories that seem to preclude any means of sexual acquisition. But even these probably are often wrong: consider the person who denies being sexually abused or assaulted or has blocked that memory. If there are some genuine non-sexual acquisitions, they are very rare.

Assuming you are not a virgin -- you've had sex -- then you can assume you have had HPV. If not, you will acquire HPV (probably more than once) once you become sexually active, pretty much regardless of your partner(s) sexual history. For that reason, you should be immunized against HPV, which will prevent infection with the 9 types that cause 90% of all medical problems from HPV. And then don't worry about it. You'll never be infected by the sorts of things you mention -- through common showers or towels, shaking hands, or how you contact your genital and anal area for hygiene or when using the toilet.

The large majority of genital, anal or oral HPV infections remain asymptiomatic -- i.e. do not cause warts, cancer, or anything else -- and are cleared by the immune system over a few months. The infected person is entirely unaware. Most people are infected several times: roughly 50% acquire HPV after 3 lifetime partners, and at any point in time, 30-50% of people age 20-40 have detectable HPV DNA in the genital area. Transmission generally requires the virus to be massaged into the tissues, which is why warts appear primarily at sites of friction during sex (think penis head and shaft, vaginal opening, labia minora) -- which also helps explain why they rarely show up on hands, face, etc; and why the virus is rarely if ever transmitted by contact with a contaminated environment.

For these reasons, getting and having genital HPV should be viewed as a normal, expected, and unavoidable consequence of being sexual. For the same reasons, HPV is just as common in people with, say, 5 lifetime sex partners as those with 100 or more. Vaccination prevents those infections most likely to cause harm, but has no effect on more than 100 additional HPV types. These are also the reasons all women need to follow pap smear guidelines -- even those with lifelong monogamy with a single partner.

Bottom line: take common sense sexual precautions and get vaccinated. Then forget about HPV as a health issue. And don't search the internet for exceptioins to the rule, or at least stick with scientifically reputable online sources.

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

HHH, MD

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24 months ago

Thanks for all the information!!! It sounds like transmitting HPV via a wet towel is not a real thing. However, just out of curiosity, if someone had genital warts and touched them and then touched their mouth, could they spread the warts to their mouth? Or from their penis to their anus?

Since it sounds like Very Well Health is not a very good resource, could you recommend some more reliable places to find articles about sexual health information?

I'm planning to get vaccinated, but I'm in the process of looking for a new doctor. When I asked my current doctor about STD testing, I was given a lecture about abstinence. Also, when I called and asked about the vaccination, the head nurse told me that she would look into it and get back to me. When I followed up a month later, she told me I could get it but I got the impression she didn't want to do it. The whole thing made me uncomfortable and a little squeamish about getting the vaccine from them. While I get that every individual doctor (and nurse) will have their own unique beliefs, is there generally a certain type of doctor that you could recommend seeing for sexual health issues and getting stuff like an HPV vaccine? I don't know if it matters, but my current doctor specializes in family medicine. I'm in my thirties, single, and don't have any children.

H. Hunter Handsfield, MD

24 months ago

Transfer of infection from one body area to another is called auto-inoculation. It is generally uncommon with HPV, especially when infection has been present for a few weeks -- maybe more auto-transmissible with more recent infection. (The immune system is very effective in preventing new infection with HPV of the type someone already has. For the same reason, couples infected with the same HPV type probably do not "ping pong" the infection back and forth, even with repeated sex -- or only rarely. In any case, oral warts are very rare in people with genital warts -- and of course there must have been billions of self-exposures of the mouth of this type, and yet almost no oral warts.

The HPV vaccine is definitely recommended for everyone under age 26, and only in the past year has been approved up to age 45. Between 26 and 45, it's generally recommended for people likely to be changin partners with some frequency and less important otherwise -- so perhaps that sas the nurse's concern. But I have no way of knowing if the nurse or that office indeed misunderstand the value and indications for the vaccine or its safety. 90% of family medicine and GPs are on board with accurate information, so call around. Or contact any health department clinic or Planned Parenthood, where I guarantee you'll get a positive reception about HPV vaccine. Assuming that, as a single man, you're likely to have a handful of sex partners before perhaps settling into a committed relationship; and if cost isn't a critical issue (around $500 if not covered by insurance -- which it probably will be unless you haven't spent this year's deductible), you should do it.

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24 months ago

Thanks a million! You have clarified everything I was wondering about and did it in a way that I found understandable.

I just have three more questions. If you get warts on your hands, is there a chance that through masturbation you could transfer those warts to your penis? And if this is possible, would there be any way to differentiate the warts you wound up with on your penis from sexually transmitted genital warts?

Also, I feel like I talk to a decent amount of people who seem to spit as they talk. Is it possible for someone who has oral herpes to give someone else oral herpes by spitting onto their face in casual conversation? And if this is possible, would the person have to have a cold sore? Or, would transmission be possible even without a cold sore present?

H. Hunter Handsfield, MD

24 months ago

As noted above, auto-inoculation of HPV is rare and that applies to masturbation. The HPV types that cause common hand and foot warts (mostly HPV1) almost never is found in genital warts, which shows that this doesn't occur or so rarely it can be ignored. Visually there is no way to distinguish the types of HPV causing warts; but DNA testing rarely if ever identifies HPV1 in genital warts.

The opportunity for follow-up comments is intended for clarification of the original question, not to raise enitrely new issues. I'll just say that auto-inoculation of HSV is rare and occurs only during the initial infection with HSV. Chronic, longstanding infections (like almost all oral herpes) is not transferrable to other body areas. If you need more detail than this, you'll need to start a new qustion.

That concludes this thread. I hope the discussion has been helpful.

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