[Question #506] Oral HPV worry

40 months ago
In June of this year I ended up performing oral sex on a girl I went to High school with.   I am a 36 year old healthy male who rarely gets sick.   I have had 4 sexual partners in the past the number is low because I have always been in a long term relationship since 1997.    I did not have sexual intercourse with her but did perform oral on her about 5 times.    She is 39 years old and was just recently divorced ( Married for a little over two years and has a 1 year old)  Not sure these details matter.

Not to sound rude but afterwards I found out that she has had alot of partners.  I started to freak out because I strayed from my current partner with this affair.  It has been almost 8 months now and I have been worried about the possibility that I may have contracted oral HPV.   I am constantly checking for oral warts and am concerned that somewhere down the line I will suffer from throat cancer.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to the forum. Thanks for your question.

Let me start with some perspectives about oral HPV. On average, at any point in time, it's about a quarter as common as genital HPV. That's a good news/bad news scenario: not as common as genital, but frequent enough that a very high proportion of sexually active people (probably over half) get oral HPV at one time or another. Second, oral HPV is probably not acquired only by oral sex. In the largest US national study of oral HPV, its presence was correlated with no. of lifetime sex partners, but not with frequency of oral sex. So it is likely that oral HPV often (usually?) is acquired by less direct exposure, such as auto-transfer from one's own genital infection, and perhaps because sexual fluids get spread around quite a bit and can easly get into the oral cavity without oral sex. (Sex is inherently sloppy, right?) Third, a higher proportion of oral HPV infections, compared with genital, cause no symptoms and no disease; and almost all infections are cleared by the immune system. Fourth, transmission of HPV from oral infection to partners appears to be uncommon. While oral sex may account for a few genital infections it partners, it is far less likely than genital to genital transmission.

Going to your specific exposure, I see no cause for worry. First, for the general reasons above. Second, active genital HPV infections are quite uncommon in women your partner's age, regardless of their current sexual partner numbers, sexual lifestyle, etc. This is the main reason why HPV vaccines are recommended only for persons up to age 26; after that, both new infections and existing infections become increasingly uncommon. Accordingly, performing oral sex a few times on your past schoolmate carries little risk. And even if you were to have been infected, the chances you'll ever know it, or that you will infect your wife, are very low. To put it another way, the chance you have oral HPV or that your wife will acquire HPV are not any higher now than they were before this affair took place.

Having had 4 lifetime sex partners, there's at least a 50% chance you've already had genital HPV, and probably a 10-15% chance of oral HPV. Those risks might actually be higher, depending on your wife's sexual lifestyle and exposures before you were a couple. That risk is not materially higher on account of this particular partnership.

Finally, throat cancer. First, despite all the media hype about it, throat cancer from HPV remains rare. Even with roughly double the numbers compared with 10-20 years ago, there are only around 12,000 cases per year in the entire US, despite millions and millions of persons who have (or have had) oral HPV. It's far less common than the cancers people really need to be concerned about like prostate, colon, lung, breast, etc. Second, only one HPV type (HPV16) is actually associated with throat cancer, and there is no proof that those with that rare complication actually acquired it by oral sex (notwithstanding the media stories a couple years ago when a particular movie star attributed his throat cancer to oral sex).

So there's a certain low chance you'll have throat cancer from HPV someday, that your wife will develop an abnormal pap smear or even cervical cancer, or that you'll get penile cancer. But these risks are part of life, and they are no higher than they would be without your recent affair. You can and should stop examining your mouth for warts, continue your normal sexual practices with your wife, and put all other concerns about HPV behind you.

I hope this has helped. Let me know if anything isn't clear. Best wishes--

HHH, MD


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