[Question #7713] HPV Questions

1 months ago

For reference, I was fully vaccinated with Gardasil way before (7 years) any of this happened. I am coming here to ask some questions regarding HPV. About 2 months ago I found a squamous cell papilloma on my soft palate. This was diagnosed and removed by an ENT and he said there were no further changes that I needed to make in my lifestyle, (even regarding it being an STI) except to look out for a reoccurrence. It was biopsied to confirm it wasn't type 16 or 18 but any further genotyping was not covered by my insurance.

I am assuming this must have been associated with the only sexual encounter that I had in a few years which was around 4 months ago, which was only oral sex. Also, a couple of weeks ago I noticed a small wart growing on my hand which was diagnosed and frozen off by a dermatologist. My questions are as follows:

1. Would it be safe to assume that the oral papilloma wouldn't be associated with a strain that would affect my genital area? (Considering I am vaccinated against 6/11 which are the most common overlap between oral/genital lesions) (As well as the seemingly (timeline-wise) related wart forming on my hand which isn't usually associated with genital strains)

2. Since it has been around 4 months since initial exposure, when can I safely assume that I am not going to form a genital lesion?

3. How careful do I have to be about potentially spreading my oral HPV to my genital area, if at all?

4. Going forward, at what point do I not have to disclose my oral HPV infection with sexual partners?

Thanks in advance
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
Welcome to the forum. Thanks for your confidence in our services.

Please understand that we are not highly expert in oropharyngeal (mouth & throat) HPV infections and the clinical problems they can cause. This is really the domain of the otolaryngology (ENT) specialty. I'll; answer as best I can, but you may want to confirm with other resources. Perhaps most important, it sounds like your own ENT doc is knowledgeable; if he doesn't feel up to date on the sexual transmission aspects or detailed epidemiology of oropharyngeal HPV, I imagine he could recommend a good resource.

That said, I think the two most important aspect of all this are that 1) you have been vaccinated against HPV, making you immune to the HPV types that cause ~90% of warts and cancers; and 2) that your papilloma wasn't cause by HPV16, which is the cause of the large majority of pharyngeal cancers due to HPV. (The media often portray "head and neck" cancers as often due to HPV, but by far the main one is pharyngeal squamous cell carcinoma.) Further, warts themselves infrequent progress to cancer, and the HPV types that cause them generally are low-risk, including HPV6 and 11, to which you also are immune on account of vaccination.

I don't think you can safely assume you acquired the HPV that caused your oral papilloma 4 months before diagnosis and removal. While I don't know the detailed research for oral HPV lesions, for genital and anal warts can develop anywhere from 2 months to several years after acquiring HPV. And assuming you have had a reasonably typical sex life (at least until a few years ago), you can assume you have been infected with HPV -- perhaps several times. Almost all sexually active persons with more than 2-3 lifetime sex partners get HPV. In your case probably not with the 9 types prevented by Gardasil, unless you were sexually active before you were vaccinated. Also, I agree with your ENT doc's advice about not needing to make any "lifestyle changes" (whatever you and he meant by the term) -- just to be on the lookout for recurrence of the papilloma.

Those comments directly or indirectly address your 4 questions, but to be explicit:

1,3. As noted, you can assume you have had and may still be carrying one or more genital HPV infections. Your oral papilloma neither raises nor lowers the possibility that you had and may still have genital HPV. Self-transfer (auto-inoculation) of HPV from one body area to another is uncommon, and you're probably now immune to new infections (including auto-inoculation) with any HPV type(s) you already have elsewhere. You needn't take any precautions at all about protecting your genitals from your oral HPV infection (which, having been surgically treated, may no longer be present anyway).

2. Since your exposure 4 months ago included only oral sex, there is no reason to suspect you acquired genital HPV at the same time. Almost certainly you did not.

4. HPV disclosure is tricky, with opinions and advice all over the map. If I were in your situation, I would feel no need to mention oral HPV/papilloma to partners. Any partner you may have can be assumed to have had HPV, and likely still carrying it; and since at any point in time 10-15% of people test positive for oral HPV and 30-50% for genital, she will be at no higher risk from you than from any other partner she might choose. Having said all that, not all people understand all this, and rightly or wrongly might expect to be informed. As I said, there's not easy answer or universal agreement.

The bottom line is that I do not see this as a particularly important health issue for you or for your potential partners. I hope this information is helpful. Let me know if anything isn't clear.

1 months ago
Thank you for the very detailed response! For some reason, it has been pretty hard to find online resources/studies about oral HPV and the associated lesions which is why I came here and I think you were definitely able to provide some very useful input. I did find it a bit surprising that my ENT didn't really touch too much on the sexual transmission aspect even after I brought it up, but maybe he honestly didn't think it was anything to worry about. I will have to ask about it next time I see him.

With all of that being said, I did just have a few small follow-up questions.

1. I see that you mentioned that I would probably be immune due to the type that I got orally. So just for clarification, as long as I clear the infection orally, then I will be immune to that specific strain genitally (or anywhere else on my body)?

2. I saw in an old post on here that you mentioned that oral HPV usually clears quicker than other places, do you still stand by that?

3. I also saw in a recent post on here that you mentioned that the types that infect orally aren't usually the ones that infect or cause issues in the genital area, do you think that would apply to my case?

Sorry if the questions might be kind of redundant, but I had a fair bit of distress with the oral HPV and the reassurance helps a lot.

Thanks again!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
Thanks for the thanks. But these questions go even more deeply into areas I don't know much about.

1. Correct. At one time it was thought HPV infection redsulted in 100% immunity to new infection if reeexposed to the same HPV type. It's now known that proection isn't complete. However, it's very strong -- your risk of infection if reexposed to whatever type caused your oral papilloma will be very low, if not quite zero.

2. I don't recall saying anything like that and am unaware of any data. Data may exist -- there are several groups of HPV experts whose research emphasizes oral infection, and I suppose there have been studies of duration of carriage. It would make sense they would try to replicate the sort of data available for genital infection, but I just don't know. Sorry.

3. Certainly the genital (i.e. sexually transmitted) HPV types cause many oral infections, but other types do so as well. Over time, the proportion of gental types in the oral cavity may have increased as a due to rising frequency of oral sex over the past several decades (the same reason HPV16 pharyngeal cancer has risen in frequency). But there's really no way to judge the odds of which sort of HPV might be responsible for your papilloma, short of more extensive genotyping (DNA testing). But I really don't think it matters much at this point. Having been vaccinated, you can consider yourself at zero risk, or close to it, for cancer.