[Question #11865] HPV
11 months ago
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Hello Doctors i have a few questions concerns about HPV, I am a 25yr old male i received the gardisil 4 shot back in 2013 before i was sexually active however i only received one dose, Since i have had over about 50 sex partners most of them i have done oral as well i am not proud of my actions i never knew about HPV or how dangerous it really is i have never had warts i then received another dose of gardisil 9, 2 years ago but i think it wasnt effective at all since i had already had a lot of partner. I was young and stupid. My current partner is a 25yr old woman who had about 2/4 sex partners before me she also received gardisil 4 before being sexually active she has all 3 rounds of shots i am scared she will develop cancer due to my dirty past.
I have seen all over the internet that a single dose of the vaccine is highly efficient in preventing HPV cancer due to HPV 16 and 18 and that some countries only do one dose now so that makes me feel better what do you guys think?
I realize the newer vaccine covers more strains then the vaccine me and my partner have received so we know our chance of cancer is still very high due to other high risk strains what is your opinion?
I have read on this thread that you guys claim once you are infected with a certain strain and you clear it you are immune, But also i have seen a lot of stories of people who have got the same strain more then once,
I also read on this thread that you guys claim the vaccine is close to 100% effective however i read on reddit stories after stories of people who have received gardisil 4 before being sexually active and still getting Strains 16&18 or genital warts so it seems like the vaccine has maybe 50% percent or less of effectiveness? Or non responders to the vaccine what do you think. I am very scared that my partner will develop cancer due to my past or that i will die to throat cancer.
11 months ago
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For some reason it shows you guys have replied to my question but i do not see any comments.
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H. Hunter Handsfield, MD
11 months ago
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Welcome to the forum. Thanks for your confidence in our services. (Users are notified when their question is assigned to one of the moderators. The reply itself usually comes a bit later -- up to 24 hours, although we try to reply sooner than that.)
Your question reveals some misunderstandings about HPV. Your comment about "how dangerous it is" is mistaken: even with the high risk (cancer causing) HPV types, the large majority of infections do not lead to cancer. Most infections remain without symptoms of any kind and are controlled by the immune system. You and your partner can consider immunization with the newer vaccine (covering 9 HPV types), but even if you do not do that, it is wrong that "[y]our chance of cancer is still very high...." She will be nearly 100% protected against cervical cancer -- the main malignancy due to HPV -- by having regular Pap smears. As for vaccine effectiveness, just about the worst source of health information is personal testimony by people on websites intended for and by persons with the problem or at risk for it -- like Reddit, for example. Most people who "go the same strain more than once" have just had reactivation of the original infection, not newly acquired HPV. (Many people -- especially women having Pap smears -- are positive, then become negative and may remain so for years and years, only to then have a reactivation of the same infection. This can result in a newly abnormal pap or recurrence of warts, but that doesn't mean they were reinfected.) And anyone can write or claim anything they want online: trust the research science, not personal testimony of this sort -- whether it's HPV, HIV/AIDS, colon cancer, or any other serious health problem. There is no doubt about the 100% effectiveness of the HPV vaccines against the HPV types each vaccine covers, if no prior infection with those types. Finally, regardless of your sexual history, there is very little chance you or your partner will ever have throat cancer due to HPV (which usually is curable, by the way).
It is true that a single dose of the vaccine is quite protective, but not 100%. However, having had two doses, one each of the two vaccines, you probably are at least partly protected; even with your sexual history, it is likely you had not been infected with all 9 HPV types in Gardasil 9. It still makes sense for you to get at least one more dose of the second vaccine. In addition to protecting against new infection, more recent research has shown that vaccination also somewhat reduces the likelihood of reactivation of past HPV. And your partner, having had all three doses of Gardasil 4 has up to 90% protection against genital warts and 70% reduction in HPV cancer risk.
There is no such thing as "non responders to the vaccine", except people who already were infected with the HPV types the vaccines are designed to prevent.
All things considered, I would advise you to get at least one more dose of Gardasil 9, and your partner to get two doses of it. And for her to have regular Pap smears according to standard guidelines (her gyn can advise her). Then you and she should stop worrying about HPV. The chance either of you will ever have a significant health problem from HIV is a lot lower than you fear! Finally, if you continue to search for information online, I would advise sticking with professional sources or those that at least are professionally moderated; and avoiding those by and for people at risk (like Reddit, for example).
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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11 months ago
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Thanks for the reply,
Wouldnt it make no sense to get the the additional vaccine ? Ive had way to many sex partners and mostly all where sex workers. So i am pretty sure i have already been infected with all 40 strains of genital HPV this is why im scared that i will get throat or penile cancer since im not circumcised or my partner will get cancer due to my past with these high risk exposures.
If a single dose isnt 100% why did some countries update there guidelines to only one dose now ? Studies Claimed one dose had the same level of antibody 10years later then 2 or 3 doses.
My partner is up for a pap smear this year so we will see what happens i have a feeling she will be positive for all 40 of the HPV genital strains.
11 months ago
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& Also is what your saying is anyone who claims they got HPV vaccine before sexually active and still got a strain that the vaccine covers is lying then ?
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H. Hunter Handsfield, MD
11 months ago
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There is no clear way to answer the question about additional vaccination. You are correct that with increasing number of sex partners, there is rising probability someone has been infected with more of the vaccine-covered HPV types. However, there are no data that allow a specific prediction: in other words, I can't say how many of the 9 vaccine types you already have been exposed to. But it's probably a high proportion. Therefore, I agree the vaccine might add little benefit. On the other hand, as I also said, vaccination may lower the chance of future reactivation or th frequency of progression to warts, pre-cancer, or cancer itself. Vaccination is entirely harmless -- so if covered by your health insurance, or if you can afford the cost, why not do it?
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Various countries probably have different health financing and cost priorities. Most expert agencies and scientists still advise at least 2 doses. In addition, 2 or 3 doses may increase the duration of protection. I am unaware of the data you cite on antibody levels after 10 years following only a single dose.
Since your partner has had the G4 vaccine, probably her Pap smear will be normal. If HPV positive, I would be very surprised if there were so many strains. Also, I believe most routine HPV testing with paps is for something like 10-15 HPV types, nowhere near 40.
Some persons may lie in online statements, but mostly it's probably forgetfulness, misunderstanding about when and from whom someone was infected, and similar reasons for inaccurate information. The research on 100% protection is very strong. Further, some HPV infections are unexplained -- apparently acquired prior to onset of sexual activity. This is obviously rare, but rare events in a country of 330 million (like the US) still translates to thousands of such cases.
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11 months ago
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https://immunizationevidence.org/the-power-of-a-single-dose-evidence-for-a-single-dose-hpv-vaccine-schedule/
Here are a few articles i was able to find.
Thanks for the info doctor i guess i can now assume i most likely have had every single genital HPV strain and now exposed my partner to all of them due to my past i guess ill be the cause if she ever gets cancer. I wish i knew about HPV before having sex. Now i realize i will very likely develop warts or penile or oral cancer in future.
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H. Hunter Handsfield, MD
11 months ago
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Thanks for the citations, which are quite recent. I'll read them.
However, your conclusions about your own and your partner's HPV risk are flat out wrong. There are people with far more partners than you have had (like 500-1000 or more lifetime partners) who have not been infected with all 9 vaccine types, and the large majority never develop HPV disease (warts, cancer, etc). Oral cancers are particularly uncommon -- especially since only one type (pharyngeal squamous cell carcinoma) is caused by HPV, and almost all these by HPV16 -- to which you and your partner probably are immune due to vaccination. The odds are strong that neither you nor your partner will ever have either warts or HPV related cancers. Of course she should hang in with regular Pap smears, and someday we may see recommendations for pharyngeal HPV testing in hope of preventing the rising but still low numbers of pharyngeal cancers. Stay tuned -- but tone down your fears, which are seriously overstated.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.
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