Oral to Genital Transmission of HPV

[tex8402]

Hi,

First I want to thank you for running such a useful forum; this is a very confusing area as there is so much misinformation out there.  I know this question has been asked before on this forum, but I also know research over the topic is evolving, so I wanted to hear your opinion based on the latest guidance.  What is the risk of being infected with HPV from a female who performs oral sex on a male, who subsequently found out that she tested positive for high risk HPV (possibly type 16)?   Could she have been infected orally by performing oral sex on the host carrier, and then passed it on orally through fellatio to others?  I believe I read that if a person has an active infection, it is passed through genital to genital contact 2/3rds of time.  Does the same percentage hold true for genital to oral and oral to genital infections?  Also, can you clear up some of the confusion about the virus “clearing” itself?  How long does it take, and what percentage of people successfully clear the virus?   Also, does the virus just lie in a dormant state that can be reactivated, or would you have to be re-exposed to the virus to have an active infection?  Once again, thank you for your time!

[Edward W Hook, MD]

Possible - yes.  common, no.  Exact transmission rates are unknown.  EWH

[tex8402]

Dr. Hook,
Just to clarify, is genital to oral transmission from the host carrier even possible?  If so, is the risk of oral transmission less so than with genital to genital contact?  

Thanks!

[Edward W Hook, MD]

You ask a variety of questions, several of which still do not have good answers.  If you have a partner with genital HPV, it would be quite unusual for her to pass it on to you through oral sex.  Even if she did, this really is not a big deal as HPV is of little direct consequence for men and the vast majority of infections (which are not detectable without special tests - HPV 16 does not cause visible warts) will clear by themselves without any residua in less than 2 years.

As for the issue of HPV clearance, let me share with you a comment that Dr. Handsfield made recently which summarizes our perspectives well.  "Many HPV biologists believe HPV DNA usually or always persists indefinitely.  However, even with the most sensitive tests available in research labs, the virus becomes undetectable, typically over several months to a year or two -- longer for the high-risk (cancer-associated) HPV types, shorter for low risk and wart-causing strains like HPV-6 and -11.  After that, it is uncommon for that particular infection to reactivate -- i.e. recurrent warts or newly abnormal pap smears are infrequent -- and subsequent transmission to sex partners is rare.  So for practical purposes, the infection is completely resolved and can be considered cured.  "Uncommon" doesn't mean these things never happen; they do, but infrequently. "

Hope these comments help.  For additional information you may wish to take a look at the American Social Health Association web site - it has much excellent information.  (disclosure, both Dr. Handsfield and I are on the ASHA Board).  EWH