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Is this true? I have seen a question like this:

Does vaccination protect the unexposed region from the same type of HPV if one has a genital exposure, but not oral, or vice versa?

I could not find info on this, now if I were knowledgeable on all the mechanisms behind HPV, this seems like it has an obvious answer, but I am not. I only know that oral HPV without the visible lesion is not easily transmittable, that HPV-16 is nearly all of oral HPVs. I wondered, HPV-16 is the most common, if I were to be exposed genitally, but not orally, would Gardasil or similar vaccine protect me orally? Or once the virus entered your system somewhere, at that moment, vaccination cannot help, so vaccinating will protect me from everything else that it covers, but not HPV-16, regardless the location.

Is question legitimate? If this was true, it might mean that if you are clear at the genital region, you are also clear in the mouth region if we are talking about HPV-16 for example, for one particular type.

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Welcome to the support group. OCF has been involved in the research of the oral aspects of HPV infections since 1999 when a research collaborator of ours Dr. Maura Gillison first laid out the evidence that HPV was driving the rapid growth in oral cancers, specifically oropharyngeal cancers. So from a science perspective, this has been historically one of the foundations strengths. There is a ton of information on our main web site about all this both our writings and also lots if links to the solid information the CDC and others have put out. That section of our site is at this link

https://oralcancerfoundation.org/understanding/HPV/

There are also the full science articles as published in respected peer reviewed science journals for those that want to get every detail in the research section of our web site in chronological order as they were funded, understood, and published if someone really wants to understand things at that level.

https://oralcancerfoundation.org/research/

So to your specific question. HPV is not a systemic infection. It does not travel from the cervical area for instance to the oral environment through some pathway or mechanism in your body. Each site that is known to be vulnerable to infection requires it’s own exposure.

Testing positive for HPV in a cervical exam is not a predictor that you will get oral or oropharynx HPV etiology cancer. But it is possible to pass the virus to a sexual partner while that infection is active. The important thing to remember is that the vast majority of men and women that get an active infection DO NOT subsequently get a cancer from it. The virus is ubiquitous in our world. Pretty much everyone that is sexually active will get an infection early in their sexual lives mostly in their teens and twenties. But 99% of those that get infected will have an immune system that will recognize this threat and destroy the infection. Only about 1% of individuals have an immune system that will fail to recognize it and then it will ultimately over many years, decades even in oropharynx cancer, prosper into an actual malignancy.

With the changing of sexual behaviors that occurred starting in the 1960s, this became an increasing problem particularly in oropharynx cancers. The increasing trend line of higher incidence rates continued and for several decades went unabated. That was until the introduction of a safe an effective vaccine that prevented the main versions of the virus particularly hpv16 from ever getting a foothold in vaccinated children. That was 2006. Several years later the vaccine was improved to cover even more oncogenic versions of the virus. Studies today particularly in cervical, show its effectiveness as the incidence rate of cervical cancers has declined. That has not been seen in head and neck cancers yet, though they will ultimately decline as well, because if the many decades long latency period of oropharynx cancers. The vaccines impact is systemic and protects all areas . Essentially if you cannot get the infection, you cannot get any of the HPV cancers.

So your second question. Remember that most people who get the infection have an immune system that will clear it. No matter how many times they are infected. Most do not even know they have been infected, as there are no outward symptoms, so you will get it, clear it, and never know that you had the infection. Women who get tested for HPV during cervical exams can test positive on and off during their lives depending on the timing of infection and testing. That does not mean that they will get cancer. The ones that test positive and continue to weeks and months later, have persistent infections and are the ones at risk.

There is no good HPV testing mechanism for men. For us that is a problem as it can exist for decades in us asymptomatically until the cancer develops if we do not clear it naturally.

Getting vaccinated after a number of sexual partners that may have infected you unknowingly has decreasing value as you age and have more partners. For sure the versions that you have not been infected with, and also are lesser threats, you will be protected from. This is why it is so important to vaccinate our kids before their sexual debut. Parents don’t like to hear this, but that is usually before the age of 13 when experimentation related to sex occurs, so between 10 and 12 years old is the recommended age. There doesn’t appear, now with many years of data, that the vaccine wanes in effectiveness so there are no boosters required.

One more point - there are no visible HPV lesions, only visible early cancers. So testing is your only course of discovery. If you have ever tested positive for the most dangerous one version 16, and you have had since that positive test no development of pre cancers changes to your cervix it would be safe to assume that you have a robust immune system that has protected you, and has left immune B cells behind to rapidly detect any new infection so that it will be dealt with.

I’ve lectured on this at universities and medical dental professional society meetings for many years. Most of those presentations were four hours long. There a lot of little details about all this that are interesting. Doctors, not average people, need to know all that. If between what I am posting today and the website pages that are vetted information did not cover what you want to know please ask more and I and others will try to get you the right information.


Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.
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Hello Brian, I appreciate your thorough answer greatly, thank you for all the information you've provided me with. (coming back here after typing my thing out) Now I see that you are the founder of the forum and also a survivor, thank you for your work sir!

I do have a few follow up questions;

> So to your specific question. HPV is not a systemic infection. It does not travel from the cervical area for instance to the oral environment through some pathway or mechanism in your body. Each site that is know to be vulnerable to infection requires it’s own exposure.

That is awesome! However to be sure I understand this correctly, does this mean that if a female patient with a diagnosed cervical HPV-16, who for this example we are sure that never caught oral HPV, if that patient takes Gardasil 9 for example while being still positive or not (does it matter?) for HPV-16, the vaccine which covers, well all current vaccines cover HPV-16, will this person be able to protect himself from HPV-16 in the oral cavity after gaining immunity? If this is true, then I am confused, how does the vaccine protect us at all sites, does naturally having and clearing genital means that one will be naturally protected in the genital, but not oral once again.

Also, I see that nearly always it is HPV-16, does literature found any other type, regardless how rare that is? And if testing is not approved, how do we isolate HPV-16 as the main cause and we proof that it is the one that causes it always?

Also what are the transmission rates of both genital and oral, or at least oral more specifically and for the transmission to happen - must visible lesions be present?

I know that about 3% woman and 10% men currently in the US do have oral HPV, but when I read the studies it becomes cloudy, studies of such type I believe are hard to make, additionally it seems like there are no approved tests for oral HPV and in these studies they use for DNA/mRNA swab tests. So I wondered, if there are some FDA approved tests that work on swabbing, like the cobas or the Aptima, if these are swabs for epithelial tissue, why can't they be used in the oral cavity, does the oral cavity needs to have lesions to be measured at all? Or even penile or anal regions? How come then there are studies talking about transmission rates, if as I've seen HPV lesions in the oral cavity don't just pop up in a a few months, all too confusing?

I see there is a lot of literature and I have read some, but I am afraid that I will need to spend eternity and still not be qualified to answer these above questions. frown

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First to reiterate, there are no visible HPV lesions. There are cascade lesions like precancerous tissue changes, those are something more now than HPV. So there is nothing to see to tell you it’s there. Testing is a blind superficial swab or a more effective brush cytology cell collection commonly used in cervical. Bush cytology works very well in cervical, and since its introduction in the early 1950s is responsible for the dramatic drop in the death rate from cervical cancer. It is also a blind collection of cells, and as it is an abrasive collection of cells, it is nothing like swab collection. The idea works in cervical because it’s a relatively small area, unlike the oropharynx which is a huge amount of territory to scrape cells from, especially for a cancer that is not on the superficial tissues.,.

Abrasive brush collection of cells and then the following pathology to look at them under a microscope has many positives. It’s inexpensive, it collects a large number of cells from a specific area, so the pathologist has a decent sampling for a screening exam, but not as much information as from a real incisional or punch biopsy. A company tried to market brush cytology to the dental community for several years as an alternative to conventional biopsy, but failed. Part of their logic was that since general dentists are disinclined to do biopsies (ugh blood, eek), they might do this instead on visible lesions and catch early precancers that were visible but undefined as to what they actually were. But pathologists found the samples too small, and worse there was no cellular architecture, the layers of cells in proper positions from the outer epithelium down to the basal layer. Instead of nicely structured layers of cells like a punch or incisional biopsy, you got scrabbled eggs. Cells from all strata of tissue out of relationship to each other. Not as useful or definitive.

So other collection ideas were tried like gargling in the back of your throat with saline, but again while it dislodged some cells, who knows from where any suspicious cell came from. Add to that oropharynx cancers in the tonsil for instance, are within the tonsil not on the surface, so not visible, or collectible,or in the tonsilar crypts which are folds of tissues and again nothing early in there is easily accessible or visible.

From all this you can see that not being visible, and not being sampled easily is the problem with early discovery outside the cervix.

The vaccine is systemic. Non vaccinated people need to get the infection in each individual site, and can get them at different times in their lives depending on exposure. But they are seldom synchronous cancers. If you had and cleared a cervical HPV infection, the odds are very much in your favor that exposed elsewhere you would also clear those as well.

In oropharynx cancers version 16 is almost always the culprit. In determining oropharynx etiology (viral or something else) there, the p16 test is often used because it’s the most likely to cause those cancers. In the cervical areas it is a major player but so are a few other versions, most never found in oral. As stated earlier, no visible lesions means no easy detection. Oropharynx cancers are usually found late as a neck node metastasis, which Is hard to miss.


Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.
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Thank you once again, I love nothing more than detailed explanations.

I still have follow up questions and a few that I have thought about, but have not researched:

0-A.) To confirm the following:

> So other collection ideas were tried like gargling in the back of your throat with saline, but again while it dislodged some cells, who knows from where any suspicious cell came from. Add to that oropharynx cancers in the tonsil for instance, are within the tonsil not on the surface, so not visible, or collectible,or in the tonsilar crypts which are folds of tissues and again nothing early in there is easily accessible or visible.
From all this you can see that not being visible, and not being sampled easily is the problem with early discovery outside the cervix.


If oral HPV is so hard to detect and all the superficial easy methods are a failure, does this allude that the transfer from oral to vaginal or penile (it seems like oral to vaginal is harder than penile due to the penis physically reaching the depths of mouth much "riskier" compared to only the saliva and the tongue of the mouth when oral is done on a vagina) is also much much harder and rarer than anything else?

0-B.) To follow up on this I read on the website:

> More males than females will develop oropharyngeal cancers. This understanding was elucidated and the reason revealed for it in a published study by Gillison et. al. Through conventional genital sex, females acquire infection early in their sexual experiences, and rapidly within very few partners, seroconvert that infection into a systemic antibody that protects them through life. Males take a far greater number of sexual partners to seroconvert an infection into a systemic protective antibody. This increased number of partners and exposure before the development of a protective antibody against the invading virus is most likely the reason that more males will later in life develop oropharyngeal cancers than females.

This is something we have touched on, though it is different here it seems. The process of seroconversion is going from infected, to having antibodies I assume, googling says from infected to having antibodies that an infection can be detected. It says that males take a far greater number of sexual partners to seroconvert the infection into systemic protective antibody, but why? Are they slower to build an immune response? I am really not understanding this, here we are saying that if a woman is exposed only to genital sex(?), because they are faster in building systemic protection, by the time they are exposed to oral sex and oral HPV, they already have the systemic protection? But in real life isn't it much more common for females to be exposed to oral sex before genital sex and much more commonly then men? There are a lot of studies published by Maura Gillison, so I could not find this specific one where it explains the issue, but I do not understand this abstract/conclusion paragraph. frown

0-C.) Something that I am heavily confused of, some studies that I have read say that transfer of high-risk HPV is like 20% in 6 months of couples having sex on regular basis, how come do we so easily assume that everyone has HPV past a few sexual partners, even if those were one-offs? By this statistic not many people under 25 should have HPV, because it is hard to get, and it takes time for exposure?

1.) I understand what you mean when you say that HPV has no lesions, everything you see, for example on the cervix, is a pre-cancer most of the time caused by HPV. Now I know that the PAP test has different grades and then the biopsy has CIN grading. Let's say one does a mRNA/DNA swab on the cervix, they find a presence of the virus, but the PAP is totally clear, does this mean that this person can infect others, but is immune to. Or it does not work like that? I have a friend who for at least 3 years had the ACSUS status, before that she was clear - but it was 4 years before these, since that clear PAP to the one that is not, she was with 1 partner in a monogamous relationship. Now has been constantly on the ASCUS status, and newly single and still very young she is always concerned if she needs to declare this to people she has sex with, even though she always uses a condom, she is not sure what to do with the status - if she has a robust immune system that does not let the disease progress, why does the cell changes not go away? Her doctor just keeps saying to go on regular 6 months check ups, but it is always status quo.

2.) When you explained systemic vs non-systemic, I kinda realized that you will always get the virus, with the vaccine, you will just clear it, but does this also mean that in the mean time you can spread it to people having sex with if they are not vaccinated or have not been previously exposed to the variant, then you can transfer them the virus?

3.) I see tracking studies done and it seems like the protection lasts, now I am not sure which antibody test exactly was done, but do you recommend re-testing on a decade basis, or even taking a booster shot? This is a question I wondered, let's say the ultimate Gardasil for the following decade is Gardasil 16 (All high risk + warts), can I take it and be protected, I have not read literature on this issue, people boosting from Gardasli 4 to Gardasil 9 or any combination of it, so I wondered, also why do adults need 3 doses and kids 1, does it have to do with a more robust immunoresponse in children?

4.) Also this week I am getting a booster shot of COVID, Pfizer more specifically, so do I need to wait or not? I read that the shot can be given with other vaccines, but not some like the pneumococcal vaccine, now Pfizer is mRNA and the pneumococcal vaccine is conjugate vaccine, according to hhs.gov, it groups recombinant vaccines (HPV) with the pneumococcal vaccines. So does this mean that the I should also delay my immunization due to my pfizer booster or the vice versa?

5.) For me personally I am a male that most likely have gotten penile HPV, I am about to vaccinate myself this month because I just now at 26 realized that this is possible, but I might not have gotten oral HPV, because I had a limited experience with it, but I have deep-kissed a few people, but this is also debated, it seems like it is possible, but again to isolate variable as this one is a bit hard I imagine, though it only makes sense that this transfer is very possible.
So I am curious to know what else I can do to protect myself from this, you can link me any material, but if I can do 80/20% study on this, would be awesome. Of course I will vaccinate myself, but sadly the system failed us and even though I am young I might be be a bit late to that, but also I might not. So anything that you hoped to know, but you did not, something that everyone should but does not, like I just learned the other day about the over under cable wrapping method and I also recently learned that measuring a blood marker like ApoB over LDL-C is much preferred, but no clinician does it, though the guidelines do. Also measuring Lp(a) at least once, will give you an indicator of your genetic atherosclerotic risk and a marker that still does not exist, but one for a family of lipoproteins ApoC3 would be also really useful in the future. I know these stuff because family members have notorious cardiovascular issues, so I read a bit on the topic. I am in awe how I never knew about HPV, although it is not statistically as important as other issues, it is something totally preventable by a simple shot in your youth, a problem basically fixed 15 years ago, but my memory until recently was that HPV vaccine is something that no girls even took because there were some issues with it, then I added 2+2 and it is 2022 realizing that that was bullshit! Once again, I am curious about anything when it comes to sexual health at this point.

6.) What are the best methods for screening, if the gargling methods and swabbing are not available, and if visible changes are late stage, what is something that everyone should do, but does not know, something like the ABCDE of Melanoma, or testicular cancer. Once again, any simple material, blogs, pocket guidelines would be greatly appreciate it over studies, but anything is fine. I browsed the web now and I have not read, but would: https://oralcancerfoundation.org/screening/ conclude everything mentioned in this question?

7.) This is mind baffling to me, why is it always mentioned that condoms do not protect against HPV, when studies do show reduction, in the case of HPV warts, I understand that these are more transmissable and outside the vagina or the penis glans. However why is condom usage in a way condemned against protection of the high-risk types fully? If you use a condom and wash yourself without touching your penis to the other parts exposed, or even better for women, there is no other fluids from the male partner, if he only has HPV-16, how does condom not protect fully in that case?

I am trying to be as responsible as I can be towards this sexual infection/disease, so any suggestions or pro-tips in this sphere I would wholeheartedly appreciate and immediately adapt!

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Respectfully, you are asking about things here that you have no control over, and will likely never impact your life. Remember that the data after many years shows that only about .9% of the American population will have a non resolving HPV infection that cascades into a cancer. That makes your risk in all this very low and not worthy of changing your sexual life.

I will answer one of your questions tonight. Condoms do provide good but not perfect protection. As a male there is always an area around the base of the penis that is not covered. This will come in contact with your partner. That area is not at risk for cancer but genital warts caused by HPV. As to the types of testing you are referring to, those are generally not available to the public, used mostly by researchers, and are wildly expensive.

Each day I get between 15-25 emails from oral cancer patients, most who are in difficult situations or needing information about immunotherapy’s that are still in clinical trials. I need to devote my time to actual patients and care givers, so I won’t right now be able to get into the minutiae of your questions, which the answers to will not impact your life. I hope you do not find this rude, but in the next few weeks if time permits I will try to answer you a bit more.

Your can set your account to email you when anyone posts a reply to your thread. Please do that and in the hopefully near future I will reply further. If it makes you feel more secure there is no harm in getting vaccinated, millions have without issue. But in general I do not advise it to most people that have had a few sex partners. HPV is without question the most common sexually transmitted infection and pretty much every sexually active person will be infected at some point. You probably already have been and your immune system has taken care of it without any signs or symptoms of the event.

Last edited by Brian Hill; 01-12-2022 08:17 PM.

Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.
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You are right, answers to any of these questions do not matter, the past is the past and the future is me getting a vaccine, it is as simple as that. For the worst, at worst I have a lot of time until. I greatly appreciate you being direct with me and it is my bad that I have not realized that answering such questions is not something you write in 15 minutes. The real reason I am asking so specifically is because I am genuinely curious about the mechanisms of the virus, but it is very selfish of me to ask for your time just because of my curiosity, when as you said there are people truly having life changing issues due to it. My curiosity can be drooled on all of the scientific work that has been done, partially thanks to the hefty contributions of Maura Gillison, but I do know how deep one can go into the rabbit hole of research, especially as a newbie, so I will not let my Dunning-Kruger naive curiosity bury me in such material, so I will just let this topic live and if you ever do have the time for answers, I will gladly read them.

I will however, ask one question just because it is something I will need to bring a decision on right now, and that is the question number 4.

4.) Also this week I am getting a booster shot of COVID, Pfizer more specifically, so do I need to wait or not? I read that the shot can be given with other vaccines, but not some like the pneumococcal vaccine, now Pfizer is mRNA and the pneumococcal vaccine is conjugate vaccine, according to hhs.gov, it groups recombinant vaccines (HPV) with the pneumococcal vaccines. So does this mean that the I should also delay my immunization due to my pfizer booster or the vice versa?

Hopefully you don't find me re-asking this offensive, but I understand if you do, so I am sorry for that. Once again, thank you for all the information you provided me with, thank you for being direct and honest. Hopefully HPV related oral cancers will be eradicated and hopefully people will make more educated decision for opting in or out the vaccines against this virus. Thanks for your contribution Brian and bringing such place as this one to life!

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I do not know the answer to your question about the Covid vaccine. What I know about it is only like most people, what I learn from the news stations. I went and got all three of the Moderna shots as soon as I was eligible. I think that your priority should be to get vaccinated and when ready booster shots for Covid without delay. That is more of an immediate and present day danger to you. Asking your medical professionals about when after that they felt HPV vaccination was ok would be better information than I can offer you.

I too am scientifically curious, and I think that makes you and I more alike than different. I read science journals all the time, or other books and items that inform me about something, less novels for entertainment. Your questions are not a bad thing, I just have to put some patients ahead as I am sure you understand. Be well.


Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.
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Thank you Brian. Yes, I agree with that statement, all my books are non-fiction and all my podcasts, blogs, forums all focused on the techincalities of stuff. I am reading scientific journals much more in recent time, but I am also having a fear that I am broadening, diverging to say - a bit too much, that instead of focusing on one or few of the stuff that truly interests me the most, this is why I am saying I won't go into this rabbit hole of this one and trying to just get a shortcut answer, I did not expect someone like you to come honestly, but kinda perfect! smile grin

Thank you again though, kudos to you!

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