[Question #5931] HPV and Oral

17 months ago
Hi, I've been doing a lot of research about HPV and, obviously, been freaking out about it. I'm a 26 years old heterosexual man and I've had sex about 6 times in my life - some of them with sex workers which is adding to the stress. I've always gave oral (cunnilingus) and after learning about HPV risks I started stressing out a lot. Whenever I give oral, I think I mainly just use a little of my tongue and I always spit it out as it goes on (I don't swallow any vaginal fluids).

So my question is, does swallowing or not vaginal fluids make any difference? If I use my tongue and spit it out, could HPV stick to my tongue and make its way to other areas in my mouth (such as the throat or roof of the mouth) or is it necessary direct contact? Meaning only my tongue could potentially be affected by it. 

I remember seeing an article saying that throat cancer due to HPV has been increasing in "healthy" people in their 20s and this is when the stress began. However I do know that a lot of articles are written in a preventive way, so I wanted to get some proper view from the experts.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thanks for your questions. Sorry it has taken somewhat longer than usual to respond.

You are overreacting to what you have learned about HPV, certainly about oral infection and perhaps about HPV in general. Getting and carrying HPV is a normal, expected, and largely unavoidable consequence of being sexual, except through vaccination (more about which below). At least 90% of us get HPV at least once, often several infections. At any point in time, 30-50% of people have detectable genital HPV, but this frequency is not significantly higher in those with few or many sex partners. That your partners include sex workers probably does not elevate your risk. Fortunately, the large majority of HPV infections -- genital, anal or oral -- are cleared by the immune system over time and never cause symptoms. Some HPV types are classified as "high risk", i.e. can cause cancer, but even with these types, the large majority of infections do not lead to cancer. Oral infection is quite a bit less frequent than genital or anal infection, but still quite common. It can indeed be acquired by oral sex, but probably not only by oral sex:  people with genital HPV probably sometimes auto-inoculate (self infect) their oral cavities. (Research shows only a weak association of oral HPV with frequency of oral sex.)

There are several kinds of oral (mouth and throat) cancer, but only one -- squamous cell carcinoma of the pharynx (throat) -- is regularly caused by HPV, and this is caused by only one type of virus, HPV16. But even with HPV16, the large majority of infections do not develop into cancer. Pharyngeal cancer indeed has been increasing in frequency, probably due in part to the rising frequency of oral sex over the past few decades, but it remains an uncommon cancer -- a lot less frequent than cancers of the colon, lung, breast, prostate, and so on. 

No data exist on the detailed mechanics of acquiring HPV by oral sex. But almost certainly the entire oral cavity is exposed and potentially infected during oral sex -- not just the directly exposed parts, such as lips or tongue. I doubt swallowing genital fluids makes any difference one way or the other.  

And by the way, condoms are not highly protective against HPV. Even if you have used condoms consistently during your sexual exposures, it is likely you have acquired genital HPV.

The HPV vaccine used in the US (and most industrialized countries) provides 100% protection against the 9 HPV types that together cause 90% of HPV-caused cancers and 90% of genital warts. It includes protection against HPV16, and thus protects against pharyngeal cancer. Having had only 6 lifetime sex partners, most likely you have not yet been infected with HPV16. In that case, vaccination will prevent any chance of getting it in the future. You should discuss it with your doctor. Until recently, vaccination was approved and recommended for persons up to age 26. It is now approved up to age 45, especially for people like you -- i.e. few sex partners plus likelihood of future exposures. However, some medical insurance policies have not caught up with the new guidelines, so I recommend you discuss vaccination with your doctor before you reach your 27th birthday.

I hope these comments are helpful -- and that they lower your worries about HPV. Let me know if anything isn't clear.

HHH, MD
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17 months ago
Okay, that's definitely reassuring. I thought that any type of HPV classified as high-risk could lead to any type of cancer regardless of where the infection is located. For example, all types that cause cervical cancer could potentially cause oral cancer. But based on what you said, it does seem less likely that I could have been in contact with the one that specifically causes oral cancer.

Would you say that heavy smoking and heavy drinking would drastically increase the chances of HPV16 leading to oral cancer? Could this also be a major factor while those cases have been increasing? It seems rare to find someone who doesn't do at least either one of them these days.

Also, from what I've seen most HPV infections clear up within 24 months. So, if someone is infected with a high-risk HPV, only then is that this type of HPV could lead to cancer? So this would probably take years? (Assuming they don't clear up) What happens to low-risk HPV infections when they are not cleared by our immune system? Do they stay in the body and simply don't cause any issues? Is it harder to clear up high-risk HPV infections (compared to low-risk) or not really? Trying to understand HPV a little more.

I'm from Ireland, so I'm not sure how does it work over here but I will definitely look into it.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
HPV only causes one kind of cancer, squamous cell carcinoma -- whether cervix, anux, rectum, skin, or pharynx.

Smoking increases the risk of progression of cervical HPV in women toward cervical cancer, and both smoking and alcohol probably have the same effect in pharyngeal cancer. But certainly not "drastically":  the elevated risk from smoking or alcohol is modest.

Correct about HPV clearance, which can occur within 2 months or not for a few years, with average time roughly 24 months for the high-risk types and more like 12 weeks for non high risk. Some low risk infections might persist indefinitely without any known adverse effect.

I would think vaccination is readily available in Ireland. If you happen to be in Dublin, world class STD services are availalble in both public clinics and private care settings.
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17 months ago
Okay, so since I can have another reply.

I know that the best weapon against HPV infections (assuming you are already infected) is a strong immune system. I don't smoke, rarely drink, been working out and been trying to add more fruits and vegetables in my diet. What else would you recommend? Is there any minerals and vitamins that are essential to maintain a strong immune system? Would you recommend any multivitamins - the ones that come in capsules / water-soluble etc? The information you gave me is very reassuring, but extra reassurance wouldn't be bad, plus having a strong immune system is always a good idea.

I appreciate the information provided. I will definitely look into getting the vaccine and hopefully I am able to. All the best.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
 I suppose you could look at a "strong immune system" as the "best weapon" against HPV, but you can't do anything about it. There are no health lifestyles that are known to have any effect on how the body resonds to HPV, other than not using tobacco. The others you mention aren't harmful and may promote your general health, but I doubt they will make any difference in regard to HPV.

That completes the two follow-up comments and replies included with each question and so ends this thread. I'm glad the discussion seems to have been helpful.
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