[Question #8908] HPV transmission, cancer risk

38 months ago

Hello,

I am a 30 yr old female recently diagnosed with HPV (was tested during prenatal care with my current pregnancy). I have done extensive research but figured I'd ask specific questions related to my individual circumstance.

!.) My HPV test was positive for a high risk strain and negative for 16/18. Is it safe to assume that since my partner likely has it as well, he has the same strain? Is it possible that he may have the 16/18 strain? If he did, wouldn't I also have it as well? Or could the 16/18 come back positive for me later down the road?

2.) I also have a two year old son. I am assuming I have had HPV for some time, although I was not tested for it during my first pregnancy. I am worried that I may have exposed my son through non-sexual contact throughout his two years of life. If I, or we considering my partner likely has it as well, did expose him to the virus, I am worried he is not at the age to be vaccinated and won't be for some time. Should I be worried about his health? Is he at risk?

3.) I am also worried about my partner's risk of developing throat cancer due to HPV, especially considering he has regularly performed oral on me for years prior to me finding out. He also smokes marijuana regularly. He did receive gardasil 4 as a teen but only received 2 of 3 doses and he was 16 at the time. Should he get the gardasil 9 vaccinations? Will his smoking increase the chance of developing HPV throat cancer?

Thank you in advance.

H. Hunter Handsfield, MD

38 months ago

Welcome to the forum. Thanks for your confidence in our services.

My first thought is to say your positive HPV test doesn't necessarily mean you acquired it recently. At age 30, most positive HPV tests result from reactivation of an infection acquired previously, often many years earlier; you might have had this for years, regardless of previous normal Pap smears and/or negative HPV tests. It is also possible your partner is infected and only recently transmitted it to you. Probably you will never know; it's generally not possible to know when and from whom any particular HPV infection was acquired, except in the uncommon circumstance when HPV is detected in someone with only one lifetime sex partner. To your questions:

1) Your partner has definitely been exposed to your infection. As noted above, he may or may not have been the source. I see no reason to be concerned that either of you also has HPV 16 or 18, but it doesn't really matter: the strain you have is neither more nor less likely to cause pre-cancer or even overt malignancy than types 16 or 18 would do (except for HPV and throat cancer, discussed below). In other words, all high-risk HPV types have about the same risk of progression to pre-cancer (dysplasia) or cancer itself. But also keep in mind that even for the high risk types, the vast majority of infections do not actually progress to cancer. You don't say whether your Pap smear was otherwise abnormal, i.e. dysplasia etc. That's more important than HPV type in determining cancer risk and treatment needs.

2) HPV is not transmitted to nonsexual household contacts. No children acquire their parents' genital HPV infections, assuming no sexual abuse. You should not be at all worried about his health on account of your HPV. The same will apply to the baby you are now carrying -- no significant health risk.

3) HPV type 16 causes almost all HPV related throat cancers. Despite a lot of media attention about rising rates, throat cancer remains uncommon -- a lot less frequent than other common cancers (breast, cervix, lung, prostate, colon, etc). Even among persons with oral/throat HPV16, the vast majority do not develop cancer. In any case, your partner almost certainly is immune to HPV16. Although three doses of HPV are officially recommended, it is now known that two doses provide equivalent protection; in fact, even a single dose is highly protective. Assuming he was not infected with HPV16 before he was vaccinated, he can safely assume he is immune to it -- and therefore probably at zero risk for throat cancer due to HPV. Assuming he is close to your age, I would not advise either of you get revaccinated with Gardasil 9.

You apparently are aware that smoking increases the frequency and rate at which cervical dysplasia progresses to cervical cancer. I am unaware of such data in regard to throat cancer, however. In any case, since HPV16 probably isn't in the picture, I wouldn't worry at all about his smoking and throat cancer. (Of course he should stop smoking for other far more important health reasons.)

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

---
---
---

38 months ago

Hello doctor,

Thank you for your response.

Considering my partner has received two doses of the vaccine as a teen, is it safe to assume he is fully vaccinated? Would the Gardasil 4 vaccine offer life-long protection? I have read some blogs from health care providers that state being revaccinated would act as a "booster" for increased protection, what are your thoughts?

Thankfully, my pap smear did not indicate any changes to the cells at this time and I was told to return in 1 year to test again. However, since my diagnosis I have been under a lot of stress and anxiety and I fear this could have caused progression of cancerous cells or cause cell changes. I've also seen other women experience progression from CIN 1 to CIN 3, for example, pretty rapidly due to stress. Should I ask my OB if I can be tested sooner than 1 year?

My final question is, is it possible for other high-risk strains, 16 or 18, to appear positive later down the road (assuming I have not had any new partners). Considering many infections can go dormant and then "reactivate" or appear on a HPV test, is it possible that I may have contracted those other strains as well, however it is undetected right now, could it come back as positive at a later date?

Thank you in advance.

H. Hunter Handsfield, MD

38 months ago

As I said above, "Although three doses of HPV are officially recommended, it is now known that two doses provide equivalent protection...." Gardasil 4 and 9 are equally effective against the four types covered by the first, which includes HPV16. There has been speculation that another, later dose might add to protection, but little or no data to show that it does. Probably nearly 100% protection lasts for life after either two or three doses of either vaccine.

On average, it takes 5-10 years for HPV infections of the cervix to progress to cause cancer; rechecking at a year is virtually 100% protection. Even if cellular change start to develop, by one year they are exceedingly unlikely to have advanced to actual cancer. Your doctor is following standard guidelines, which are considered 100% protective against actual cancer. Contrary to your friends' experience, there is no evidence that stress has any effect on progression of cervical dysplasia.

Yes, it is possible you have additional HPV infections that might reactivate in the future. The same is true of at least 90% of women your age. Everybody gets HPV, often several times, then live forever the the possibility of reactivation. This gets into another issue about vaccination: Although initially believed to only protect against new infection and to have no effect on existing HPV, newer evidence indicates the vaccine reduces the chance of reactivation of established infection, and might reduce the potential for progression toward CIN3 or cancer. It't not proved, and whatever benefit there is is fairly modest. Still, it's something to discuss with your doctor. If nothing else, perhaps vaccination would increase your confidence and reduce your anxiety about your HPV situation.

---

37 months ago

Hello Dr. Handsfield,

Thank you for your detailed and reassuring responses. I'm returning to this thread to ask a final follow-up question, if that's okay. Considering the information your provided about my partner's two gardasil-4 vaccinations providing significant protection, I am pleased to know his risk for throat cancer is low, if any. However, considering we resume our sexual lives, knowing we both have a genital HPV infection, am I at risk for throat cancer if I continue performing oral sex on my partner? (Unfortunately, I am not vaccinated but intend to receive it next year after giving birth). Is oral sex in general out of the picture for us now? Does having sex in general have any impact on our chances of "clearing" the virus allowing it to go dormant?

I'm just not sure how to move forward with intimacy knowing we both have this horrible virus.

Thank you in advance for any insight you may provide, as well as for this valuable service.

H. Hunter Handsfield, MD

37 months ago

Really, I would encourage you to drop all concerns, web searching, or any other investigation or worry about throat cancer. There is no reason to strongly suspect you have or or at risk for HPV16; if you have it, it isn't necessarily in your pharynx; and even in that case, the chance you will get cancer is one in thousands. You are at far higher risk of all the other more common cancers like breast, colon, lymphoma, and others than you are of throat cancer. It really should not be a concern for you at all. There should be absolutely no limitation on your sexual expression with your husband. If everyone like you started modifying their sex lives, few married people would ever be able to have oral sex! Absolutely any and every sexual practice that gives you mutual pleasure should be on the table according to your inclinations and desires.

I would also take issue with your characterization of HPV as "this horrible virus". HPV (and probably hundreds of other viruses not yet identified) are similar to the billions of bacteria that normally inhabit our skin, body cavities, and all body openings. Those include E. coli, Staph aureus, bacteria that cause fatal pneumonia and meningitis, and innumerable others that sometimes cause serious health problems but mostly do not. Look at HPV the same way -- part of humans' normal complement of natural viruses. That a few strains sometimes (not usually!) cause important health problems, or that HPV (and many other bacteria and viruses) involve the genital tract and therefore are transmitted sexually does not make them any worse or worrisome than others. Please do your best to understand and accept this perspective.

This advice doesn't mean ignoring HPV. As suggested above, it would be reasonable for you to be vaccinated (discuss with your doctor) and of course you should follow her advice about your recent cervical infection and its follow-up and management. Beyond that, try to submerge all worries about HPV! I hope this discussion helps you do so.

That concludes this thread. Best wishes and stay safe.

---
---
---