Good point David. We know that HPV-16 takes two years to clear, but in men it takes twice that amount, so it's 4 years. There are some HPV-16 strains that may be more resistant to treatment, and of different biology, and some even show failure rate after 5 years. I read before that multiple exposures of HPV increase the risk of HPV SCCC, so that goes back to your question, how, if there is an antibody after exposure. More HPV discussion to follow. Where is MD when you need him

The body in PEOPLE WHO HAVE AN IMMUNE SYSTEM THAT RECOGNIZES HPV 16 AS A THREAT develop antibodies, not patients who do not. (We didn't and so we got the disease.) Many patients come out of treatment theoretically with HPV still in their system, but without a good way to test for it, no really good study has been done of this. Ironically some develop antibodies and some do not. Treatment doesn't change your immune system. I don't know of but one study that looked for circulating HPV antibodies after treatment. That was a really small group and strong opinions about this could not be drawn from it.

I don't think that anyone who knew about this study going on, expected anything to be different than what they found. Spouses are mathematically just like the general population to begin with (some with protective immune systems and some without protective immune systems to HPV in ratios that should be identical to a general population), so their antibodies re this would match those in the general population, not be unique because they were married to someone that had HPV 16 disease. (Or in the general population date someone with HPV16). The patient is the person that is different, not the spouse. The spouses odds are the same as anyone in the dating world for getting and clearing HPV. This study was done to quell the dysfunction in sexual and intimate relationships between oral cancer HPV+ patents and their spouses, which is a common phenomenon. Personally I don't think it will change things much, facts as they relate to making intimate decisions only speak to one of the reasons for dysfunction.

By the by, who said that men take longer than 2 years to clear an HPV infection? And where is the data on multiple exposures? I don't even know how you would study that�. Reference please.

Thanks Brian, I'll have to read this thee times to finally absorb it all. I read that "twice as long as women comment," in a otolaryngology HPV, head and neck cancer book, and will have to look for its reference, and know it wad referenced in others as well. The multiple exposures, I could be misreading, could mean multiple infections, but will check that too. May have been with HPV cervical cancer, not sure. Hopefully I can get that today.

Most of what we know about this is derived from the cervical cancer model, and while there are some correlations that can be made, the science of what happens in one anatomical structure when compared to a completely different one is not a straight across transfer. In oral we are looking at heavy involvement of lymphoid cells which are not the same kind of cells that are on the cervix. Even the two year clearance point which is a reference made often is related to cervical, we have no clue that I am aware of in oral that it is the same. One study took a cursor look at this, (NHANES). We all just suspect that the immune system deals with both in the same ways, and the same amount of time.

So this is again a demonstration of how far behind we are in understanding HPV16 itself, and working from the data which is all related to a different anatomical site with different characteristics. We can't scientifically assume with absolute certainty that it all behaves the same, so in the absence of hard data, we make scientifically based GUESSES.

Another example is the decades of dormant or latent development of a cancer so frequently mentioned by doctors in the media. We know that some viruses behave this way- but others do not. People like Posner and others are speculating when they say this because it seems to make sense. But there are no existing science articles that prove this in HPV the way we can prove it in HSV-1 for instance. When in its dormant state we can go find it living on the ganglion of your nerves. HPV -no clue. So there is a lot of scientific supposition and speculation, that may very well be right, but if there is a dormancy period after an early 20's exposure how do we account for the 20 year olds that re getting an HPV+ OPSCC? Absolutes in cancer should never be used. There is also some logic socially to support this idea. Maximum sexual partners and exposure happens in late teens and twenties. After that, people usually end up in stable monogamous relationships limiting their exposure - but late 40's is a peak for cancer coming to light. That would be a good argument for dormant period of development. But remember no hard science to support any of this.

Posner has also promoted the idea of self inoculation. Someone transfers a virus from their genitals to their mouths. Interesting idea.... not one shred of evidence that suggests this actually occurs. Doctors that are talking heads in the media get lots of weird and off the cuff questions, which some attempt to answer on the fly. When they do that, even if they are a knowledgable treating doctor, they sound authoritative on TV, but at the end of the day in the science community they are frowned on for going to where there is no evidence and speculating as if it were fact. Sometimes it is best not to worry so much about being thought of in the media as the "go to guy" to get your name out there more (some of these doctors actually have agents which work to get them bookings) than to just say we don't really know for sure when the reporter wants an answer that has meat on it. The difference in all these doctors in my mind is that if you have your name on a peer reviewed journal document, you are the real deal. Otherwise you are just another TV talking head. Said with respect for these guys that are constantly being put on the spot, by someone who, as a lay person, has no problem with stating that I don't know in public. After all I'm just another guy, not a doctor that should know what's what.

There is a lot of data on cervical, not so much on oral.

Brian, here is the book name, chapter, quotes and links (through OCF I can't copy pdf) to the two items I mentioned in this thread:

"HPV and Head and Neck Cancer. Guest Editor Sara I. Pai, MD, PHD
Otolaryngollogic Clinics of North America.Volume 45. Number 4. August 2012"

Biolgy of Human Papillomavirus Infection and Immune Therapy for HPV-Releated Head and neck cancer. Simon R. best, MD, Kevin J. Nipaerrko, AB, and Sara I. Pai, MD, PHD:

"Most HPV infections are cleared by the immune system within 2 years, defined as an absence of HPV DNA detection on follow-up serial swabs after after detectionof the initial infection. 2 At 12 months, 66% of infections are cleared; this increase to 90% at 24 months. However, in men, HPV-16 has been identified as one of the slowest viral types to be cleared, and takes nearly 2 times longer to be cleared than other high-risk viral types. 2. This is interesting finding because HPV-16 is the viral type that accounts for more than 90% of HPV related oropharyngeal cancers is the United States, and this disease is more prevalent in men than women, suggesting possible gender differences in the ability to mount immunologic responses agianst this viral type."

2. http://www.oralcancerfoundation.org/HPV/pdf/LANCET-HPV-in-men-2011.pdf

Peristant oral HPV infection is a risk factor for the development of HPV-related Oropharyngeal cancers. The prevalence of any HPV type in the oral cavity for both men and women is approximately 6.9%. However, when separated by gender it is signiifigantly higher in men (10%) than in women (3.6%). 5 Oral HPV infection is associated with certain sexual behaviors, with risk increasing with the number of oral sex partners. 6 In healthy individuals, the clearance rate for oral HPV infection at 6 months is approximately 40%. 7

5. http://www.oralcancerfoundation.org/HPV/pdf/Jama-2012.pdf

The take away statement in the Lancet article was that clearance time OF ANY HPV, was 7.5 months, but for the one that we all worry about HPV 16 it was about 12 months which correlates with the cervical clearance experience of 16 & 18. Very common #'s 6 and 11 can take years to clear, the ones known for genital warts.

So if you really want to be grossed out about something (as the science guy, I seldom get to frame things in those terms, that is just me speaking as a guy) 50% of all men have a skin infection in the gentile area (not only your equipment but the surrounding tissues) in America currently have a non papilloma producing infection with 6 or 11 or both. The number for women is 60%� so while it isn't producing warts in most individuals, it is still there, and still transmittable to others. I have never been more pleased that I am not in the dating world today. eeeewww�.

Also the very important Gillion article from the NHANES study, really told us tons abut who, and what age, with what behaviors, gets infections, and this study defined the demographics of who is getting this. There is a lot of meat in this paper. Bottom line 7% of us have an active oral HPV infection at any moment in time across all population types. However when you look at age, the number really changes that overall average with two peaks one in the forties and one in the 60 year old groups. The paper states (and this is obvious in most diseases), that this was expected, and that there was a distinct relationship with higher age to increases in infection. As we age, our immune systems become increasingly incompetent. Welcome to your golden years. So we get more of everything, HPV infections are just another thing on a really long list.

Umm Brian, I don't think the figures quoted from the Lancet are correct. the

[quote]The take away statement in the Lancet article was that clearance time OF ANY HPV, was 7-52 months, but for the one that we all worry about HPV 16 it was 12-19 months which correlates with the cervical clearance experience of 16 & 18. Very common #'s 6 and 11 can take years to clear, the ones known for genital warts. [/quote]

It appears to be a layout issue but the figure you are reading as 7-52 months is actually a single median figure of 7.52 months (ie less than 8 months) for ANY HPV and 12.19 months for HPV 16

I can find no suggestion that time to clear is any different for men than for women. And certainly not 4 years

Nice catch Karen!! Thank you, we don't want bad info out there. Well, at least we got this right - it is the same period of time. I'm going to go back and edit that post later to get the bad info off the thread so no one is confused in the future.

Thanks for the updates, Brian.