(32m and 29f)

Recently i think ive found warts on my penis that may have been there for months or years, ive been in a commited relationship for years. 

The warts were not from my gf as i was her first for everything except kissing. Where as I engaged in a lot of high risk sex prior to us. 

I keep trying to find some clarification on oral HPV and transmission.

My misses and I have had plenty of unprotected vaginal and oral sex - though i do not perform, only she does - we also share drinks. 

3 years ago i got double jabbed with G9 and im going to get my final soon as a catch up (maybe a fourth?) and im going to get her triple jabbed.. 

She had a cervix screen and came back negative for all the nasty HPV types. (hooray) 

1. Is her clear cervix screen an indicator that we most likely dont have cancerous EGW/ oral hpv. 

2. Is kissing/ sharing drinks a confirmed strong transmission route of oral hpv

3. Does oral HPV clear faster in the mouth than the genitals

4. Is it difficult to get internal anal warts without anal penetrative sex

5. Are 6/11 more persistent/stubborn to clear than 16/18

Thanks in advance! 

It seems likely that the penile bumps you found are not genital warts. There are other causes of such bumps, and warts rarely persist for years. Even several months is on the long side, especially if there has been no change in their appearance or number during that time. So my first advice is to see a health care provider for direct examination and diagnosis.

My second comment is to congratulate you and your wife for being immunized against HPV. Good move! But it's still likely that the two of you have shared one or more HPV infections, just because HPV is so common. If so, however, it is only through sex. HPV is not transmitted by sharing drinking glasses, eating utensils, etc; also not through shared toilets etc. Only by sex, and mostly by vaginal or anal intercourse -- less commonly by oral sex.

And third, don't be too freaked out about oral HPV. There has been a lot of media attention in recent years to oral HPV and throat cancer caused by the virus. However, oral HPV is a lot less common than genital, even in couples who regularly have oral sex together; most oral HPV never causes symptoms; only one type of cancer (squamous cell carcinoma of the pharynx, i.e. throat) is regularly caused by HPV, and only one type of the virus (HPV16) causes throat cancers; and although HPV related throat cancer has increased in frequency in recent years, it remains an uncommon cancer overall. You are at much higher risk of all the other cancers you know about -- colon, prostate, etc; or, for your wife, breast cancer.

To your numbered questions:

1. Yes. Most oral HPV occurs in people with active genital infection. Your wife's normal Pap smears reduce the chance she has oral HPV, although it doesn't eliminate the possibility.

2. No, these are not confirmed transmission routes. Kissing is possible, although oral sex itself is by far the higher risk. As I said above, shared drinking cups and glasses definitely do not transmit the virus, or so rarely that it can be ignored.

3. I'm not aware of data that compare speed of clearance of oral versus genital or anal HPV. Probably there isn't much difference.

4. Excellent question. Anal HPV isn't rare, even in people who do not have anal sexual exposure. Some infections probably are auto-inoculated (self transferred) from the genital to anal area just because they are anatomically so close; or by one's own fingers. However, internal (rectal) warts are rare except in people who have experienced penile penetration into their rectums, i.e. receptive anal sex.

5. In general, the immune system clears the low-cancer-risk HPV types, like HPV 6/11, more quickly than the high risk types like HPV 16 and 18. But there is a broad range:  some HPV 6/11 infections last years, and some HPV 16/18 infections are gone in a few weeks.

Two excellent resources for further HPV information and health advice are CDC (www.cdc.gov/std, then follow the links); and the sponsor of this forum, the American Sexual Health Association (https://www.ashasexualhealth.org/human_papilloma_virus/).

I hope these comments are helpful. Most important, do get professionally examined to confirm (or perhaps refute) your self diagnosis of penile warts. Let me know if anything is clear.

HHH, MD

I have a couple more questions though, i hope you might be able to help with about warts. 

1. A lot of online material classifies warts as benign self limiting growths. Does mean large warts and wart spread (on one self) is somewhat uncommon/ rare unless you are actively irritating them? 

2. Are external warts a visual representation of your body struggling to fight the infection or more just representing how long the infection is lasting. 

3. Besides to control spread, should all warts be treated? 

4. In laymans terms, what is a subclinical wart

5. Are warts in the urethra rare

Thanks again for taking the time to answer my questions! 

Thanks for the thanks; I'm glad to have helped (so far).

2. Good question. In general, warts grow because there is no immune response to the causative HPV infection, or at least not a very strong one. Once immunity kicks in, warts often melt away quite quickly.

3. This is a personal decision. In general, I think treatment is a good idea, to lessen the chance of irritation and secondary bacterial infection. And, for many (most?) affected persons, for the relief and satisfaction that often occur. But it's highly personal and varies from one person to the next.

4. "Sublinical wart" is not a commonly used term. I would interpret it as similar to "flat" warts that may not be visible to the naked eye. Warts in general can be viewed as the tip of an iceberg:  most people with visible warts have HPV in nearby skin that isn't apparently abnormal.

5. Urethral warts aren't exactly rare, but not an everyday occurrence either. I'm unaware of any precise data. In my personal experience, I've only seen urethral warts in people with recently acquired infection, i.e. along with newly appearing non-urethral warts. If your penile bumps are warts (as I said, I'm not convinced), it probably is unlikely that you have or will develop urethral warts (in case that's what's on your mind).

I have a few final questions regarding warts and also now moving towards cancer questions:

1. When it comes to spreading HPV as far as i have read, its very site specific. Aka having penile warts doesnt mean you will get perianal warts and doesnt mean you will get anal warts. But it can be spread through auto inoculation. So my question then becomes, is this the same with HPV 16/18. i.e a heterosexual male who does not partake in anal play is less likely to aquire hpv 16/18 within the anus? Also can stuff like hemorrhoids and anal fissures act as a pathway for HPV in to the anal canal? 

2. From what i understand about risk factors. Just having one or two isnt probably enough to cause cancer or even catching the disease, it just increases the chances. i.e multiple sexual partners and having anal warts doesnt mean you are going to develop anal cancer. 

3. You may not be able to answer this, but ill ask anyway. We are seeing a rise in anal cancers, though i see its still considered rare and even rarer in young men and women. Is there a specific demographic thats seeing the incidence rise the highest? i.e young gay men, fsw, etc etc

I think that is all for today! 

Thank you again

2. True. Just as most heavy smokers don't get lung cancer, the large majority of people with HPV (including HPV 16, 18 and other high risk types) do not get anal or any other cancer.

3. Anal cancer rates due to HPV in men who have sex with men are just as high as cervical cancer in women who do not get regular Pap smears -- that is, quite high. The risk of anal cancer is very low in other population groups. (For more detail on these and other cancer rates, the American Cancer Society had very detailed information if you care to explore these issues further (www.cancer.org). 

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.