I've been on this board forever today and have to sort through a lot of info that belongs to the low-risk HPV, or sometimes confused between the two. I would appreciate it if we could start a topic that only has information/questions about HIGH risk HPV.

To start with a question:
Is there a need to protect yourself during oral sex in a long term monogamous relationship, where both partners probably have the High risk HPV? Since it does not seem to ping-pong and we a re not talking about warts, it should be safe. Or...?

Much info I found on this topic belongs to the low risk type.

Hi there,

It's tough to give guidance here that's very specific, because no one really knows just how likely HPV is to be transmitted through oral sex (whether high risk or low risk).

Increasingly it seems that this happens, but no one can say just how often. Oral diseases related to the high risk HPV aren't detected very often, and seem to most often be related to just one genotype, HPV 16. This conversation usually turns to a discussion about oral cancers or, more properly, head and neck cancers (since that's really what we're talking about).

What I can say is that these cancers are pretty uncommon to begin with, and those related to HPV are probably half or fewer of the already small total. The risk doesn't seem overwhelming, but it's not for me to tell you what your comfort level should be.

A reasonable approach is not to engage in oral sex while any lesions (for example, cervical cell changes) are present. Beyond that, it does depend on your comfort level and how important oral sex is to you and your partner. Few experts would tell you to just give up on it, though.

Hope this helps.

Fredo

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My ob gyn told me that since it is presumed that both my and my fiance' have the high risk type we are safe doing any sexual act, provided that we are monogamous, because the same strain (16- 18) does not transmit again to the same person ! Is she right? What to believe?

Yes...you can continue to have sexual intercourse and can't continue to ping pong it back and forth. This however is regarding the virus being in your genital region. Transference from genitals to the oral region is still being researched although the common belief is that the risk is still low but it can't be ruled out. So if you feel more comfortable, you can certainly use a form of barrier protection.

Fredo, this brings up an interesting question. Does barrier protection need to be used for both partners if only one of them is diagnosed with high risk HPV? Assuming both partners share the same strain, but only one of them is being treated (obviously the female partner), it seems extreme to have to go years with either no oral sex or with barrier protection. Also, it strikes me that most women with high risk HPV are not told exactly what strain they have. Should women be pushing their doctors more to provide this information since the head and neck cancers are associated with HPV 16.

Fredo, this brings up an interesting question. Does barrier protection need to be used for both partners if only one of them is diagnosed with high risk HPV? Assuming both partners share the same strain, but only one of them is being treated (obviously the female partner), it seems extreme to have to go years with either no oral sex or with barrier protection. Also, it strikes me that most women with high risk HPV are not told exactly what strain they have. Should women be pushing their doctors more to provide this information since the head and neck cancers are associated with HPV 16.

There's a lot of caution when discussing issues like this, because no one really knows just how much of a risk is posed by oral sex re: HPV. But I agree it does seem extreme to go years either without oral sex, or using barrier protection if you do. It probably makes sense not to have oral sex while any lesions (warts or cervical cell changes) are present. Beyond that, it gets back to each couple's comfort level. I know, I know, that's not much of an answer...

As for figuring out exactly which genotype of HPV one might have, currently there's no test approved for clinical use by the FDA that can do that, although that will likely change eventually (such tests exist and at least one has been submitted to the Feds for review as a clinical tool). Some clinics might offer such tests at present, but most don't. "Off label" use is not likely to be covered by insurance.

Best,
Fredo

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Ok...maybe I need to make it clearer. I understand that when a woman is diagnosed with high risk HPV that oral sex should not be performed on her. But does that mean that she cannot perform oral sex on her boyfriend until her lesions clear??

I understand that when a woman is diagnosed with high risk HPV that oral sex should not be performed on her. But does that mean that she cannot perform oral sex on her boyfriend until her lesions clear?

Oh, ok, NOW I SEE! I don't think whether or not her lesions have regressed has any bearing on her being the one to perform oral sex; the school of thought we're discussing refers directly to not performing oral sex on a partner who actually has warts or cell changes on their own skin.

I don't know if there's any consensus about what to do if, say, the woman is recently diagnosed with HPV, her partner is presumed (but not proven) to share the virus, and she wants to give the partner oral sex. I think not having oral sex or using barriers forever is, indeed, overkill. And, I also think the risks to her should be pondered with this in mind: 1) we don't know for certain the partner still has HPV, or if it's even contagious; 2) oral HPV infections aren't a huge clinical issue; 3) serious oral diseases related to HPV, while they do occur, are even less common than genital diseases.

What should she do? Here we get back to the term I seem to use several times daily now, comfort level. If the idea of oral sex just freaks her the heck out, well, maybe she shouldn't do it for awhile. Or, perhaps she'll feel better using barrier protection. Still, she might look at all of the above and not work up too much of a sweat. Again, I do think the abstinence/barrier angle is not something that's needed over the long haul.

I will add this: I'm not aware of anyone who's pushing barrier protection for oral sex very strongly re: HPV.

Fredo

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Fredo said: As for figuring out exactly which genotype of HPV one might have, currently there's no test approved for clinical use by the FDA that can do that, although that will likely change eventually (such tests exist and at least one has been submitted to the Feds for review as a clinical tool). Some clinics might offer such tests at present, but most don't. "Off label" use is not likely to be covered by insurance.

WAIT A SECOND!
My OB Gyn toldme I have type 16-18. How does she know?

WAIT A SECOND!
My OB Gyn toldme I have type 16-18. How does she know?

Well, like I said some clinics (not most, but a few will...) do tests that can figure out a specific genotype, so maybe that's what she did for you. HPV 16 and HPV 18 are the types most often found in cervical diseases, so perhaps it's a reasonable assumption they're making.

Not sure knowing the specific genotype will drastically change the recommended follow-up, but if it's HPV 16 they might tend to watch a bit more closely. The outcomes are all pretty similar with early detection, though.

Fredo

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Fredo,

On a side note... I'm not ready to jump into the "run for the hills" oral HPV band-wagon or anything but I did have one concern. Given the lack of testing in males for HPV I would think that oral testing is even more rare or even nonexistent. Wouldn't it be worthwhile to do an oral HPV screening even in a clinical setting to determine presence of HPV vs symptoms/diseases?

It could be that we'd all test positive orally for HPV and yet not be having any problems with it all. I still think that more research is needed. If nothing else it would keep you from having to use all of those "likelies and uncommons"

I have not had sex since July...
Since breaking up with my ex I'm afraid to date & have to try to explain the High Risk HPV.
I was diagnosed last jan. had the coloscopy, biopsy...
lots of testing.... due in March to test again.
I have been taking care of myself trying very hard to be healthy & build up my immune system. I pray I have a clear PAP...
if so my question is do I still tell future partners? Will it still be there just in submission??? Am I always putting someone at risk?
I know my ex has moved through many partners..he always felt he had no warts (like low risk) so he didnt have anything (which lead to the end of us)
It is fustrating that men can not be tested with the High Risk and women are the ones that suffer most from it. In my head I think even if the man I am with doesnt care that I have it...if we dont work out he will bring it to some other unsuspecting girl!

This issue of partner notification is tricky to navigate. I can walk you through the steps of what to say, and maybe how to say it, but the larger question is "Do I need to say anything at all??" and THAT is where I start hiding in the corner!

The issue of the need of partner notification with HPV is not as clear as with some other STIs for a number of reasons. HPV is unique when compared to infections like chlamydia, herpes, and HIV in that 1) virtually everyone probably haves HPV at some point, but in the overwhelming majority of cases 2) the virus does no harm and 3) will clear naturally. With the other common STIs, not all three of those points apply. Herpes is usually harmless, for example, but symptoms can recur years after infection. Chlamydia can be cured, but often has no symptoms and, undetected, can lead to problems in either gender.

That's not to say that HPV is always harmless, because of course it isn't (and women need regular Paps), but most often the infection causes no medical issues.

So, more and more you hear folks in the community say it's not worth the potential trouble of bringing it up.

Still, what about a partner's right to know? Maybe with knowledge of HPV they'll be more likely to insist on condom use, for one thing, which might reduce risks with the virus. Some would argue that even though the infection is common, usually harmless, etc etc, none of that trumps the need for open discussions about sexual health.

If you do feel the need to discuss HPV with your partner, emphasize the fact that the virus is a normal among most all sexually active people and there is seldom anything a man needs to do when a female partner is diagnosed, and that the immune system typically gets rid of HPV on its own.

I hope others who use this board will weigh in to let us know what they think about this issue.

Hope this helps.

Best,
Fredo

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I have a couple of issues- one relate to the one above- In July of last year I broke up with my sexual partner of 9 years because he wished to explore other relationships. I have had yearly PAP smears for the last 30 years or so and suddenly in December I had a pap smear showing ASCUS- I had a colposcopy with the same results and was set for a PAP smear at the beginning of March which came back as severe dysplasia. I am scheduled for LEEP in April.
My question- since I know his intention is to explore relationships with other women and since I am relatively sure the HPV had to have been present during our relationship(I have been abstinent since our breakup) should I notify him? We are still friends. My fear is that if this should develop into something more serious, he is going to be very upset if he finds I did not tell him and, I do have concerns for other women.

Second- How did it go from ASCUS to severe dysplasia in three months?

Hi Jac,

I think it might be too much to expect you to notify a former partner, or to expect him to notify his current or future partners about an infection that, even if he had it once, he may not presently have. There's no reason to tell him based on worries for his own health; really, there's no testing he can do that would be helpful in that regard.

But let your gut be your guide here. Sometimes the best reason to talk about this with someone is if you feel strongly compelled to do so, and are unhappy about not bringing it up. I stress, though, there is little medical urgency for him, and unlikely to be any for his new partners, either.

Hope this helps.

Best,
Fredo

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