I was in a relationship with my ex for 10 years and we both have genital warts. I am recently single and hooked up with a guy three times. I have not had penetrative sex but have engaged in unprotected oral sex. I have given him unprotected oral sex three times, and he has given me unprotected oral sex once. I realized I had a small wart the next day on my labia near my clitoris when I examined myself. It was obviously there when he gave me oral. I am now terrified that he is going to get genital warts from me since he gave me oral with a wart present. Is that possible? Can he get genital warts if I gave him oral? After reading about oral HPV, I’m now worried I could have it if I use to give my ex unprotected oral sex when he had warts. So, I’m also worried I could have transmitted genital warts from giving oral to the guy I hooked up. Any information on transmission would be helpful. 

Thank you

I'll assume you have correctly self-diagnosed your labial wart, having had experience with warts in the past. However, there are other causes of genital surface bumps -- and although you don't say how long it is since you and your ex partner were diagnosed or your previous warts treated, if all that was more than a year or two ago, a recurrence at this late would be unusual. You may want to be evaluated professionally.

Oral HPV isn't rare, and is often the result of oral sex -- although it's almost as common in people who never perform oral sex. (Some cases probably are acquired by auto-inoculation, i.e. self transfer of the virus from genital or anal infection on fingers and hands.) The risk of transmission from any single oral sex exposure is not known, but it must be quite low:  at any point in time in people age 20-40, about half have genital HPV detected by DNA testing; and yet the prevalence of oral HPV is much lower, despite the high frequency of oral sex in the large majority of the population. So clearly any one exposure has to be low risk. Further, oral warts are very rare:  the large majority of oral infections cause no symptoms.

Another factor to keep in mind is that your new partner can safely be assumed to have been infected with HPV, as are all sexually active persons, and could well be among the 50% who would test positive, i.e. to have an active genital infection; or in the ~15% who have active (DNA detectable) oral infections at any point in time. So his oral exposures to your genital area may not have increased his chance of infection at all.

All things considered, the chance your partner will develop oral warts or any other health problem from oral sex with you is extremely low. I can't say it's zero, however, so you probably should discuss this with him. But this really shouldn't be a big deal for either of you. A final aspect is for you both to consider HPV immunization, which would protect you from the 9 HPV types that collectively cause 90% of genital warts and 90% of HPV-related cancers -- not counting any of those 9 types you have already had.

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

HHH, MD

It’s definitely a wart. I have unfortunately suffered from them for about 8 yrs so I’m all too familiar. I had one remaining one that was frozen off in February and was clear for about 3 months before I noticed this most recent one.

Just for some clarity, if I gave him oral sex, I would have to have oral HPV to potentially give him genital HPV (assuming he hasn’t had this strand). He likely would not get genital HPV if I gave him oral if I don’t have oral HPV (even though I have genital warts)? 

On the other side, him giving me oral could result in oral HPV but not genital HPV? I guess I am a bit confused on whether oral HPV means your whole body is infected and you would also get genital HPV?

In lesser words:

If I give him oral, and I have oral HPV, that could cause him to get genital HPV. If I don’t have oral HPV, he is unlikely to get genital HPV from me via oral sex.

If he gives me oral, it could result in him getting oral HPV, but wouldn't cause genital HPV. 

I ask all of this with the understanding that he could have been infected in the past, or even infected now. Just wondering what the risk of transmission is if he hasn’t been before.

You cannot transmit HPV from an uninfected anatomic site; there is no particular reason to suspect the genital infection causing your warts also is in your mouth. Similarly, he cannot transmit HPV to your mouth by contacting your genital area; and if you do not have an oral HPV infection, you cannot give HPV to anyone (anywhere on their body) except by contact with your mouth. HPV doesn't spread inside the body from one site to another. An infected site must have been in direct contact with infected tissues or fluids. 

If you don’t have oral HPV and can’t give it to anyone if you don’t, what do you mean by “except by contact with your mouth”?

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.