Question on past HPV exposure and oral risk

[joeshakes]

I've read through most of the questions on HPV but wanted to ask something specifically as I haven't seen anything asked quite this way.  I know I came in contact with a high risk type of HPV around 12 years ago by a partner at the time having a pretty advanced dysplasia.  The partner immediately after that also within a few months of our relationship also had a procedure done for a dysplasia, and around 3-4 years later, what would be my future wife had dysplasia within 6 months of beginning our relationship.  

It seems, at least for 5-6 years , I was definitely passing a high risk HPV on (don't know what particular strain), and have read that most cases clear in 2 years which certainly didn't happen in my case.

My wife hasn't had an issue or any abnormalities after that one procedure and I haven't noticed anything other than one wart a long time ago around my initial contact with the first partner.    I smoked for around 10 years, but have quit for nearly two now.

1.  Since I definitely was not clearing the virus for many years, should I be really concerned about oral cancer from HPV as I have engaged in oral sex with those partners?
2.  Should I go and have any type of screening at an ear nose throat doc?
3.  Should I have the oral screening test to see if HPV is present that is offered at a local dentist?  

[H. Hunter Handsfield, M.D.]

No, this doesn't change my opinion or advice.  You are correct that I cannot exclude the possibility that you are a continuing carrier of high risk HPV.  But even if that is the case, your health is not likely to be at risk.  Assuming your wife is your only current or anticipated sex partner, since she hasn't had any pap smear abnormalities or other manifestations, it is unlikely she will have them in the future.  If we assume you infected her (if she had not previously had the same HPV strain herself) early during your sexual relationship with her, we can also safely assume she was infected and her immune system has cleared the HPV.  She might discuss this with her gyn, if she hasn't done so before now -- then follow any advice she may get about future pap smears and/or HPV tests.  My bet is the gyn will agree in general terms with my assessment and advice.  (You could print out this thread as a framework for discussion.)  But I stress that I believe it remains unlikely you are still infected with HPV, even if you were at one time.  You should not let this situation bother you.

[joeshakes]

Thank you for the response.  I understand the logic in the response, but it seems very likely that I was not clearing the virus since (while I know I cannot be 100% certain) one partner that I was with had the dysplasia and never had a partner before me and the other only had 1 or 2.  Both had abnormal paps within 6 months of our relationship, and those relationships were somewhere 5-6 years apart.

With that knowledge, you still think this is nothing to be worried about?  

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

I understand your concern; being the partner of two women with cervical dysplasia naturally raises concern about your own HPV infection status.  However, you are drawing several conclusions that are not necessarily valid.

First, you cannot assume either of your partners both acquired the HPV causing their cervical dysplasia from you.  Since 10-20% of women have cervical dysplasia at one time or another, it is entirely plausible that one man could have relationships with two such women merely on the basis of random chance.  Second, you do not know that either of their HPV infections was due to a high risk HPV type.  That determination cannot be made without testing for HPV; even "advanced" dysplasia can be caused by low-risk HPV types.  Third, as you have already noted, it would be unusual for you to have an active, transmissible infection with HPV (whether high or low risk) that persisted for several years.  For those reasons,I cannot say the scenario in your mind hasn't happened -- but it is unlikely.

To your specific questions:

1) As just discussed, the premise probably isn't true, i.e. I doubt you "were not clearing [a continuing HPV infection] for many years".  But if you were, I would not conclude you are at particularly high risk of oral HPV or of an HPV-related oral cancer.  Even if you had an oral infection with HPV 16 (the type associated with certain oral cancers), the chance you would develop cancer is very low.

2,3) I don't recommend you be tested for HPV of the genitals, oral cavity, or anywhere else, or that you have an ENT examination unless you are having symptoms that concern you.  

Oral HPV and cancer are on a lot of people's minds because of actor Michael Douglas's recent revelation that he has had oral cancer due to HPV.  For comprehensive discussion, see this thread from earlier today, as well as the other threads whose links are provided there:  http://www.medhelp.org/posts/show/1956567.

Best wishes--  HHH, MD