[Question #11183] HPV Vaccine Question from a derm PA
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16 months ago
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I'm healthy 28yo male PA working in dermatology with history of GW that were treated/cleared 2 years ago, possible recurrence this Feb. One ~1mm lesion was treated, but nothing since then. Biopsy of similar lesion nearby said "epidermal hyperplasia, no definitive viral cytology, but given proper clinical context, could be early evolving condyloma", so still unclear completely.
I’ve recently started dating a 23yo girl who is unvaccinated, but is in the process, and has had 2 sexual partners before meeting me. She has had the first 2 shots, 3rd is in Sept. I really like her and want her protected.
My question:
1. How effective are 2 shots out of 3 in preventing HPV infection if we have sex before her third shot? OBGYN doc’s I’ve asked this to have told me “just use condoms while she is getting vax’d”. I’ve told her we should wait at LEAST 1 month after the 2nd shot to at least mount an immune response to that one.
Can give more info. Hopefully @ Dr Hansfield only bc I've read his stuff.
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H. Hunter Handsfield, MD
16 months ago
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Welcome to the forum. Thanks for your question. FYI, it's by chance I'm responding; users do not have the option of selecting the expert who responds, but in any case Dr. Hook's expertise is no different than mine.
Your prospective partner is completely protected already. Research the last few years has shown that two doses of the HPV vaccine is fully protective. Although the third dose is still recommended, it's now a soft call and most experts consider it important primarily to assure prolonged (perhaps lifelong) protection. But she is now fully immune to the 9 HPV types covered by the vaccine -- which includes HPV6 and 11, which cause ~90% of genital warts. (Not counting any of those 9 types with which she might already have been infected, which is unlikely based on her sexual history.)
From an HPV standpoint, there's no reason you and she cannot safely consummate your relationship whenever you're ready.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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H. Hunter Handsfield, MD
16 months ago
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One more minor clarification: your partner will be fully protected once a month has passed since her second dose. That time might have already passed.---
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16 months ago
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Thanks for the info. And as an aside, my comment about specific expert adevice isn’t meant as any disrespect to Dr Hook.
Follow up question: do you still stand by previous statements regarding clearance/“cure” after 3-6 months assuming no recurrence in young, otherwise healthy people?
Anecdotally, I’ve had many 50+yo male patients with chronic recurrent GW, but I feel this may only be selection bias that they present to my office given their difficulty clearing the infection.
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H. Hunter Handsfield, MD
16 months ago
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My advice and that of my clinic staff about time to reduced infectivity, or true suppression by the immune response, is and always was a rough, nonscientific estimate. When treating warts in the STD clinic, we advised it was likely that transmission risk is immediately reduced to some extent by immediate wart removal or shrinkage; and that probably viral shedding is a lot lower and transmission risk further reduced over time; and that if warts were gone and had not recurred by 6 months, probably they were not infectious for partners. But there was no science whatsoever behind all this-- and there are no guarantees. In any case, since your prospective partner has been immunized, if I were you I would be entirely comfortable going ahead with a sexual relationship even if I had visible persisting warts.
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I'm not at all surprised by your experience: obviously dermatology practices see a very biased sample of genital warts. It makes sense that that's where problem patients and those with atypical late recurrences are likely to go.
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16 months ago
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Thank you,
My final follow up question, and this is likely redundant, but for clarification:
On the specific topic of HPV, given a month has passed since the second vaccine, do you see any value in using condoms, or is it a moot point in light of the high efficacy of the vaccine?
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H. Hunter Handsfield, MD
16 months ago
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From an HPV standpoint condoms are not necessary. And they don't work well for HPV prevention anyway -- too much skin contact above the condom plus secretions working their way under the rim. (The chance of HPV transmission is reduced for any single exposure, but with multiple exposures over time HPV is just as common in condom users and non-users.)
That completes thread. I hope the discussion has been helpful. Best wishes for a rewarding new relationship!
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