[Question #5866] Receipt of Oral

72 months ago

I have been married >20 years, but the marriage has been sexless for the last 7 years. About 2 ½ years ago, I received deep throat oral sex from another male for an extended time. Recently, my wife has become interested in sex again, but I am concerned I caught an STD from the oral sex--namely HPV. The only possible symptom was, ~4 months after receiving oral sex, a small red patch <1/2" diameter that appeared on my penis shaft. It looked like dry skin & disappeared on its own w/in 5 days. There was no pain, itching, blistering or fluid.

About 5 yrs into our marriage, my wife's pap smear showed HPV. Since she only had 1 other previous partner, she blamed the HPV on my relationships prior to meeting her. Her HPV cleared, but then recurred ~5 yrs later & then again 7 yrs after that (i.e., ~4 yrs after we stopped having sex). I believe she has not strayed. Why does HPV keep recurring in her?

Could I have caught another strain of HPV from the oral sex? If another strain shows up on my wife's pap smear now, my marriage will end. That is why I don't want to start having sex with her again. How worried should I be? I know your typical advice is to not worry about HPV, but I feel being in a 20 year marriage is a different situation—a new HPV infection after >20 years of marriage would show I strayed.

Regarding any other STD's I could have caught, would I definitely have had symptoms?

Is there any reason at all to not begin having sex with my wife again?

H. Hunter Handsfield, MD

72 months ago

Welcome to the forum. Thank you for your question.

It is almost never possible to know when and from whom any particular HPV infection was acquired. Assuming you and your wife had other partners before (or during) your marriage, her HPV could have been from any of them. Your wife is correct that her infection could have originated from a past sexual relationship you had, but there's no way to know. And what does it matter anyway? The large majority of all humans get genital HPV, often more than once, and there is no point in assigning blame for it. Nobody is ever to blame for having or transmitting HPV, since being infected and transmitting it are unavoidable. As for your recent sexual contact outside your marriage, HPV is not commonly transmitted by oral sex. Statistically, it is unlikely your male partner had an active oral HPV infection at the time; and even if he did, probably unlikely you were infected from that event.

Most STDs cause no obvious symptoms. If you had acquired gonorrhea or syphlis, you probably would have known it. In any case, almost all gonorrhea or chlamydial infections would have been cleared by your immune systme within a year of cathing them. The chance you have any active STD now, 2.5 years later, is extremely low. But if you want complete security about it, see a doctor or clinic for testing -- speciifically, a urine test for gonorrhea and chlamydia and blood tests for HIV and syphilis. You definiteoy can expect negative results. In the meantime, you should resume sex with your wife. The chance you have anything is truly too low to worry about.

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

HHH, MD

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72 months ago

Thank you for your response. You state “[m]ost STDs cause no obvious symptoms. If you had acquired gonorrhea or syphlis, you probably would have known it.” Did you mean most STDs DO cause obvious symptoms?

Since my wife has access to my medical records via internet electronic chart, I am hesitant to get tested—if I do get any tests, I’ll have to find some way to do it anonymously. Since you say I can resume sex w/ my wife and that the chance I have any active STD now 2.5 years later is extremely low, I think I won't get tested for any STD. Does that make sense? You don’t think the small red patch ~4 months after receiving oral sex was an STD?

Regarding HPV, I’m curious why HPV keeps recurring in my wife—after 1st showing up ~5 yrs into our marriage, it recurred ~5 yrs later & then again 7 yrs after that (i.e., ~4 yrs after we stopped having sex). Why does this happen?

I believe I read on this forum that oral HPV is more likely to be “high-risk.” Is that true?

If I did catch HPV from the oral sex 2.5 yrs ago, and if I now transmit it to my wife, will it show up as a new strain of HPV (after >20 yrs of marriage) during her annual test? If that is the case, she will know I strayed—I feel stuck between a rock and a hard place. I realize most humans get HPV, but not after 20 yrs of marriage! How are HPV results reported to the patient—as a specific HPV strain number, as either High or Low risk HPV, or is the patient simply told they have HPV?

Thank you again for the info you provide!

H. Hunter Handsfield, MD

72 months ago

I forgot to include "however", i.e. "However, if you had acquired gonorreha or syphilis...." Sorry.

No STD causes a "red patch". And the large majority of genital skin problems are not STDs.

Persistent or recurrent HPV is a mystery -- nobody knows why it is so common, or more common in some people than others. But it has nothing to do with your sexual activity and exposures.

I am unaware of any data that oral HPV is more likely to be a high risk than low risk type. Perhaps you're confusing that with the fact that the only HPV type known to cause oral/throat cacner is HPV16, a common high risk type.

As I said above, "It is almost never possible to know when and from whom any particular HPV infection was acquired." If your wife should show up with an apparently new HPV infection, there will be no reason to believe it camne from any particular sexual exposure that either you or she migt have had. Your statement "not after 20 years of marriage" is wrong. Apprently new HPV infections can and do show up in people monogamous for 20 or more years. Most are reactivations of distant past HPV infectsions.

HPV is a normal, expected, unavoidable consequence of being sexual. Everybody gets it. There is never any rationale to ascribe blame for it or to know when or where it came from. On top of which, genital HPV is infrequently acquired by oral sex: you were at little or no risk. Do your best to stop obsessing about this -- it doesn't matter!

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71 months ago

Thank you for your responses and all the info you provided. I have a few more follow-up questions, if you don't mind.

I wasn’t aware that genital HPV is infrequently acquired by oral sex—I thought for sure I caught HPV. Just curious—why is that? Is there a way to quantify (or make an educated guess) the risk of catching HPV from receiving extended deep-throat oral sex for several minutes?

I also didn’t know NEW HPV infections show up in people monogamous for 20 or more years. If a new HPV infection shows up in my wife’s yearly exam, will they tell her it’s a new HPV strain number? Or will they simply tell her it is an HPV infection of High or Low risk, in which case it won’t necessarily be identified as a new infection?

I have read on this site that a person’s immune system typically gets rid of HPV in 3 years. So, if I did catch HPV, can it be gone from my body soon?

Besides HPV, are gonorrhea, syphilis or chlamydia the only STI’s I could have caught? If so, it sounds like those infections would be gone by now. So, you really don’t think I need any testing?

I realize this is my last follow-up. Thank you again for your patience and information--it has really made me feel much better and less stressed.

H. Hunter Handsfield, MD

71 months ago

Most experts believe HPV is lower risk from oral sex simply because oral HPV infections are less common than genital. Many or most HPV types favor genital and anal tissues over oral, so oral infections often don't take even when persons are orally exposed. Further, it is possible that oral HPV infections are less readily transmitted. And no, research to quantify the risk for any one exposure, oral or genital, would be extremely difficult to design and carry out.

Not all apparently new infections are actually new. In monogamous settings, many infections are recurrences of active HPV in people infected years earlier. But truly new infections are also possible, if an old infection reactivates in one partner and is transmitted to the other.

If your wife ever devleops HPV in a pap smear, it will probably be known whether it's high or low risk. But when and where she was infected would not be apparent. Anyway, this happens all the time in monogamous couples. It generally doesn't bother them much.

Yes, if you acquired HPV, it likely would be cleared by your immune system -- usually sooner than 3 years, ypically around a year for low risk and 2 years for high risk types.

The main STDs acquired by oral sex are gonorrhea, syphilis, and herpes due to HSV1 (the type that usually causes oral herpes). HPV and chlamydia are uncommon but can happen, and HIV is not known to have ever been transmitted oral to penis. Absence of symptoms is good evidence you didn't catch gonorrhea or herpes, and without symptoms testing is not normally recommended after a single such exposure. But if you want 100% certainty, testing is the only way to go. In that case, have a urine test for gonorrhea and chlamydia any time and a syphilis blood test after 6 weeks. And optionally HIV, but realistically no risk.

That completes the two follow-up comments and replies included with each question and concludes this thread. For more information about HPV, I recommend two main sources: The American Social Health Association, which sponsors this forum (www.ashasexualhealth.org) and the Centers for Disease Control and Prevention (www.cdc.gov/std). Any additional questions you may have almost certainly are covered on either or both sites.

I hoope the discussion has been helpful.

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H. Hunter Handsfield, MD

71 months ago

Note that I corrected a typo in my orginal reply. It now correctly states "In that case, have a urine test [not throat swab] for gonorrhea and chlamydia...."---