[Question #11613] HPV infectivity, transmission

13 months ago

Female, 35 years, healthy. 5 years ago I had GW, treated by laser. Had some residual GW and the second treatment was 2 years ago. Since then 2 gyn reassured me there is no relapse. I noticed some small bumps in my vagina, but 2 experienced Gyn examined me and were sure these are normal anatomy vaginal rugae. So officialy GW free 2 years ( allthough I am still a little suspicious bumps inside vagina could be GW?).

1) My gyn says I am not infective any more. I read you guys say a person is not infective if 6 m gw free. What is your rationale behind this?

Could I be still infective after 5 y?

2) I was vaccinated after the infection with 9v Gardasil- does this diminish the infectivity?

3) Several scientific work ( Finnish family study) claim hpv can be transmitted to babies while carring for them- how can I protect my babies, to be 100% risk free I cannot even wash our dishes ( if I carry the hpv in the mouth- its possible), clothes and towels together? - its hard to live like that :-/

4) Is HPV eliminated when cleared or it is still in our body forever?

Thank you

Edward W. Hook M.D.

13 months ago

Welcome to our Forum. Thanks for your question. I'll be glad to provide some information

HPV is widespread, present in nearly 80% of unvaccinated adults. Vaccination has transformed the illness, providing >97% protection from infection with the types of HPV covered by the vaccine and partial protection for many others. For most people, between vaccination and for women, following recommended sexual health care measures, the infection is preventable or fully manageable. With these introductory comments I'll answer your specific questions:

1) My gyn says I am not infective any more. I read you guys say a person is not infective if 6 m gw free. What is your rationale behind this?

Could I be still infective after 5 y?

If you do not have detectable HPV you are almost certainly not infectious to sexual partners. Our 6 month recommendation is based on the fact that, IF a wart is going to recur, it typically does so within 3-6 months following treatment. The fact that you have not had a recurrence imakes it most unlikely that you will

2) I was vaccinated after the infection with 9v Gardasil- does this diminish the infectivity?

Great. Vaccination may somewhat reduce the likelihood of recurrence and certainly provides reliable prevention against future HPV due to the vaccine HPV types. Those types not covered by the vaccine are far less common than the types covered by the vaccine.

Indeed there are studies which show that following delivery to an HPV-infected mother, small amounts of HPV DNA can be detected in newborns however whether this detectable DNA translates to active infection is unclear and, in my opinion, doubtful. We very rarely see HPV is children. HPV is not transmitted, to children including babies, or other adults through activities of daily living. There is no reason to worry that you might transmit HPV to your child through normal activities including hugging, kissing, or bathing . Please d not let the fact that you had a wart in the distant past get between you and your child- there is no reason to do this.

4) Is HPV eliminated when cleared or it is still in our body forever?

In a fraction of persons who have had HPV treated and do not suffer recurrence, or in those in whom the infection goes away on its own, sophisticated, specialized research tools can sometimes find small amounts of HPV DNA still present in tissue. This does not pose a problem for most people with HPV

Bottom line- I fear that you may have been misinformed about HPV and it's consequences, including transmissibility. If you have not had a recurrent of the GW that was treated, you are quite unlikely to in the future. The fact that you had a genital wart is certainly not a reason to not fully participate in the care and displays of affection with your children.

I hope that this information i helpful. EWH

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13 months ago

Thank you for your answear, I would like to clear some points:

1) My gyn did not test me for hpv dna, his claim that I am not infectious was based solely on the fact that I am GW free ( he seemed sure about that). You say 6 m GW free is noninfectious. But how does this go along the claims that a person can be infectious also without visible GW? Is this based on your work experience?

2) I do not understand really if once HPV + or GW diagnosed a person is potentially positive or infectious for life?

3) How do your HPV/ Gw patients manage the household with children- can we safely wash the clothes and towels together without infecting the babies? ( some papers talk about transmission through towels). Can I sit on the beach on the same towel as my baby and be sure to not infect her if I have the swimsuit on?

4) I feel so stupid to have catch this, I was always so careful, but about other diseases, not hpv- because I thought it trully is a transient infection like flu, but only now I read it is not :-/ is there any way to be sure that I pose no risk to my children?

5) Does Gardasil diminish the infectivity of already positive patients because the viral particles are shed in mucosa full of Ab?

6)Can HPV be transmitted through saliva like some papers claim?

Lastly- is hpv a lifelong diagnosis like HIV regarding infectivity to others?

Thank you.

Edward W. Hook M.D.

13 months ago

Straight to your follow-up questions:

1. I'm surprised to hear this. Typically when persons are seen for their regular reproductive health care visits ("PAP smears" HPV testing is done. You might check with your GYN to be sure. If you are GW free however, as I indicated above, you will not transmit your GW to others. Not all persons with GWs have visible warts. Persons with HPV not manifest as GWs could potentially transmit their infections to others. Statements on this site are based not only on our combined more than 80 years of taking care of persons with STIs but on decades of research and reading the scientific literature

2. If HPV is present and untreated, in a small proportion of persons the infection may persist (i.e. the majority of HPV infections go away without treatment) and when persistent, active, detectable infection is present, persons are potentially infectious to others through sex.

3. This is repetitive. As I said above- "HPV is not transmitted, to children including babies, or other adults through activities of daily living. There is no reason to worry that you might transmit HPV to your child through normal activities including hugging, kissing, or bathing . Please d not let the fact that you had a wart in the distant past get between you and your child- there is no reason to do this." Thus you can certainly sit on the same towel as your child is on at the beach- HPV is NOT transmitted in this way.

4. I think you are confused. As I said above, HPV is widespread- over 80% of sexually active adults who are not vaccinated will get HPV. In nearly all of these infections (over 97%), the infection does go away without treatment.

5. Some studies suggest that the HPV vaccine enhances resolution of existing HPV infections

6. There are no data to suggest that HPV is transmitted in saliva. Kissing your child WILL NOT give them HPV

Regarding lifelong infection, as I said above- "In a fraction of persons who have had HPV treated and do not suffer recurrence, or in those in whom the infection goes away on its own, sophisticated, specialized research tools can sometimes find small amounts of HPV DNA still present in tissue. This does not pose a problem for most people with HPV" In other words, in a small proportion of persons with HPV, the virus can be detected for years after initial diagnosis. If the virus does persist, it is readily managed with routine GYN check-ups and care.

As I also said above, I think you are over reacting to your history of having a genital wart. Please DO NOT go to the Internet for information on HPV- much of what is found there is misleading. If you wish more information, go to the reliable web sties such as the one for the CDC or our parent organization ASHA (The American Sexual Health Association)

Final reminder- we provide up to 3 responses to each client's questions. This is my 2nd response. After your next follow-up the thread will be closed. EWH

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13 months ago

Thank you for your reply. I will use my last chance just to clarify some points and I thank you in advance for your patience.

I had a PAP C 5 years ago, in the same time as GW, HPV +, but after that all my PAP were A- normal, that is why he did not retest HPV- he said it is irrelevant and that HPV stays forever ( the second opinion gyn said the opposite, that it goes away).

1) Can you please explain- why a person is no longer infective if 6 months GW free if you say that people are infective also without visible GW? I really do not understand this and would be grateful for some clarification.

2) If I understand correctly our body definitively gets rid of HPV in 97% of time in a couple of years, there is only a very small proportion of people where it stands in the body like HIV or HCV and is capable of reactivation? ( some people clain hpv stays in the body forever and is always capable of reactivation and u are infective forever)

3) From your experience, in what time frame do GW usually dissapear on their own if left untreated? Would it be correct to assume that after 5 years the chance of me being still infective is very small? -I have a regular partner for 2 years and he did not get GW, I am mostly concerned to pass it to familiy members accidentaly through indirect contact.

4) If I take a bath- and sit naked in the bath, then after that my child stis on the same bath, in the case that I would be infective- from your 40 y of experience- does this pose a risk for transmission to my child? How do you advice your patients in this situations?

5) Does washing the underwear together pose any risk?

Thank you for your patience and congratulations for your great work here.

Edward W. Hook M.D.

13 months ago

As you know, this will be my final response. It appears that you continue to misunderstand that for nearly everyone with HPV, it is not a threat to health and not a problem. I encourage you to visit the web sites I mentioned earlier and to talk with your doctors.

1. Not all HPV infections lead to visible warts. In fact most HPV infections in women are detected on PAP smears but are not visible warts. These infections are detected by testing of PAP smear specimens for HPV and can be a source of transmission of infection to others. As I've said before however, if a visible wart is treated or goes away on its own and does not return for 6 months, that wart virus infection is not likely to be transmitted to sexual partners.. . Your GYN should be testing you routinely.

2, HPV infections are VERY different from HIV or hepatitis C. See my earlier comments above about why some people say that some (a minority) HPV infections can be detected after apparent resolution or successful treatment. Do NOT compare HPV to HIV or hepatitis C

3. Untreated HPV infections typically resolve without treatment within 2 years of follow-up. Visible genital warts are slightly less likely to go away without treatment than the flat asymptomatic HPV infections which are detected by PAP smears.

4. As I also said before, activities of daily living, including having your child sit in the bath tub you use or even is the same bath will not lead to infection of your child. I advise my patients, in the same way I have already advised you, NOT to worry about transmission of HPV to your child through kissing or activities of daily living.

5. Washing your underwear with that of your child or other family member does NOT pose a risk for infection for them.

Again, I think you misunderstand the significance of your past genital wart and are worrying entirely too much. This completes this thread. EWH

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