[Question #12298] HPV, health, and relationships
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8 months ago
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Thanks in advance for your help: I did a pap smear/HPV test & received ASCUS w/high risk HPV for the strains falling between 31-68. I was negative for strains 16/18:
1.I got Gardasil in '07-'08 but now know Gardasil 9 released in 2014 (wasn't informed by any medical practitioner at the time that an updated version was available.) Do you recommend I get the HPV vaccine now? What about my sexual partner (male, late 30s, unlikely vaccinated).
2. What do I need to disclose to my monogamous (but casual) sexual partner? We have a trusting relationship, so stopped using condoms after confirming negative STI statuses. I plan to disclose but don't want to alarm him since, as I understand it, there's nothing actionable for him.
3. Since men can't be tested, what are his next steps- is he just looking for warts?. I haven't noticed any on myself.
4. I've received a referred for a colposcopy -Should we: stop having sex altogether, start using condoms again, or stop engaging in specific sexual activities (e.g. oral) until I get the colposcopy?
5. What, if anything, would he or I need to disclose to future partners?
6. What precautions would we need to take in the future to limit reinfection?
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Edward W. Hook M.D.
8 months ago
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Welcome to our Forum. Thanks for your questions. I’ll be glad to comment. FYI, it’s hard to fault your doctors and there is no concensus on the need for boosters. The CDC does not recommend additional vaccine for persons who received the original Gardisil containing 4 vaccine types. The question is what to do going forward. It sounds like you have a good plan for yourself. Assuming you’ve had prior tests, your current infection may become undetectable with time. You are good to ask about the way forward for your partner. Regarding your specific questions:
1. Some persons choose to be boosted with the newer vaccine which covers an additional 5 types which are associated with 10-20% of cervical cancer. It’s an individual choice and worth discussing with your doctor.
2. Disclosure is always a personal choice and a good thing if your partner won’t freak out. Your current infection may have come from him unknowingly ( lots of variables here including how long you’ve been partners). Has he been vaccinated? Perhaps the conversation could start with telling him about your suprise at finding out that you have HPV despite your vaccination.
3. Nothing to do other than self inspection. I wouldn’t expect him to have warts.
4. No need to abstain or use condoms. He’s already exposed and, as pointed out above, could be the source of your infection.
5. See response 2 above. We do not feel strongly that disclosure is essential. If future partners are vaccinated, they may be protected and if not there’s a high probability that they already have HPV. We have extensively discussed the nuances of disclosure in numerous other threads on the Forum. I’d suggest you take a look at some of them. We leave prior threads available as sources of information.
6. None other than things you’ve already mentioned. Discussing vaccination status with partners often provides the opportunity for discussion.
I hope these comments are helpful. If anything is unclear, please use your up to 2 follow ups for clarification. EWH
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8 months ago
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Hi Dr. Hook -Thanks so much for your speedy reply. I feel a lot better and have a better sense of how to navigate my personal relationship moving forward. I really like your suggestion of starting with asking about HPV vaccinations --that's a great tip. Just a couple follow ups:
1.I understand vaccination is a personal choice and I've posed the vaccination question to my doctor as well. I'm leaning towards yes currently, mainly because it would offer a kind of "psychological" protection. I just want to check my understanding though, of what it's actually protecting me from...The strains covered in Gardasil 9 are the strains I'm infected with now. Wouldn't I be immune from it moving forward, once the infection clears, because of the immune response?
2. I feel empowered to navigate next steps with HPV: I have the educational resources and a medical care team, and a referral for a colposcopy. My sexual partner on the other hand, doesn't have a PCP and his preventative care.practice is unclear to me. When males have been infected with high-risk HPV, are they expected to seek medical care, in the same way that a woman needs to? Basically, how forcefully do I need to encourage him to do a male wellness check, and share his HPV infection with a doctor?
Finally, thank you for this service! It's been helpful getting answers, and a different perspective, while I wait to hear more from my doc.
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Edward W. Hook M.D.
8 months ago
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Thanks. I'm glad you found my comments helpful. Straight to your follow-ups:
1. My bias is would be similar, particularly if you can get your insurance to pay for it. You are already protected against the 4 strains contained in the original Gardasil. The vaccine would possibly boost your immunity to the new infection you have (in general the vaccine produces better levels of immunity than natural infection) as well as providing protection from any infection that you do not have. There is some conjecture (not proven) that the additional immunity may help prevent recurrence and enhance response to therapy.
2. When I am asked about men's health care I find it quite frustrating. This is an area where women are better off than men. This is not an emergency/high priority for him from a health perspective. If he has no visible lesions I would not recommend anything further. If he has questions about his sexual health, depending on where you are, the local health department Sexual Health (STD) Clinic may offer a low cost, confidential source of care and/or information. T
Glad I could help. EWH
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