[Question #8009] HPV Transmission Unprotected Oral Sex

49 months ago

I had protected intercourse with an individual 7 days ago. However, there was about a 5 minute session of unprotected oral sex (giving). I woke up the next morning and found a bump on the shaft of his penis. I didn’t notice anything the night before and it was dark. I confronted him about it and told him he needed to get it checked out.

He messaged me later in the week after finding out it was a wart and he’s getting it treated. Should I be concerned about transmission to me due to the unprotected oral sex? This is my worst fear. I’m not vaccinated as the vaccine came out when I was outside of the window then was married for a long time.

I spoke to a general practitioner who stated I shouldn’t be overly concerned as oral transmission is lower and it was only one time. Should I avoid having sex with anyone for a certain amount of time? Will I get warts in my mouth?

H. Hunter Handsfield, MD

49 months ago

Greetings and welcome to the forum.

First, HPV is rarely transmitted by oral sex. Second, oral warts are rare: even infected persons usually do not develop visible warts. Third, despite not having been vaccinated against HPV, there's a good chance you have previously had HPV 6 and 11, the types that cause almost all genital warts. These are among the most common HPV types, and if you have had an average sex life over the years, you could well have been exposed and infected and are now immune to new infection with them. Finally, new HPV infections are quite uncommon after age 25-30, which is one reason the vaccine is recommended primarily for people up to age 26, usually not older persons. (Your comments suggest you're on the mature side, right?)

For those reasons, I agree with your GP. You are very unlikely to have been infected or to develop oral warts, and I definitely do not recommend holding off on sex with either current or new partners on account of this event.

I hope this response is helpful. Let me know if anything isn't clear.

HHH, MD

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49 months ago

Thank you for the clarification and information. I am a 32 year old female who tries to have safe sex while being responsible. I feel that I’ve had enough sexual partners to know what I’m doing but not the extreme.

Do you have any information on managing the anxiety or fear of STIs? This seems to be a rooted problem where I want to be a sexually free person yet this fear gets in the way.

Also, am I just supposed to be asking people their sexual health status? This seems invasive and rude but I need to protect myself.

H. Hunter Handsfield, MD

49 months ago

Thanks for the clarifications. Comments on this forum and elsewhere suggest that many people have open conversations with prospective partners about sexual history and health -- you might find that many don't have adverse reactions, and I would guess many are feeling the same concerns and will be relieved if you bring it up.

As for general STI fears and anxieties, Perhaps the main thing is to understand that as important as STIs are, with common sense partner selection the risks aren't as high as you might assume. At any point in time, most sexually active persons don't have active, transmissible STIs. HPV is an exception, since up to half of all persons age 20-40 may be infected. However, everyone gets HPV anyway, and the large majority of infections remain asymptomatic and never cause obvious health problems. You could be vaccinated if it would help you cope with the potential risk: although you undoubtedly have already been infected, probably you remain susceptible to some of the 9 types covered by the vaccine, and although age 26 remains the main age cut-off, the vaccine is approved (and thus covered by most health insurance) up to age 45, for people (like you) who remain sexually active and potentially at risk-- something to discuss with your doctor.

Beyond that, if STI fear is really a dominant issue in your life, professional counseling is a consideration. There are psychologists in many communities who specialize in sexual health issues.

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49 months ago

Hello Dr.

Thank you for the info. Chiming in with a recent update. 3 days ago I went to the Gyno for severe vaginal pain, redness, and difficulty urinating. She did a few swabs and tested for the standard STDs (labs still pending). She said it appeared to be the beginnings of a yeast infection and prescribed a 6 day capsule and some hydrocortosone cream. I went back to work. Came home around 4PM with a temperature of 102/38.8.

The next day I was up in horrific pain and have the worst pain urinating. I am telling you I have a high pain tolerance and this was the worst thing I have ever experienced. I went back and she prescribed an antiviral (aciclovir in a 400mg tablet and a tube of cream). This was the worst day but with the antivirals seemed to help. They also pulled a blood test for HSV1 and HSV2.

Fast forward 2 days (today) and my blood test was negative for HSV1 and HSV2. However I have lesions inside of my vulva and a few bumps appearing on the outside (about 12 of them). However they do not appear to look like the standard HSV mini bumps in clusters but larger in size. My question...was this too soon to test for HSV via blood? Could this be some other type of infection that has just manifested and become awful.

My COVID test was also negative. Please advise. I understand this is different than my previous question and I would be happy to pay for another if needed. I am an American working and living in Germany so sometimes things get lost in translation. Although the care is great here it is always nice to have an American perspective.

Thank you!

H. Hunter Handsfield, MD

49 months ago

It sounds quite likely you have initial genital herpes; acyclovir has no effect on any infection other than herpes, so your doctor obviously believes that's the problem, and your symptoms are very typical. The timing is a bit long; most new genital herpes has onset of symptoms within 5 days of exposure, but it can take up to 10 days (occasionally even longer). It is unfortunate your doctor apparently did not do a PCR swab test for HSV, which is far more useful than blood testing to confirm initial herpes. However, there probably is still time; if a test can be collected in the next day or two. If not done, or if it's done and negative, you can have a follow-up blood test in a few weeks. Your current negative blood test is to be expected, even if you have initial herpes: but in that case, probably it will become positive in a few weeks. Your vaginal sex was protected, reducing the likelihood of acquiring HSV2; if he performed oral sex on you, HSV1 is more likely. In any case, it is very important to know for sure which virus type you have: the likelihood of recurrent outbreaks in the future, and of sexual transmission to.a future partner, is highly dependent on virus type (higher risk for genital HSV2 than HSV1). I really hope you can convince your doctor to see you very soon -- today if possible -- for a genital lesion swab for HSV PCR.

You also should re-contact your partner and let him know your likely diagnosis. If it turns out he has known oral or genital herpes, it will be a strong clue as to which virus type you have. If not, he'll need professional evaluation, including an HSV blood test.

That will have to conclude this thread. If you'd like to continue the discussion about herpes and its diagnosis and treatment, I would suggest starting a new question, which will be answered by Terri Warren, who handles the herpes issues on this forum. I hope the discussion has been helpful. Best wishes to you.

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