[Question #7180] HPV16 HNC in 2011 - did I infect recent partner of 2 years?

6 months ago

In March 2011, at age 51, I was diagnosed with stage 4 SCC tonsil cancer. I then had TORS bilateral tonsillectomy, a right side radical neck dissection to remove 19 lymph nodes and my right side jugular vein, all with negative margins. The tumors turned out to be HPV16 indicated, and subsequently I underwent 67 Gray radiation therapy over 5-6 weeks, and weekly cisplatin treatments during the same period. In May 2015 I had SBRT for a small metastasis in my upper right lung node, which appears to have been successful in killing that tumor. At the time I was married, since divorced. I started a new relationship in late November 2017 - I want to note that I did not have sex for 9 months before this relationship started, and that I was only with my ex-wife in the time between my cancer and this relationship.

Fast forward to Spring 2020 - my now ex (as of the past 2 months), age 53, say she has been diagnosed with high-risk HPV positive cervical dysphagia, requiring LEEP, and that I am the one who infected her, sometime in the past 2 years, since she claims all her prior PAPs were negative. She says she is suing me for not disclosing my prior tonsil cancer was HPV16 positive - this since she now has an uncertain, fear-filled future and so I don't "spread my infection" to other women. Given my history and treatments, wasn't I cured? or did I likely cause her cervical infection and am I still an HPV 16 carrier and likely to infect other women?

H. Hunter Handsfield, MD

6 months ago

Greetings. Apologies for the delay in replying.

First, congratulations on the successful treatment of your pharyngeal cancer. I’m glad to hear that part of your story!

Otherwise, what an unfortunate and unpleasant situation. It is sad that your relationship came to this. Mutual counseling with an STI/HPV expert might have settled these issues both to her satisfaction and yours. As I think you’ll understand, the legal implications of your questions require a cautious response. Here is what I can say. Probably your oral HPV16 infection is long gone. Most HPV infections and dysplasia (not dysphagia) diagnosed at your partner’s age result from reactivation of past infections, not newly acquired ones. Normal pap smears over the years do not mean HPV is absent; HPV often reactivates after long periods of not being detectable. Most experts agree that people with past HPV, especially many years distant, are not obligated to inform their partners.

To the extent these comments help you understand the situation, I’m glad to help. But if your partner follows through with her threat to sue, you must not rely on them as your only response. In that event, of course you’ll need an attorney’s advice, in which case in-person consultation with an HPV expert might make sense.

Best wishes-- HHH, MD

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6 months ago

Thank you for the info. It helps verify what I was told years ago by my onco. Do you schedule in-person consultation , if it comes to that? (You can reply off-line).

6 months ago

One other question: does smoking and high stress increase the risk of an hpv recurrence and/or causing dysplasia, and if so, is it an incremental or a significant increase?

H. Hunter Handsfield, MD

6 months ago

Smoking is associated with a higher rate of progression of dysplasia to cancer and perhaps a higher risk of persistent or recurrent HPV. In both cases, the effect is small; the rate of cancer in women with dysplasia or in smokers with pharyngeal HPV is only slightly higher than in nonsmokers. Stress or other lifestyle issues (diet, exercise, adequate sleep -- things that might weaken the immune system) have no known effect on HPV or HPV-related cancer risk. Not smoking and otherwise maintaining a healthy lifestyle of course are recommended for all, but HPV and its cancers are not among the most important reasons.---