ASHA,

I went to the dentist today, and I might have an HPV wart.  I am scheduled to have a biopsy in about a month.

I am 36 year old male.

Sexual history

a. 2001.  Received brief oral sex (after 20 seconds, I chose to stop the oral).  I used my finger to stimulate her vagina.  After the date, I likely masturbated - likely with a different hand (not 100% sure but likely).   I do not remember if I washed my hands or not.

b. 2001- same as above with same girl, but no oral.

No more sexual contact until 2011 when I got married.
Unprotected vaginal sex with wife. 
Oral sex (either way) is NOT part of our practice.
2015 separated from wife, no sexual contact for about a year.

Questions:

[1] was there any reasonable reason to think I would likely have obtained high-risk genital HPV from  my 2001 encounters?

[2] In 2008, before we were married, my wife's doctor told her to get the HPV vaccine, but she declined.  She told her doctor that she was a virgin, and she said that I was a virgin, thus she told her doctor she did not need it.  Her doctor strongly suggested she should, but she turned it down.

(note that at that time, my to-be wife did not know about my 2001 experience.   I did not hide it, it just never really came up... I considered myself a virgin).

I had assumed that HPV was transmitted through anal-genital sex (which I had not had), so I agreed that I was a virgin (at least in the context of HPV transmission).  Ignoring  rare circumstances: Was I wrong here?  If she and her doctor would have known about my 2001 experiences, would that have changed the importance and value of her getting the vaccine?

[3] Since I may have oral HPV, what is the connection between oral HPV and genital HPV.  I do not have any genital warts.  But, if I have an oral HPV wart, is there any reason to think that I also have high risk genital HPV that I could have shared with my wife?

There is no reason to think that my wife had sexual contact (of any kind) before we got married.

Thanks ,

-Robert

Welcome to the Forum.  I will try to help.  I would first urge you to hold your concerns about a possible oral wart until you know that the lesion in your mouth is an HPV infection.  Other sorts of oral lesions can have appearances which resemble warts.  Even if the lesion does turn out to be a wart, there is little reason to think that the exposure you mentioned 15 years ago is related to the lesion.  There is still much that is unknown about HPV infections and their transmission and it is clear that while many genital infections result from sexual contact, not all do, nor are all HPV infections sexually transmitted. 

In answer to your specific questions:

[1] was there any reasonable reason to think I would likely have obtained high-risk genital HPV from  my 2001 encounters? 

The activities you describe are not activities that would be expected to put you at risk for HPV acquisition.  If the lesion noted is a wart, it is not likely to be one of the types that are associated with increased risk for cancer. 

2.  I had assumed that HPV was transmitted through anal-genital sex (which I had not had), so I agreed that I was a virgin (at least in the context of HPV transmission).  Ignoring  rare circumstances: Was I wrong here?  If she and her doctor would have known about my 2001 experiences, would that have changed the importance and value of her getting the vaccine?

See above regarding your activities and risk.  While I recommend the HPV vaccine for all patients, that you may have an HPV infection does not mean your partner does.  I think you are getting ahead of yourself.

[3] Since I may have oral HPV, what is the connection between oral HPV and genital HPV.  I do not have any genital warts.  But, if I have an oral HPV wart, is there any reason to think that I also have high risk genital HPV that I could have shared with my wife?

First, find out if you have a wart.  Even if you do, there is little risk that your wife has been infected.

Hope these comments are helpful.  Please wait and find out what your biopsy shows.  Even then you (and your wife have little to worry about). 

Please let us know what the biopsy shows.  EWH

Dr. Hook,

Thanks for your response.   You all are providing such a wonderful service (and I hope you are sitting on a nice grant b/c $25 a pop does not seem like it would cover the costs).

I would like to summarize what I learned here (and elsewhere),  do you agree with the following statement?

If high risk genital HPV would ever become apparent in my wife, there is no reasonable reason to think that it would have originated from my low-risk 2001 experiences  (based on our current understanding of HPV transmission).    Do you agree?

In about a month (or so) I will share the results as of my mouth biopsy (I guess by just replying to this thread if it is not closed).

Thanks,

-Adam

Dr. Hook,

I know that this follow up will conclude our exchange on this topic due to the 2 follow up limit.  And I do appreciate your compassion and patience.   But I thought I would ask one more follow up.

In my description of my 2001 experience, I said that I likely used a different hand on her than I did on myself after the date.  While this have been true (not because of any STD awareness back in the day - but for other reasons I won't bother you or the internet about). 

 However, lets say that that was not true, and that I did in fact use the same hand on both her and me afterwards.   Would that in any significant way change my risk of of picking up high risk HPV from those events,  or your evaluation of the experience?

From reading what you have written before (on both this site and on medhelp), my guess is that it would not have (in any significant way) increased the risk of my exposure to high risk genital HPV.   Do you agree?

Your question comes down to how likely is it that HPV that you might have acquired HPV through the transfer of genital secretions from a partner to yourself on your hands and fingers in the process of masturbation.  The answer will involve some equivocation.  For other STIs it is clear than transfer of genital secretions while engaged in mutual masturbation to not a meaningful risk factor for transmission and is a no risk event.  For HPV, I suspect that the same is true but there are no studies of this issue and all experts acknowledge that there are a small minority of cases in which HPV appears to have been acquired without penetrative, direct sexual contact.  Thus there may be a small possibility that transmission may have occurred in some people in this way.

IN YOUR CASE HOWEVER, when we also consider the long interval since the events you refer, my assessment of your risk and the likelihood that you acquired infection which is now manifest as an oral wart is unchanged and I again urge you to not worry further at this time.

As you point out, this response will complete this thread and there will be no more replies.  If there are further questions, you will need to open a new thread..  I will leave it open however in the hopes that you will post your biopsy results so that I and our clients can learn from your experience.  Take care, try not to worry.  EWH