[Question #9762] Follow up Question to "[Question #9753] Q for Dr HHH ideally"
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29 months ago
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Thank you for the responses Dr. I have 2 follow up questions: from thread #9753 from yesterday.
1) So based on your comments in the other threads I highlighted, my risk is essentially or as close as possible to 0% for oral HR HPV from kissing the 5 x CSWs? Would that be a fair assumption?
2a) On your point around reactivation: "For undetected (asymptomatic) reactivation that doesn't result in new symptoms or transmission to future partners, probably quite a bit higher, maybe 40-50%?" - What does this actually mean? Could you explain it more? Is this a latent infection that has not properly been cleared? As opposed to an infection that has successfully been cleared by the body's immune system? (thus leaving only a 5-10% reactivation probability as per your other examples?)
2b) Reason for asking is that obviously I am concerned that if I did catch oral HR HPV from the CSW kissing encounters 10 years ago, and cleared them, am I then in this bracket and have a 40 - 50% chance of it reactivating in the future?
2c) Or would this example fall into the 5% or 10% category if I managed to clear the initial infection? (and the 40-50% example is only if you didn't fully clear the virus?
Concerned this is going to follow me round for the rest of my life.
Thank you again for your support - I am just trying to fully understand this as find it all quite complex.
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Edward W. Hook M.D.
29 months ago
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Welcome back to the Forum although I'm disappointed that you felt the need. As Dr. Handsfield explained, clients are not permitted to choose who responds to their questions; part of the reason for this is that we have worked together for more than 40 years and while our verbal styles vary, we never disagree on the facts of our responses. In your case I happened to pick up your follow-up questions. In preparing to answer them I reviewed your earlier interaction with Dr. Handsfield and agree with all that he said. My sense after reviewing the interaction is that you are overly concerned about oral HPV for reasons that are not apparent and that if you continue to worry about HPV, orally or otherwise, the single best thing you can do is get vaccinated. Vaccination would prevent future infections and recent research suggests that vaccination may somewhat enhance control of existing infections. Regarding your follow-up questions:
1. As Dr. Handsfield indicated, that you kissed 5 CSWs in the past is a virtually no risk activity and does not meaningfully increase your risk for having oral HPV. Your assumption is correct.
2a. As Dr. Handsfield indicated, reactivation of HPV infections is a relatively rare event. This phenomenon has been primarily studied for genital infections but what data there are do not suggest reactivation of oral infection is any more common than at other sites. If anything, estimates of a 5-10% reactivation rate are on the high side.
2b and c. I think your assessment of having a 40-50% likelihood of re-activation is too high. I would assume that you had cleared any original infection had it occurred and, as previously explained, your risk for oral infection is relatively low and unchanged in relationship to your kissing CSWs years ago.
There are many reasons in life to worry but oral HPV infections in your situation is a minor one at most. Further, other than regular dental exams (dentists now routinely look for evidence of oral HPV and other abnormalities) there is not much to do unless you develop symptoms. I urge you to stay of the internet regarding oral HPV as it is full of mis-statements due to information taken out of context or misinterpreted by those who are posting there. EWH
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29 months ago
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Thank you Dr Hook for your responses and I don't mind who answers.
I'm pretty confused now as I didn't estimate 40-50%, Dr Handsfield did. He layed out 3 scenarios one of which was 5%, one 10% and one 40-50%. The 40-50% scenario he details is below:
"For undetected (asymptomatic) reactivation that doesn't result in new symptoms or transmission to future partners, probably quite a bit higher, maybe 40-50%?"
1) Could you review #9753 and let me know what he meant by the 40-50% scenario as I don't understand it?
2) If I then caught and subsequently cleared Oral HR HPV from the CSW kissing incidents I describe, what then do you think the reactivation percentage is, more like 5 to 10%?
Many thanks for your time.
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Edward W. Hook M.D.
29 months ago
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Sorry for the confusion. once a response is started we cannot go back to earlier interactions without losing the entire thread.
In his final response Dr. Handsfield said "The problem is that this percentage is very difficult to estimate, and depends largely on how "reactivate" is defined. For recurrence of previous warts, maybe 10% or so? For delayed Pap smear result, many years after catching HPV and testing negative in the interim, maybe 5%? For undetected (asymptomatic) reactivation that doesn't result in new symptoms or transmission to future partners, probably quite a bit higher, maybe 40-50%?"
The scenarios he laid out were ESTIMATES and were qualified by his statements that there are few data and that estimates of re-activation may vary. Further, these estimates were, I believe, cumulative estimates describing possible "reactivation" over a period of years (i.e. the ability to detect viral material without leading to potential transmission or progression/symptoms [remember, virtually all HPV other than visible warts is asymptomatic and detected only through testing, something that is not routinely available for oro-pharyngeal infection]). The higher estimate described hypothetical, inconsequential reactivation only detectable through testing (I should also point out that the sort of testing described here is a research tool and not widely available).
For all practical purposes, meaningful reactivation would be at the lower estimate, 5-10% at most.
Let me repeat here however, it appears you have gone down a rabbit hole:
1. Kissing an infected person, CSW or otherwise is not a known risk factor for oro-pharyngeal HPV.
2. Nearly all HPV infections are self-limited in the sense that there clear and become no longer detectable relatively soon after they are initially detectable.
3. That minority of infections that "reactivate" in the sense that after being undetectable are then, once again detectable rarely if ever progress or are transmissible to others.
I urge you to put your concerns (I remain unclear why you are concerned) aside and try to move forward. EWH
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29 months ago
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Thank you Dr Hook for the detailed explanation, that now makes sense to me.
One last question then: In the studies done on reactivation, how are they sure that what they class as "reactivation" isn't in fact a new infection with the exact same HPV isolate?
Surely given the endemic nature of something like HPV 16 this is a strong possibility?
Thanks for your time as always.
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Edward W. Hook M.D.
29 months ago
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As you know, this will be the final response as part of this thread. Dr. Handsfield and I have spoken about your continuing concerns. We are in agreement that your level of concern appears to be far out of proportion to the tiny risk that you acquired oral HPV, either through your exposure to CSWs or to others. I hope that this final response will allow you to put your concerns aside and move forward.
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You asked- "In the studies done on reactivation, how are they sure that what they class as "reactivation" isn't in fact a new infection with the exact same HPV isolate?"
Response: Reactivation is an observed scientific phenomenon of unknown significance and of unknown import to issues of HPV transmission and the rare long term consequences of infection. That said, person who acquire HPV and reinfection by the same type of HPV is relatively rare. Resistance to re-infection in persons with HPV is relatively rare due to this immunity. That said, in science, with limited data we can never say never however, in my opinion, the likelihood that among persons classified as re-infected, the likelihood that these are new infections is low.
I hope that you will move forward. In my opinion, you need to and your level of concern is far out of proportion to the risk you seem to be focused on.
This completes this thread. Please do not return with additional "what if" questions. You need to move on. i say this out of concern for you, nothing no more. EWH