[Question #6260] HPV conflicting info

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69 months ago
Anxious and confused
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69 months ago
Hello Doctors,
I stupidly had a hand job performed on me at a massage place in south east asia. Dumb drunk and full or regret. I have a pregnant wife and two young kids. Only lasted 2-3 minutes max i recall. I consulted on online doctor - dermatologist and std expert - who told me that a handjob is harmless. I should forget about it and get on with my life. I want to. No risk from anything including HPV - after research, my main fear. He explained that hands have no mucius membrane and can not transmit HPV. I can sleep with my wife guilt free. Feeling better i booked an appointment with an internationally known std doctor for hopefully final reassurance. He told me that i have no risk stds except HPV. Went as far to say 40% chance but probably less with one exposure. When i asked him how std experts can have such a difference in opinion he informed me of the latest studies and a spike in the last 5 years. Feeling sick at this point, he then told me that this is very common and can be as easily picked up from normal activity in crowded cities? Finally, he informed me that HPV is very common and i should put it behind me and continue my life as normal including sex with my wife. Short, both doctors said i can forget about it. However i am confused. Reading your collective posts written over the last ten years suggest minimal risk. I have read many reassuring comments of no need to worry, this will not infect you, zero risk etc. Very recent study in Feb 2019 claims no risk of hand - genital but other studies suggest so. I may copy and paste links. Doctors, any advice on this? What is my chance from a single exposure of 2-3 minutes with a massage girl? Should i relax and move on? Why conflicting info - and not just from casual bloggers but from experts? I want to move on from this but full of anxiety and guilt.
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69 months ago
://www.genengnews.com/news/hpv-transmission-unlikely-thr
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H. Hunter Handsfield, MD
69 months ago

Welcome to the forum. Thanks for your confidence in our services and your insightful question -- and for reviewing similar ones before posting your own. You posted this question 3 days ago; I was writing my reply when the ASHA server went down. Your question and my reply were lost. You'll hear from the forum administrator in the next day or two, with an offer to refund the extra posting fee. Apologies for the inconvenience. 


The differences between your two experts aren't as different as it may seem. Both are correct, depending on perspective. As you probably saw in other threads, in my 4 decades in the STD business, I have never had (or heard of) any patient with genital warts or other evidence of HPV in a patient whose only possible exposure was hand-genital contact, fingering, etc. So if it occurs, it is exceedingly rare, apparently Expert 1's experience and advice. Expert 2 probably is thinking of reports the past several years that HPV DNA can be present under the fingernails or elsewhere on the hands, primarily in people who also have genital HPV infections. This suggests there is at least a theoretical risk of transmssion by hand contact. However, DNA does not necessarily mean living, transmissible virus is present; or if present, it could be in extremely low amounts, perhaps not enough for transmission. (DNA testing is so sensitive it can be misleading, probably detecting amounts that have no possibility of catching hold when passed to another person.) This may explain Expert 2's comment that "it's no big deal", and I doubt s/he has actually observed patients believed to have been infected in this manner. (Or maybe s/he just means that getting genital HPV is no big deal, since it happens to everyone and most cases cause no disease -- which also is true.) My guess is that your two expert contacts would agree with each other and with my comments above.


Thanks for posting the link; I was unaware of the study published in Lancet earlier this year. I have not read the paper in detail (which I will do), but the online summary is exactly concordant with my comments above (which I wrote before following your link and didn't alter afterward!):  detection of HPV DNA on hands does not correlate with transmission to partners' genitals, but genital HPV does predict transmission.

 

To the extent there may be some slight risk from hand-genital contact, it probably would be more likely when genital fluids are used for lubrication, not because of transmissible HPV on hands or fingers. That said, further research may provide more information about all this. But for now, you can consider your recent massage adventure as a no risk event in regard to HPV. Anyway, assuming you're not a virgin, and especially if you have had at least a few genuine sex partners in your life (i.e. not just hand-genital events like this), you can safely assume you have had genital HPV, perhaps several times. And assuming you don't plan life as a celibate hermit, you'll have more HPV exposures and infections -- no matter how carefully you select your sex partners or who they are. Your recent massage event for sure does not materially elevate that risk.

 

Which leads to the standard, common sense advice about HPV:  Get immunized. The standard HPV vaccines are 100% protective against the HPV types covered (9 types in the standard vaccine used in the US, 4 types in some countries). Those types cause the large majority of genital warts, cancer, and pre-cancerous lesions of the cervix, penis, anus, and throat. (I would not necessarily recommend the one vaccine that covers only two common cancer causing types, without wart prevention, still in use in a few contries.)

 

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

 

HHH, MD
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69 months ago
Hi Doc,
Thanks for advice. Lots of conflicting info. Here is one talking of HPV amongst lesbians https://www.verywellhealth.com/lesbians-and-hpv-514139
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H. Hunter Handsfield, MD
69 months ago
The high freqeuncy of HPV transmission among lesbian women has been well known for nearly 30 years. In fact, some of the earliest research was done by my colleagues, inclusing one of my own trainees (now a senior, nationally respected authority on the topic). I'm not sure what your point is in posting this particular article about it. In any case, the whole point of my reply is that there's actually little conflict about HPV transmission at the scientific level or among experts, even if some websites and articles imply differences of opinion.---
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69 months ago
https://www.healthtap.com/topics/can-hpv-be-spread-by-hands
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69 months ago
There were 4 instances of transmission from the woman’s hands to the man’s genitals, including 1 case in which it was the sole source (couple I). 
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69 months ago
https://www.verywellhealth.com/lesbians-and-hpv-514139
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69 months ago
However, if it is ok to bury this, can I move on in your opinion. Again, very thankful for your help Dic.
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69 months ago
Sorr y doc. Not meaning to seem rude. So to xonxlude, mive on. Zero risk. Enjoy life? Say the word and i am gone! Apologies, anxiety got the bette of me. Re-read your reply first tims.
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69 months ago
Sorry Doc. On the move when typing. It may appear incoherent. I take your advice and opinion and i will move on. Aplreciate your time and help.
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H. Hunter Handsfield, MD
69 months ago
Wow, you're really into the weeds on this!

No offense taken. But any health care provider can sign up to answer questions on HealthTap. I'm actively involved there as the main STD expert, but any doc answer whatever they want, no particular expertise required. The person who responded in the link you provide isn't even a physician but a clinical psychologist. (I have posted a comment to correct his statement.) You need to be selective in the sites you search. If you keep going through social service and other non-professional (or non professionally moderated) sites, you can find that HIV doesn't cause AIDS, high dose vitatmins cure cancer, and the world is flat. (A cute internet meme is that there are members of the Flat Earth Society around the globe.)

Your bottom line conclusion is correct: No measurable risk. Also get vaccinated against HPV, assuming you have or expect to have real sex from time to time.

That completes the two follow-up comments and replies included with each question and so concludes this thread. I hope the discussion has given you some useful perspectives.
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