[Question #11647] HPV 6 - Transmission Likelihood (5+ years without GW)

13 months ago

Hi Experts,

Approx. 7 years ago, at 18, I was diagnosed with GW (HPV 6). Initial treatment included Imiquimod and laser. A year later, I had a recurrence treated via phototherapy. I've been GW-free for over 6 years. My doctors assured me that if there were no recurrences for 2+ years, my body would have cleared the virus. They encouraged disclosure during those two years but said it wouldn't be necessary afterward. So, I stopped disclosing after two years. GW/HPV became a distant memory over the last 4 years. I also got the Gardasil 9 vaccine four years ago (all three shots).

Recently, I scheduled my first pap and HPV tests, which has resurfaced my HPV anxieties. I worry that not disclosing might have been a mistake and that I could have put my partner at risk of infection (2.5+ years in a monogamous relationship, unprotected sex for 2 years, he is male and unvaccinated). Despite understanding that the virus is quiescent and shedding risk is very low, I now wonder if I should inform him about my past infection. If my HPV test results are positive, I will inform him of any new infection. Could you please provide guidance?

Edward W. Hook M.D.

13 months ago

Welcome to our Forum. Thanks for your questions. I cannot tell you whether or not to disclose to your partner, that is something you have to decide but I will provide some information which I hope will be helpful.

The chances that your HPV 6 will recur are low. You have been treated and most importantly, you are now 6+ years since any evidence of recurrence. The longer the interval since treatment without a recurrence, the less likely it is that there will be one. Further, limited research suggests (but does not prove) that HPV vaccination augments the body's ability to fight HPV, thereby further lowering your chance of recurrence. Thus I tend to agree with the advice of your doctor- the likelihood of recurrence is low. I do however need to tell you that research shows that, in persons with successfully treated HPV or HPV which resolves on it's own, sophisticated research tools can sometimes, in a minority of cases, detect residual, quiescent HPV DNA. In some persons this may be the source of the rare recurrences which are seen years after resolution of infection. The odds however are in your favor.

Another comment. Assuming that your partner of 2+ years had other partners prior to the beginning of your relationship, the odds are quite high that he had or has HPV infection already. Over 80% of unvaccinated, sexually active adults, even those who are monogamous, will have one or often multiple HPV infections.

If you do choose to disclose however, my advice is to urge him to get vaccinated. If your tests are negative, vaccination is the best way for you both to remain so.

I hope that this perspective is helpful If there are further questions, please don't hesitate to use your up to 2 follow-ups for clarification. EWH

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12 months ago

Hi,

Thank you for your thorough response.

Could you please explain the behavior of low-risk HPV in basal epithelial cells, particularly in the context of the virus being cleared? Specifically, I am interested in understanding what happens to the viral load within these cells once active replication has ceased, without focusing on the odds of clearance.

I guess I am asking about the majority of cases, where no quiescent DNA is detected in the cells - what does the cellular action mechanism to clearance look like?

Thank you again!

Edward W. Hook M.D.

12 months ago

Your follow-up question involves scientifically and biologically complex issues which are difficult to describe. I'll do my best but before I do, let me point out that you are asking questions which have little or nothing so do with the questions you have asked.

Nearly all genital HPV infections (including HPV 6) are controlled by the immune response of infected individuals leading to the FACT that the infection is no longer detectable in PAP smears or with standard HPV testing. Despite that, careful, highly sophisticated research techniques show that HPV DNA may remain detectable in research tests. In such persons there is no detectable HPV "viral load" and the risk for onward transmission of the latent infection is low, close to zero. This persistence of latent DNA infection in tissue is presumed to be the source of occasional (but not common) detection of HPV infection years after the detectable initial infection has resolved. This phenomenon accounts for the occasional (rare) detection of infection years after apparent resolution.

I hope this explanation is helpful. As I said above, this explanation has little or nothing to do with your very low likelihood of recurrence of detectable HPV. I hope it will help you to move forward.

You have one follow-up remaining. EWH

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12 months ago

Hi Doctor,

Thank you for your continued help. My previous question was essentially motivated by intellectual curiosity.

I have one final practical question. Based on my understanding, given the likely latent nature of my infection, I present a very low risk of transmitting HPV to my partner at this point. I understand that the infection could potentially reactivate in the future, especially in the event of immune suppression (e.g., during pregnancy or menopause).

You previously advised that I encourage my partner to get vaccinated. Currently, it seems unlikely that I have transmitted HPV 6 to my partner (though he could have contracted it from another source without knowing). If my partner is currently "HPV 6 free," would getting vaccinated now protect him from potential future infection should my latent HPV 6 reactivates? Is that correct?

Thank you again for your guidance and have a great week!

Edward W. Hook M.D.

12 months ago

As you know, this will be my final reply. There should be no need to return with further questions on this topic.

At this, point, the value of encouraging your partner to be vaccinated is debatable. His current risk for infection from you is very low and there is no reason to anticipate that you will experience a recurrence. Should you, and should your partner get infected, almost all HPV infections are innocuous and inconsequential.

This will complete this thread. I think you are worrying more about your past infection than you need to. EWH

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12 months ago

Thank you Doctor, the insights were. useful. As for worrying too much, you might be right. All the best and thanks again!