[Question #929] Oral hpv question

86 months ago
8 years ago I found two possible warts. 1 on the top of my penis 1.5 inches from penis tip. 1 on lower right of scrotum. Similar in appearance. I  had them chemically removed. The one on top side of penis was successfully removed the one on scrotum did not completely go away. Nurse said she believed them to be skin tags.  Given her diagnosis at the time I left one on scrotum alone.  One on top never returned, one on scrotum never changed. One night present day I recieved fellatio for 3 to 10 seconds, very shallow no more than 3 inches. She is late 30s early 40s, no vaccination. One week later I decided to have the spot on scrotum biopsied due to internet research on passing hpv orally, which at the time I did not know was possible. During examination a wart was found at the very bottom of my scrotum near my anus, but on scrotum. Biopsy showed hpv on the wart at bottom of scrotum near anus, which I 100 percent believe was present during fellatio. The one from 8 years prior showed negative for hpv, but had the molecular structure of  a wart.  Dermatologist said it was hpv. The dermitologist found no more warts on my genital area. During fellatio, she was no where near either of the two warts. My question, what are the odds I transmitted oral hpv to her? If I did transmit my virus to her, what are the odds she will show symptoms? and what are the odds of her passing it on to her partner?  I am also conserned about the wart removed from my penis 8 years prior and any role it may play in possible transmission. I am unsure of how long the wart on bottom of scrotum had been there, as it was in a very hard to see spot. Dermatologist said it is less likely I transmitted it to her given the location of the two warts, but possible. She then said they are called genital warts for a reason, as they tend to stay in genitals. I would like any help understanding this situation or any clarification. I am freaking out. Ty for your time

86 months ago
Fellatio was closer to 1.5 inches to 2 inches. Also I only had 1 sexual partner in the 8 year time period. I am also in mid 30s.
Edward W. Hook M.D.
86 months ago

Welcome to the Forum.  I'll try to help. there is still much to learn about HPV infections including how they affect different sites of infection and how often they are transmitted.  Despite that, experts in the field have found more and more reasons to urge their clients to try to not be too concerned about HPV exposure or, if they get HPV, the potential consequences.  For all practical purposes, HPV are a part of sexual life.  Over 85% of sexually active adults will have HPV at some point (this may change as vaccination becomes more common) and the proportion of persons who will have adverse events (cancer) from this is a small fraction of 1%.  In other words, HPV is nearly always an innocuous infection.  While anything is possible, I agree with your dermatologist.  it is unlikely that you transmitted infection to your partner and if you did, there is almost no chance that anything bad will occur because of it. 

In addition to this response, I want to share several comments that my colleague, Dr. Handsfield made to another client specifically on the topic of oral HPV- because I thought it was well written I saved it to share with clients such as you (you are by no means the 1rst person to ask these questions:  "Let me start with some perspectives about oral HPV. On average, at any point in time, it's about a quarter as common as genital HPV. That's a good news/bad news scenario: not as common as genital, but frequent enough that a very high proportion of sexually active people (probably over half) get oral HPV at one time or another. Second, oral HPV is probably not acquired only by oral sex. In the largest US national study of oral HPV, its presence was correlated with no. of lifetime sex partners, but not with frequency of oral sex. So it is likely that oral HPV often (usually?) is acquired by less direct exposure, such as auto-transfer from one's own genital infection, and perhaps because sexual fluids get spread around quite a bit and can easly get into the oral cavity without oral sex. (Sex is inherently sloppy, right?) Third, a higher proportion of oral HPV infections, compared with genital, cause no symptoms and no disease; and almost all infections are cleared by the immune system. Fourth, transmission of HPV from oral infection to partners appears to be uncommon. While oral sex may account for a few genital infections it partners, it is far less likely than genital to genital transmission.

....throat cancer. First, despite all the media hype about it, throat cancer from HPV remains rare. Even with roughly double the numbers compared with 10-20 years ago, there are only around 12,000 cases per year in the entire US, despite millions and millions of persons who have (or have had) oral HPV. It's far less common than the cancers people really need to be concerned about like prostate, colon, lung, breast, etc. Second, only one HPV type (HPV16) is actually associated with throat cancer, and there is no proof that those with that rare complication actually acquired it by oral sex (notwithstanding the media stories a couple years ago when a particular movie star attributed his throat cancer to oral sex)."

Finally, I would also point out that the type of HPV that causes visible genital warts (HPV 6 or 11) is not the same type that causes cancer (see Dr. Handsfield's comment above- this is HPV 16), 

Thus, in closing, my advice is to not worry about this event or possible exposure and to not let your HPV infection negatively influence your sexual relationship with your partner - there is just no scientific reason to do so.  I hope this information and perspective is helpful to you.  EWH