[Question #5816] HPV transmission

19 months ago
So, condoms can’t prevent all skin to skin interaction.  With that said, if infection occurs on the scrotum or maybe base of the penis, will the infection stay local to that area or does it spread around to the whole genital area?  To transmit further, would a new partner have to come into those specific areas or would the whole genital region be risky?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome back to the forum. I'm taking your question this time, but I reviewed your recent discussion with Dr. Hook.

You can look at HPV infections like the proverbial iceberg, with visible abnormalities (e.g. warts, cervical lesions giving abnormal pap smears) as the tip. The "underwater" part is involvement of surrounding and nearby skin, which can appear entirely normal. 

However, HPV infection probably is most likely when the virus to be massaged into the skin. Superficial contact with infected genital fluids may not be enitrely risk free, but less likely to transmit the virus than more vigorous contact. This is why genital warts usually appear primarily at sites of maximum friction during sex:  penile shaft in men, vaginal opening and labia minor in women, or the anus if exposed by anal sex. Warts can appear on the scrotum, but less commonly than the penis etc.

One of the main take-home messages about genital HPV is that infection is difficult to avoid short of celibacy, but that most infections go unnoticed and cause no important health problems. And also that vaccination is the best protection against potentially important health consequences, i.e. warts and genital (and throat) cancers. I agree with Dr. Hook's advice to you about vaccination. Protection won't be perfect, because at age 40 you likely have already been infected with some of the 9 HPV types covered by the vaccine. But protection will be 100% against any of those strains you have yet had.

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

HHH, MD
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19 months ago
I had ordered an at home test through selfcollect.com.  A penile and oral test.  Should I go through with the testing or return the package?  Will their test tell me anything beneficial?  Will the test be able to determine if I’m currently infected with a certain strain or show the dna of any strains I may have come into contact with in the past?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
There are no tests for HPV in men that are approved by the Food and Drug Administration (or, as far as I know, by FDA's counterparts in other countries). As a result, there is no documentation of how well the tests perform:  what proportion of infections they detect, how often a positive result might be false, and the accuracy of tests to determine HPV type (e.g. high risk, low risk, wart-causing). In addition, nobody really knows how to collect specimens to maximize test performance:  even HPV researchers debate about swabs or rougher methods (including sandpaper), wet vs dry; where exactly to test (shaft? head? urethral opening? scrotum?); and for oral testing, whether to use a swab, gargle and spit, or something else. So you're taking a chance in not knowing how to interpret the result, whether positive or negative. And what are you going to do if positive? Having a positive result doesn't necessarily mark someone as more likely to have a health problem (future warts or cancer), or to prevent such a problem, or to transmit to partners. It is because of all these things that CDC and other public health experts recommend against HPV testing in men, except sometimes to test the biopsy of someone with known HPV disease like suspected cancer.

And in reply to your second question, such testing definitely will not detect all past HPV infections. Such tests can only detect DNA currently present, and perhaps miss some of those as well. A negative DNA test does not tell whether you have a past infection that might reactivate in the future.

I certainly would never test myself, even if I were still actively dating and potentially changing partners, and I recommend you not do it.
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19 months ago
Thanks!  I’ll return it and chalk it up as a $140 mistake.  Half refund if returned after shipping.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
OK, good move. That completes two follow-up questions and replies and so ends this thread. I hope the discussion and the prior one have been helpful. Please note the forum policy non repeat questions:  no more from you on the topic we have been discussing. Thanks for your understanding.---