[Question #10507] High risk HPV positive wife

22 months ago

Brief History: wife and I have been together since high school. We took a brief break in college and we each a few other sexual experiences. me 2 one night stand unprotected and she had 1 one night stand as well. other than that we have only been with each other. a few yrs ago she got a positive high risk hpv test no cin etc. at the time we were shocked considering we have not been very sexually active at all outside of each other but we have an STD! it cleared within two years. my questions are as follows1) how likely will this be an issue in the future? will it come back again. My wife is going to stay up on yearly paps. 2) is there any other std we need to be concerned about? she has had the routine std testing during all pregnancies. we have been monogamous for the last 15yrs (brief split up when other encounters happened was 15yrs ago ) 3) the only std that seems to be possible we could have and not know is HSV2. considering 80% of ppl don't know they have it. I have never had any symptoms that suggest but seems it is usually asymptomatic. how likely is it we could have that from 15yrs ago only a few brief encounters. (unfortunately they were unprotected sex ) logic tells me No BUT we also were shocked we had HPV which obviously came from one of the few onetime encounters. what are the odds i have HSV2 and for 15years dont know it and havent yet given to my wife? we have unprotected sex 3 to 4 times a week on average. Is this something to even worry about? should I test for HSV2? ( to me herpes seems like the only other thing that still could pop up bc she has been tested for all the other std during pregancies ) should we move on without further worry about HPV or some other std popping up? this put a big strain on our marriage at the time, so I do not want any other "surprises" (Her Gyno implied originally someone cheated we got a new gyno and learned that new hpv infection does not implying cheating)

H. Hunter Handsfield, MD

22 months ago

Welcome to the forum. Thank you for your confidence in our services.

We get fairly frequent questions similar to yours -- monogamous spouse recently diagnosed with HPV, usually a wife with an abnormal Pap smear just as your situation. Many of them also involve couples in which either or both partners have few if any other past sexual relationships. I'll start with some general comments about HPV and its transmission and then go to your specific questions.

Over 90% of all sexually active persons acquire HPV at least once; by the time someone has had 3 sex partners, there is at least a 50-60% chance of being infected, so it's obvious that even the first exposure often results in infection. This reflects the other basic fact that among people at the most sexually active ages (roughly age 18-25), over half are infected and can transmit the virus. With rare exceptions, the precise source of any particular infection is never known or knowable. (In your situation with so few prior partners, you undoubtedly can make educated guesses. But do not assume that the source must have had multiple partners, a history of promiscuity, etc. HPV is equally common in people with many or few sex partners.) Many or most abnormal Pap smears and cervical HPV detected during a Pap smear reflect reactivation of a distant past infection, not newly acquired infection. Therefore, these findings in a currently monogamous couple do not suggest either partner has had other sex partners recently.

Having a "high risk" type of HPV really isn't as alarming as the words suggest. The large majority of high risk (potentially cancer causing) HPVs do not progress to cancer. Even when they do, total cure is the rule with simple office procedures.

For all those reasons, being "shocked" by your experience really isn't an appropriate reaction. This sort of thing happens all the time. Most likely your wife's gynecologist has said things along these lines -- and I'm glad to see her more recent gyn understands that HPV detection doesn't imply either partner has cheated. To your specific questions:

1) It is normal and expected for HPV, once detected, to again become dormant and not be redirected on future Pap smears. However, it certainly can happen and is unpredictable. The more important aspect actually is that your wife apparently had no dysplasia, i.e. no cellular changes due to her HPV. But the whole reason for continued periodic Pap smears is to detect such issues if the ever show up.

2) Because HPV is so frequent, far more so than most STDs, having HPV is rarely an indicator of other STDs being present.

3) There is nothing in your story that suggests a significant risk you or your wife has HSV2 and I do not recommend testing for it. Your comments about asymptomatic HSV2 are somewhat mistaken. More like 30-50% are asymptomatic. It is unlikely that you both have it and both are asymptomatic -- and thus it is improbable either of you has it.

Yes you definitely should "move on without further worry about HPV or some other std popping up." And none of this is a valid basis for any strain whatsoever in your marriage.

I hope these comments are helpful. Perhaps it will be helpful to share them with your wife! Let me know if anything isn't clear.

HHH, MD

---

22 months ago

thank you for all the information very informative. I do have a few follow up questions if it is ok to ask. 1) it seems as long as my wife stays up on yearly paps her health is safe in regard to HPV. In other words, forget about it every being serious as long as she is checked routinely? correct? 2) I think my fear with HSV2 is that maybe if I have it would not have passed to her yet. IE i see where one couple can have it for years and not give to the other although I do read that men give it women at I higher rate is that true IE my transmission rate to her is slightly higher the vica versa? 3) if you dont mind me asking how low of a risk would it be that HSV2 would be a future issue in our relationship. can you put an educated guess off your knowledge of the following: i contracted HSV2 in one of those 2 unprotected encounters 15 yrs ago, never noticing an outbreak, never passed it to her yet (after 15yrs of unprotected sex with her) is this sceniro like a 1/100 chance or more like 1/1000 chance?

3) Just to understand you are saying that IF one of us got HSV2 back then it is likely we would both have it now and therefore odds are at least one of us would show symptoms? or is there a good chance if one of us had it after 15 years we still probably wouldn't have passed it yet?

not trying to get hung up on Herpes it just seems like the only other std that could be hidden between us. you were very imfortive about the HPV and have calmed me down about that.

should I forgot about HSV2 and move on without another thought of it? sorry the HPV things at first was a hard thing to get through at first mainly because of the old gyn implying cheating, I am just trying to be confident in not needing to worry about the future

H. Hunter Handsfield, MD

22 months ago

1) Exactly right, nice summary. In fact, every three years may be sufficient Pap smear frequency. She should follow whatever advice she receives from her gynecologist.

Despite "not trying to get hung up on herpes", obviously that has happened anyway; you're obsessed about it.

2) If a partner has genital HSV2 without an overt outbreak, the approximate transmission risk is once per 1,000 episodes of unprotected vaginal sex. If your partners had a roughly average chance of having HSV2, that would be 20%, so now your odds become 1 chance per 5,000 unprotected exposures. Most newly acquired HSV2 does cause obvious symptoms, maybe a 25% chance of getting it without symptoms -- bringing your risk to something like one chance in 20,000 per exposure. And you had two encounters, bringing risk back up to one chance in 10,000. These numbers are only approximations, but you get the idea.

3) There's a good chance that if one of you had HSV2, the other would be infected after 15 years, but nowhere near 100%. (If you want to continue to play the numbers game, estimate how many times you and your wife had sex in that time and figure transmission odds around 1/1,000 each time.)

"should I forgot about HSV2 and move on without another thought of it?" Yes indeed: exactly my point!

---

22 months ago

Thank you for the reply. I apologize for getting up on it there is just so much mis information out there on so many topics.

Crazy how herpes is not very easy to catch but yet 20% ish of people have it. Just want to make sure I understand this part of it. There is around a 25% chance you wouldn’t have an initial outbreak and then about 30-50% it would be asymptomatic after that?

What is the reason not to test in my situation? Waste of energy bc I have 1/10,000 chance of having it?

Also if I did in fact have it what would the chances be I would have recurring outbreaks over the years that I would have noticed? I’m not saying I have always been on the look out but ever since a few years ago with hpv I have been definitely more “aware” of things down there. In other words in the last few years I more than likely would have noticed outbreaks?

From all you have said it seems extraordinarily unlikely that hsv2 would be an issue for me….. I’m going to do my best to forget about it and move on. In other words if this was you wouldn’t even consider herpes being a possibility in your marriage?

I know this is the last follow up thanks again for all the information.

H. Hunter Handsfield, MD

22 months ago

You're right -- there's a disconnect between prevalence and the per-exposure risk. Probably the most important aspect is that the data I cited on transmission risk is for chronic, long established infection. Recently acquired infection is much more transmissible. So in highly sexually active populations, when because partner change is frequent, many people have a new partners soon after being infected, accelerating spread in that sex partner network. Also, for reasons not entirely clear, transmission is more common in monogamous couples early in their relationship than later. There is speculation that the explanation may line in the nature of sexual congress itself: longer duration, greater intensity, etc might raise transmission chances.

The main reason not to test is that the tests are poor, often wrong -- both false positives (positive results in uninfected people) and false negatives -- although the latter isn't very common for HSV2, but a serious problem for HSV1, with a third of infected people testing negative. When the chance of infection is a lot higher than yours, testing often is advised -- but definitely not in people at little risk, like you. That said, you're of course free to take the chance. If definitely negative for HSV2, it would confirm you don't have it. (If you're tempted, definitely avoid IgM antibody testing -- only IgG tests are valid. Labs will know the difference if you decide to investigate.)

Thanks for the thanks. I'm glad to have helped.

---
---