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Can my boyfriend catch HPV from me through oral sex?

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Maricela asks:

Me and my boyfriend have been together for a long time, and I just found out that I have HPV. I told my boyfriend that I had it as soon as I found out and now he is acting really weird. Now, he doesn't want to give me oral because he is afraid that he may get it. I went to the doctor and asked if he could get it, and she said that as long as we are careful he shouldn't have anything to worry about. When I told him the news he did not believe me! He still will not give me oral even though it has been a couple of months. I am really frustrated!

Heather Corinna replies:

Did your doctor have a discussion with you about the fact that your boyfriend may already have HPV?

If you have been with him for a long time, and only recently was your HPV detected (particularly if you've been good about your STI testing and pap smears before now), you may well have gotten it from him in the first place. It's very difficult to detect human papillomavirus in men, even with men who are getting regular sexual healthcare and STI testing -- and the majority of heterosexual men are not. If he had any sexual partners before you, given how common HPV is and how easy it is to transmit, he may have been the one who gave it to you. If you did NOT have any sexual partners before him, but he had partners before you, you can be certain you got your HPV from him.

Even if you didn't get it from him -- if you had other sexual partners before and got it from one of them -- if the two of you have been sexually active for a while, and you had it before you met, , he probably has already been exposed numerous times, particularly if you have had any vaginal or anal intercourse. If you have engaged in those activities and have been using condoms, condoms reduce the risks of transmission, but not as well as they do for fluid-borne viruses (like HIV or Chlamydia): they still leave around a 30% chance of transmission with any incidence of that kind of sex, because condoms don't cover all of the surface area of your vulva or his genitals. So, he may have it from you already, or even with all that exposure, he may just be someone who isn't going to pick it up from you.

Oral sex does pose limited HPV transmission risks: it's not common, but it is possible. The level of risk is not even close to as much as vaginal intercourse presents risks, though. To give you a comparison, I'd say that if you use condoms alone to prevent pregnancy, you have a much higher risk of becoming pregnant with intercourse and condoms than he does from HPV through oral sex, even without using latex barriers for oral sex.

I hope that your doctor specified to you both what she meant by "careful." Careful, when it comes to safer sex with oral sex, means using a latex barrier: dental dams, or saran wrap or a condom cut down the middle and opened up if you can't find those. The bonus of a dental dam or saran wrap is that they actually cover more genital surface area than a condom does, so they're effectively a far better protection than condoms when it comes to skin-to-skin transmitted viruses like HPV and Herpes. What that means is that when using dental dams, his risk is pretty much nil from giving you oral sex. Not only were those risks fairly low to begin with, but using a latex barrier for that activity makes it incredibly unlikely. If he did not have HPV already, he is far more likely to pick it up from you during any intercourse, even with a condom, than he would be through oral sex with a dam. I don't know what your sex life includes, but if it includes intercourse as well as oral sex, it just isn't sensible for him to be more worried about oral transmission than genital-to-genital transmission since the latter is where the real risks are.

Has your boyfriend been in to see his own doctor or sexual health clinic during your relationship and/or after your diagnosis? If not, he's overdue on his own testing, both for HPV as well as for all other STIs. That's not only important for both of your health -- both partners always need testing, not just one, and should he be carrying something else, because you already have HPV, you have a bigger risk of picking up other STIs, and greater overall health risks if you do -- but it sounds like he could use to talk to a sexual healthcare professional himself to get better filled in on the facts.

Mind, even when he's more educated, he still gets to choose what risks he is willing to take and wants to take, even if his choices are not particularly reasonable or logical.

I get that you're frustrated and empathize, and I'm also sorry your partner has made what is likely already an uncomfortable situation for you more uncomfortable. It's tough to get an STI diagnosis, and easy to feel -- even though it just isn't so -- like a leper other people are afraid to touch. Ideally, partners should be as supportive as possible while still making choices when it comes to risk-management they feel are best for them. I hope that the issue of the oral sex aside, he has been otherwise understanding and supportive.

But we don't get to dictate to partners what they should or shouldn't be comfortable with. If even after knowing that safer oral sex is highly unlikely to pose any HPV risks he still doesn't want to do it, that's something you'll just have to accept. Obviously, you don't have to stay in a sexual relationship with him if you'd prefer to be with someone who is comfortable with cunnilingus (and plenty of other potential partners will be), but if you do want to stay in this with him and he doesn't revise his opinion or change in what he feels okay with, you'll just have to live with that.

So, encourage him to get in for his own testing, as well as to have an in-depth discussion with his own healthcare provider about HPV and transmission risks. You can also help him get more filled in through some links I'll provide for you below. Once he does all that, if he still states he just doesn't feel comfortable with any kind of sex with you, again, you'll just have to accept that, and you can choose to live with that, or consider that perhaps, this isn't the right sexual partnership for you both anymore.

Here are those links for you, with my best wishes for your health and happiness:

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