Before addressing your specific question, I'm going to give an overview about HPV and how you should view it. These perspectives are inherent in Dr. Hook's comments, but it might help to see them explicitly. The bottom line is that if I were in your situation, or if I were counseling my own patients (or a close family member), I would more or less ignore HPV as a health issue. I don't meant to be cavalier about it; of course I understand the potentially important health issues, especially genital warts and various cancers. However, even though over 90% of all sexually active persons acquire one or more HPV infections, and some of them have persistent infection that may reactivate years later, the proportion who actually experience important health consequences is low. Stated another way, catching and having HPV is a normal, expected, unavoidable consequence of being sexual.

And with immunization, those risks will be substantially reduced. However, you won't enjoy the 90% protection level experienced with Gardasil given to kids before they become sexually active. You've already been infected with at least one of the HPV types prevented by vaccination -- your past genital warts -- and probably you had other HPV infections as well, assuming you had an average sexual lifestyle before your marriage, and considering your husband's previous sexual experiences. Still, you have taken by far the most important step in protecting your health and that of your current or future sex partners(s). The chance you're ever going to have an important health consequence from HPV is low. Please don't let your concerns about this mostly trivial, harmless virus significantly interfere with romance and sexual fulfillment.

For those reasons, if I were in your situation, I wouldn't wait to have vaginal or oral sex. Even without immunization, the chance either you or your partner will have a clinically important HPV outcome is very low. That said, there's certainly no problem in waiting until a few weeks after your second vaccine dose. If you do that, the other activities you describe indeed would all be low risk. Genital fluids per se probably are low risk for HPV; most infections probably are transmitted by directly massaging the virus into susceptible tissues. That's why genital warts mostly occur at sites of maximum friction during sex:  vaginal opening, labia minor, penile head and shaft, etc. Still, because of anticipated fluid exchange, your risk of HPV -- if either of you happens to currently have an active, transmissible infection -- is not zero. But it's very low -- in my opinion, too low to be any worry at all.

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

HHH, MD

I would not recommend condoms for the purpose of HPV prevention. They reduce the chance of HPV by only 70-90% at each use, so after vaginal sex several times, the risk of HPV is no lower in consistent condom users than non-users.

Chlamydia and gonorrhea testing is conclusive within 4-5 days of the last exposure. All STDs diagnosed by blood tests take 6 -12 weeks for conclusive results. But some of those tests aren't all the reliable anyway. If you would like to (diplomatically) ask him to be tested, I would recommend only gonorrhea/chlamydia (urine test) and blood tests for HIV and syphilis.

That strategy -- negative testing plus committed monogamy plus condoms for a few weeks -- indeed is the safest possible approach. However, if he has had only female partners, the chance of either HIV or syphilis is near zero, and the chance he's in a window period for any of these is even lower, so if I were in your situation I would be entirely satisfied with negative test results now, without the 6 week wait.

Reading between the lines, I have to wonder if you are convinced that he's being honest about his sexual history, or that he would really be committed to no other partnerships the next few weeks. If that's part of your concern, I definitely endorse condoms and testing again (for gon/chl, syphilis and HIV) after a few weeks.

If you say we should test before (protected) sex then I am good with that as well. I think once I have a "plan" I'll feel more comfortable / educated discussing such things with new partners now and in the future. 

Thanks so much!!

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been useful. Best wishes for romance in the context of safe sex!