[Question #7946] Oral HPV transmission

50 months ago

I keep reading conflicting information on indirect transfer of oral HPV. I have a concern that my child at one time crawled into bed during or immediately after having sex when either I or my husband or both had an active HPV infection (I had a + pap soon after this happened) and that I or my husband touched child's hand or pacifier and then my child put their hand or pacifier in their mouth. Could there have been enough virus from this type of indirect transfer from genital to had to hand of or to the pacifier to cause an oral hpv infection in my child? I read that HPV is not transmitted in bodily fluids, but then also read that it is found on the hands. Im just so scared that I passed it on this was to my child by accident knowing an active HPV infection did exist in either me or my husband or both. Does HPV infection only occur when there is direct contact with infected genital skin? Would hands be considered infected immediately after touching genitals that have an HPV infection?

H. Hunter Handsfield, MD

50 months ago

Welcome back to the forum and thanks for your continued confiedence in our services.

However, this seems to be pretty much the same question you asked about 4 years ago, answered by Dr. Hook; even the circustance (your child coming to your bed following sex with your husband). Perhaps you're wondering if new information has become available about such risks in the past few years. The answer is no.

Simply detecting HPV DNA in various locations -- e.g. under the fingernails, on hands, etc -- does not necessarily mean it can be transmitted from contact with these sites. For example, despite detection of HPV in these sites, we know that hand-genital contact rarely if ever transmits HPV. Among people with genital HPV, e.g. abnormal pap smears, genital warts, etc, physicians and clinics that manage such patients virtually never see anyone who had not had intercourse. That doesn't prove that non-sexual transmission cannot occur, but obviously it must be exceedingly rare. In addition, it is believed transmission of genital HPV usually requires the virus to be massaged into exposed tissues, i.e. mere touching usually is not sufficient This is why genital warts generally appear at sites of maximum friction during: the head or shaft of the penis, the vaginal opening and labia minor, etc -- and not much on the scrotum, groin, labia majora, pubic area, etc.

Finally, I have never heard of children in the households of others with genital HPV -- parents, older siblings, etc -- catching warts in the household, despite years of sharing toilets, towels, beds, etc.

Of course your kids likely will have warts of the hands or elsewhere -- most children get them at one time or another -- but these are not caused by the genital types of HPV. And there will come a day when they will acquire their own genital HPV infections, i.e. when they begin to have sex. I do hope you'll keep in mind the importance of having your kids vaccinated against HPV around age 11-13, as now recommended by all health experts. It will protect them from the 9 HPV types that cause 90% of genital warts and genital and oral cancers, and of course recommended before sex is likely. But in the meantime, you needn't be at all worried about them acquiring HPV from you or your husband.

Does that help? Let me know if anything isn't clear.

HHH, MD

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50 months ago

Thank you for your response. Yes this is the same incident from the prior question. I am a nurse (review charts) and have seen so many cases of oral HPV cancers more recently that it put the fear back in me. I did get my son vaccinated as soon as I could (I think he was 11) and he has had both doses. I just recently started thinking again that I could have potentially transferred a high risk hpv to him prior to getting the vaccine. I think I really just needed some confirmation. I do have a couple of questions to clarify..

You mention primarily warts in your response. I am more concerned with having transferred like HPV 16 or 18 to him during this incident I refer to when he was still a baby. I don't know if the HPV type that came up positive for me at that time was 16 or 18, but I keep thinking it could have been. So would same response reply to high risk HPV 16 and 18 as it would if it were genital warts?

And in reference to fluids, is this still known that body fluids do not transfer the virus? If this is the case then I don't understand how HPV is detected on hands at all, or is only referring to the genital wart strains?

And am I understanding that the transmission that I keep referencing of indirect touch has really zero probability of happening?

H. Hunter Handsfield, MD

50 months ago

Thanks for the follow-up information. I'm glad to hear your son is vaccinated: good show! (I assumed he was younger. Apparently the incident you are concerned about was quite a while ago.)

Thanks as well for the context of your professional experience. But I would encourage you to remember that being confronted with the worst case scenarios -- learning about persons with HPV related cancers -- don't tell the true picture. If your work involved auto accident injuries or fatalities, or (if you were with an insurance company) you managed cases of people injured or killed by lightning strikes, of course you would not be at increased risk. And I would bet that none of the cases of HPV cancers you have come across had any evidence to suggest nonsexual acquisition of the virus, or occurred in anyone believed to have been infected in the household as children.

If the worst case scenario came true -- you transmitted a high risk HPV to your son -- it's still really nothing to worry about. The vast majority of such infections do not progress to cancer; most never cause symptoms or abnormal test results. That includes types 16 and 18: putting it in personal terms, if I knew I had HPV 16 or 18 (and there was a time in my pesonal life -- long before HPV vaccines -- that make it highly probable), it would not worry me in the slightest. And I apologize if my reply seemed to be focused on warts; that wasn't my intent. My replies would be the same for HPV 16, 18, and other high risk types. As another example, smoking dramatically elevates the chance of cancer, but the large majority of smokers don't get lung cancer. sane for high risk HPV.

Here's another way to look at it: probably 10-20% of all people have or have had infection with HPV 16 or 18, including all people you have ever known. How many of your friends, colleagues, family member, and friends of all of them have had a cancer caused by HPV? We're all going to die someday, and in the US there's a rougly 40% chance it will be from cancer. Of those, a small minority will be caused by HPV. The chance you or your son will be one of those who succumb to an HPV related cancer is no higher than in the general population. This really isn't worth any worry!

For all those reasons, it doesn't matter whether or not body fluids transmit the virus. HPV is detected on hands by testing for viral DNA. Undoubtedly it gets there by contact with infected sites, i.e. a person's own genital infection or hand-genital contact with a sex partner. So what? As I said, having DNA on the fingers doesn't necessarily mean it can be transmitted to anyone else. As for transmission by "indirect touch", I don't even know what that means!

Final (?) comment: Human beings are immersed in HPV, along with innumerable other viruses and bacteria. They are part of us. That some such viruses are shared sexually rather than by less personal contact doesn't make them special or more dangerous. Please trust me on this: you and your son or other children are at no more risk for an adverse health outcome than 99% of the people you know. This really isn't something to be worried about!

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50 months ago

Thank you again for replying. I understand that the risk of getting cancer from HPV is very small and that HPV infection it is very common. I just need the reassurance that I very unlikely transferred anything to my son from this type of route. Even with a very small chance of it becoming cancer, I would feel better knowing that I most likely did not transfer any type of HPV to him accidentally prior to receiving a vaccine that can protect him from that chance (even if very small).

Thus the questions related to is it likely to spread if I touched his hand or pacifier with my hand that had touched genitals that had HPV or fluids on them? That is what I meant by indirect touch.

It would have been from genital to hand, to another hand (or possibly a pacifier )then to the mouth. I know this is last question and I realize you can't say there is zero chance, but I would like to confirm (for peace of mind) that this means is really not a risk of transmission??

Also, are there still studies going on or that have shown the vaccine may help with preventing reactivation of current infections?

Thank you for your services.

H. Hunter Handsfield, MD

50 months ago

As I said, no kids of parents with genital HPV, or otherwise living in the household of infected persons, ever catch HPV, despite all sorts of ongoing personal contact. that tells you that touching of the sort you describe is exceedingly low risk, probably truly zero risk. Your son is never at risk from the kinds of contact and touching you describe. With rare exceptions, the only way young kids acquire genital HPV itypes is through sexual abuse.

There is conflicting information online for all sorts of reasons. Some resources don't know the facts. Many people claim they acquired their HIV nonsexuallly -- either lying or, more often, making assumptions that are wrong. In some cases, experienced professionals interpret the available data differently. You'll find less disagreement if you limit searching to medical/scientific sites or those that are professionally moderated.

For years it was believed the HPV vaccines have no effect on established infection, i.e hte only benefit is in preventing new infections with the 9 HPV types covered by the vaccine. And that's still by far the most important reason for immunization. More recent research has shown that vaccination may reduce the risk of reactivation of HPV and/or to reduce the duration of chronic infection. However, these effects are small and based on current knowledge, not a reason to seek immunization.

That completes the two follow-up exchanges included with each queation and so ends this thread. I hope the discussion has been helpful.

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