I just received my second positive high risk HPV result, the first being in 2021. I have been with my husband for close to 16 years and have no doubts about his fidelity but my last previous smear was 2018 before the UK routinely screened for HPV so would assume I have had this for several years. 

My fears are to do with oral and oesophageal cancer. Please forgive this horribly personal detail, but I have a really unspeakable, now dropped daily habit of checking the taste of cervical mucus each day adopted after a previous, abusive partner told me I tasted “wrong.”  I know it is passed through skin to skin not fluids but this still seems to have been a stupid thing to have done.  My questions are:

As you may know, everybody gets genital HPV at one time or another, often several infections. Indeed it is likely your high risk HPV type was acquired many years ago, i.e. your newly abnormal paps are due to reactivation of an old infection, and not new HPV. Of the millions of people with high risk HPV in the UK, probably somewhere around 10% have (or have had) oral HPV in addition to genital or anal area infection -- in other words, still many million. Assuming UK cancer statistics are similar to those in the US, only a few thousand of those will get oral cancer as a result.  In other words, if you happen to have oral HPV, the chance it will cause cancer is extremely low.s

You don't say your HPV type. Of all high risk types, only one (HPV16) causes throat cancer. None cause esophageal cancer, at least so rarely it can be ignored. But even if you have oral HPV16, you need do nothing more than get regular dental care, at which time you can ask the dentist and/or oral hygienist to inform you if s/he sees any abnormalities. (Note that "oral cancer" is the wrong term for the risk from HPV of any time. Only one particular type, pharyngeal squamous cell carcinoma, is HPV related, and then almost entirely to HPV16. Also keep this in mind:  statistically, there's a 40% likelihood cancer will be what carries you out of this world someday -- but among those, the ones to worry about are the common ones like breast, colon, pancreas, prostate (in males), lymphoma/leukemia, and so on. Oral HPV is way down the list of risks!

Those comments partly address your questions, but to be explicit:

1) Oral HPV is only partly related to oral sexual exposures. Many people who never perform oral sex also acquire oral infection, probably through auto-inoculation (i.e. normal self contact of hands etc between genitals and mouth, which is pretty much unavoidable, since it's mostly unconscious. Your risk of having oral HPV is not significantly higher on account of your performance of oral sex on you past sex partners.

2) As you are planning, follow standard recommendations for Pap smears; and your doctor's advice about treating your cervical HPV infection, if it is causing dysplasia (pre-cancerous cell changes). There is no reason to refrain from oral sex. You could consider HPV vaccination, which would prevent infection with the 9 HPV types that cause 90% of cancers and genital/anal warts (not counting any of those types you have not yet acquired). The need for this, however, depends largely on your anticipated sexual lifestyle going forward. If you anticipate several partnerships before maybe someday being in another long-term, mutually monogamous relationship. This also is something to discuss with the doctor managing your genital HPV infection.

3) There's a good news/bad news situation here. The bad:  there's really nothing you can do to modify the risk important health outcomes from your current HPV infection, with one exception:  cigaret smoking increases the chance of progression of cervical HPV disease (dysplasia to cancer, etc), so continue to avoid tobacco. (Alcohol is statistically associated with higher risk of oral and esophageal cancers, but typically of the types not caused by HPV.) The good news is that the large majority of infections never lead to invasive cancer or any other important health outcome, especially if you follow your doctor's advice about follow-up health care.

So do your best to stop worrying about your HPV. 90% of all people have it at one time or another, and many (most? all?) carry those viruses for life. You are no higher risk of an important health outcome from your HPV than are the large majority of your friends, co-workers, family members, or anyone else.

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

HHH, MD

One thing still troubles me a bit - I carry a lot of guilt about the “tasting” habit I mentioned and resentment and sadness around the relationship that started it.  Whilst appreciating the overall risk to be mercifully low, have I statistically significantly raised my risk of oral hpv infection over the 10% you mention of the cervically infected who have also incurred oral infection risk of inadvertent self inoculation and or oral sex.  It might sound a silly detail and it probably is, as I say it is the context of the abuse which I think clouds my priorities here. I think i am hoping not so I can just draw a line under that unhappy time.  Also, provided I stay with my husband which I definitely intend to, at 40 would you still recommend vaccination and think we are fine to continue with oral and vaginal sex as normal?

Please do you best to understand that having HPV, often with several strains, is a normal, expected, unavoidable consequence of being sexual. Think of it the same way you should understand normal bacteria, as well as viruses other than HPV:  We are covered, inside and out, with billions of bacteria, which for the most part are harmless, and many of them are highly beneficial, in fact essential for healthy existence. That a few of these are shared between sex partners doesn't make them any more dangerous or worrisome. Don't let a mostly harmless hyper-microscooic string of DNA with a protein coating run or ruin your life!

2. Is it likely that, if I have had HPV for 20 odd years already, and likely for life, my chance of developing oral cancer will increase or decrease over time or stay steady at low say 1 in 1000 or so.

Thank you so much!!!!

1. I cant make sense of your mentioning auto innoculation being a common means of transfer alongside other info on this site saying it has to almost always be sexual contact and skins rubbing skin: is self innocculation likely or have most people who got an oral infection got it via oral sex?  I just want to fully understand best I can your assurance I have little chance of oral infection.

2. I am not too hot on numbers / stats / risk.  Ive tried working through the logical implications of 10% of the people who have a high risk HPV infection maybe having oral infections against UK cancer stats and just got myself in knots. I can see it is hard to put numbers on this stuff as currently elderly women most likely had fewer partners, rates are rising and the world is changing etc but any ballpark numbers you can share on what research says the likely probability of an oral infection becoming cancer would be a comfort. Thank you!!!

1)  I think it probable you do not have oral infection because only a minority of people with genital HPV (around 15%) also have oral infection with the same type. You have said nothing to suggest your situation is anything but average.

2) Your future cancer risk probably is more or less stable over time. But if you follow standard Pap smear guidelines (e.g. every 3 years), pre-cancerous changes or even the earliest stages of cancer (carcinoma in situ) will not have time to process, and cure or prevention will be 100% certain in plenty of time to have any effect on your long term health.

3) I always advise anxious persons to be very cautions in interpreting advice from societies or organizations who have special interest in a particular medical condition. Monthly checks strikes me as ridiculous as a prevention strategy.

Second set:

1) I never said auto-inoculation is common. Direct infection from oral sex undoubtedly accounts for most cases. On the other hand, national surveillance (thousands of people tested for oral HPV) found no association of oral infection with frequency of oral sex. It seems logical to assume, therefore, that some cases result from auto-inoculation. But all this is in the realm of evolving research. More solid information may be available someday.

2) For exactly the reasons you are experiencing, I suggest not trying to scope out the quantitative risks. The more important numbers are that HPV oral infection is probably hundreds of times more common than pharyngeal cancer due to HPV. Most smokers never get lung cancer, and most people with oral HPV16 will never get pharyngeal cancer. As I said above, you are no higher risk of pharyngeal cancer from HPV than any average person in the popluation.

That will have to conclude this thread. I hope you're able to move on without giving all this the over-attention it doesn't deserve! Good luck.