[Question #6542] Oral HPV and Transmission

13 months ago
Thank you for this wonderful service. I'm a long-time married older male who is considering taking a new step outside my marriage. I appreciate your not offering judgment here, because I am conflicted enough, but I would very much appreciate the appropriate medical information to weigh in making a decision. For the past 10+ years my marriage has been technically sexless (less than 10 times per year--average of 5-6). My wife and I have not had relations of any kind for the past 6 months for various reasons. I don't anticipate that total abstinence is permanent but after a decade I've lost hope that the pattern will change. While I want to be that guy who can rise above the circumstances, the current reality is hardly acceptable and I am thinking about entering into some kind of "arrangement" for [only] occasional fulfillment. I am not considering ending my marriage, because I truly value my wife and family and cannot imagine life without them. I am fairly well versed in most things STI and am completely "clean," with the possible exception of HPV from my past. So my question involves HPV, and I have read that you [the doctors] typically downplay its significance. However, if my wife were to become diagnosed with HPV at any point the origin would be obvious since I am her only lifetime partner. So with that background, my specific questions are: (1) If I were to acquire HPV orally through cunnilingus with a new partner, how likely would that be transmissible to my wife via the same route when/if we resume our sexual relationship? (2) If someone acquires an HPV strain that causes warts, how long until warts typically appear? and (3) If someone acquires an HPV strain that causes cervical cancer, how long before a Pap smear would become abnormal for a female? Once again, I appreciate your consideration and response.
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Welcome to the Forum.  Thanks for your confidence in our service.  I'll do my best to help although there are not solid scientific answers to some of your questions.  Further, as I read your question, I found myself wondering about your age.  As you move forward on your plan, there is much to recommend seeking vaccination against HPV.  The current vaccine is now recommended for persons up to age 45 and even for those who might be a bit older, the vaccine may have a good effect, greatly reducing the risk for acquisition of the two HPV types which cause most visible genital warts, as well as the 7 most common HPV types associated with pre-malignant PAP smear changes, including HPV 16, the HPV type which causes nearly all oral HPV infections. 

Further, I would suggest that you look at other posts regarding HPV risk on our site.  There is much information on our responses to those, earlier questions which is relevant to your concerns.  With this background, I'll go to your specific questions:

(1) If I were to acquire HPV orally through cunnilingus with a new partner, how likely would that be transmissible to my wife via the same route when/if we resume our sexual relationship?

There are not good data to inform us on how often HPV is transmitted through oral (or genital) sexual contact.  What we do know is that most single exposures to infected partners do not lead to infection.  Overall, the prevalence of oral HOV in women (about 3.5%) is about 1/3rd of the prevalence in men (10.5%). 

(2) If someone acquires an HPV strain that causes warts, how long until warts typically appear? 

Typically, warts take about 3-6 months following infection to occur.

 (3) If someone acquires an HPV strain that causes cervical cancer, how long before a Pap smear would become abnormal for a female?

Pap smear changes following acquisition of HPV can take several months to occur.  Please remember that even when such changes occur, most changes then go on to resolve without therapy over the next 1-2 years.

I hope this information is helpful.  EWH

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13 months ago
Dr. Hook, thank you very much for your response. My age is substantially higher than 45 (unfortunately)...more than 10 years so. Regarding my Question #1, I guess I'm asking about the likelihood of HPV transmission from me to my partner (wife) via cunnilingus -- my performing mouth to vagina. Thanks again and I await your clarification.
13 months ago
Dr. Hook I think you’ve already addressed my follow up question by saying there’s no clear answer. So if I may let me approach from another angle. Regarding HPV vaccine, I know it only covers against the most dangerous strains and does not protect against previously acquired infections. So let’s say my “new” partner had the vaccine a few years after becoming sexually active. Is it correct that the vaccine would be protective against those strains not already acquired? Also, if she had a previous infection but cleared, would that make those strains non-transmissible? I guess my strategy if moving forward would be no oral or penetrative sex with someone who has been vaccinated, but women in mid-30s for instance didn’t have access before sexual activity. And at my age, I’m not exactly into college girls. I appreciate your response.
13 months ago
* not been vaccinated
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Several additional comments.

1.  At your age, should you chose to, you could still take the HPV vaccine, you would just have to pay for it (about $600.00) and convince your doctor to give it.

2.  The likelihood that you have oral HPV and would transmit it to an unvaccinated person through cunnilingus is relatively low but clearly not zero.

3.  Your are correct, the current HPV vaccine does not have a known effect on HPV infections which were present prior to vaccination.

4.  If a person has had HPV in the past and it has clears, they are unlikely to transmit infection to new partners.

5.  Most sexually active persons in their mid-30s will like have or have had HPV but if they have been seen recently by their GYN or sexual health specialist they should have some idea of their own HPV/PAP smear status. I think this answers your final question made in f/u.)  EWH

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13 months ago
Dr. Hook,

Thank you for keeping the thread open. Here is a follow up question to close out this conversation. I met someone through a website and we have discussed sexual health and safety in exploration of becoming intimate. She is significantly younger than me -- around 30. She informs me that she had the Gardasil vaccinations between ages 18-19. There was some sexual activity previous to that. She has had no active HPV infections before or since vaccination that she is aware of. So, you might anticipate my question(s):

1. When we talk about "clearing" a previous infection (assuming she had acquired some kind of HPV prior to vaccination), how likely is it that one of those old infections could still be contagious/transmissable?

2. Since Gardasil does not protect against previously acquired HPV, what is the likelihood of someone re-acquiring a strain of HPV that they might have previously "cleared"? 

Thank you very much for your consideration.
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Straight to your questions:

1.  Consensus is that most persons who have had HPV infections which went on to clear no longer have transmissible infection.  A small proportion of persons who have cleared may have reactivation but those people are generally considered to have less transmissible infections.

2.  The vaccine should protect against re-acquisition of an infection which has cleared.

this is my 3rd response to your questions.  Hence, as per Forum Guidelines, this thread will so be closed without further responses.  I hope the inforamtion provided has been helpful.  EWH

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