I am a female, Med Student, in my late 20s. I have not had any form of penetrative sex or even genital apposition. I have dated about 6-7 guys at different times in the past. During my relationships, i have french-kissed, been fingered on occasions and had only 1 brief episode of receiving oral sex from 1 of my boyfriends 6yrs back. I have never preformed oral sex on any of my partners. When i first learnt about HPV, i did a genital self-examination and found a small papule on my labial lip. I visited a dermat who examined it and said it was normal and not related to HPV. I then immediately decided to get vaccinated against HPV. I have completed the 4-strain HPV vaccine series (3doses) 2 yrs ago and plan to take the 9-valent vaccine next month.  My queries are:

1) Can HPV spread through french kissing?

2) Can orally acquired HPV cause genital lesions (warts, cervical cancer) too?

3) Can HPV spread through fingering?

4) Can HPV be acquired genitally only through penetrative sex or are there other means of getting the genital infection?

5) Are genital warts always big enough to be evident on self examination? 

1.   We know that oral HPV infections do occur. In general oral HPV is far less common than genital infections and its presence is associated with oral-genital contact.M  transmission of HPV through deep kissing has not been well studied.    While it is conceivable that HPV might very rarely be acquired through French kissing, I would guess it is most unusual. I would not be worried. 

2.   Because the same strains of HPV which infect the throat can infect the genitals and vice versa, genital infections acquired through receipt of oral sex could conceivably progress. Once again this would be very very rare.

3.   Transfer of HPV through masturbation and transfer of general secretions in that process is extraordinarily rare if it occurs at all. 

4.   Certainly very small genital warts do occur and they may be missed on a usual examination. 

 I hope my responses are helpful to you. The activities and questions that you describe are very very low risk for HPV and since you have been vaccinated your risk for these infections is lower still. Regarding exposures and events  which may have occurred prior to vaccination  your chances of infection are very very low.   As a medical student, you know that in medicine and science we can never say "never". New discoveries and rare events occur every day.  On the other hand your risk for HPV is about as low as it is reasonably possible and not something to worry about. I trust you know  that over 99% of HPV infections resolve without therapy and are of no consequence for persons who have them.   Going forward, my advice to you is to follow usual reproductive health screening practices and to not worry about HPV infections.

EWH