[Question #1231] HPV

50 months ago
Hi, thank you in advance for your help. For background, I'm a 27 heterosexual male, and was diagnosed with genital warts about 10 months ago (by sight, of a cluster of 5 , skin colored, hardly raised warts at the base of penis/scrotum). I had them frozen then and thought they were gone but noticed about two months ago they were still there (did not recur), they are very hard to see. So I used a cream prescribed by my doctor, and they've been completely cleared for about a month. 

Questions (I've done some online research, I apologize in advance if my questions that include the research are inaccurate)
1. Can my body fight off and completely clear the virus? Or does the virus go from active to "laying dormant" in my system? (one website provides a simple explanation that it could work similar to chicken pox, not sure if you would agree or not).
2. How do I tell if it is dormant? How long must I be clear from warts for the virus to be considered dormant?
3. If the virus is dormant/inactive, can I still pass the virus to my partner (monogamous relationship)? Is it less likely?
4. My partner is 27, we have had a full discussion and have done research together before having any sexual relations. She had one dose of gardisil (hpv4 vaccination) in 2009, but did not receive the other two doses. Is the one shot still effective (any percentage effective? I've seen somewhere it could be 80%)? 
5. Can she get the "catch up" 2 doses now even though she is past 26? I read she could still get the other 2 if she had at least one dose before 26.
6. We've had sex 3 times, once unprotected. We were comfortable with unprotected sex because the warts were gone and she had one shot of the vaccine and we read it would be unlikely to transmit. Do you think we are safe that we had unprotected sex and can we continue unprotected sex? (We have both agreed for the relationship to remain monogamous).

I've done a lot of research and honestly  feel like I can't trust what I have read and it's a little dis




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Welcome to the forum. Thanks for your question. These are some of the most common concerns about HPV. The issues are complex, but I'll try to address them succinctly.

The terminology about persistent HPV, and HPV clearance, is not standardized:  dormant, latent, persistent, silent, etc often are used interchangeably. And the science isn't completley understood. Almost all infections are cleared by the immune system to a point at which they never recur and cannot be transmitted to partners, typically over a few months. HPV DNA may persist, and some experts believe DNA is never cleared entirely. Others believe it is often or usually cleared entirely. Unfortunately, there is no gold standard test to know the truth. If DNA cannot be detected, does that mean it is gone or just not enough to detect? Or that the wrong site was sampled? And if DNA is present, that doesn't necessarily mean there is a potential for reactivation. With these uncertainties, some physicians thus tell their patients that all infections are potentially lifelong. Others tell them the infection is cured as long it can't be transmitted and doesn't reactivate to cause overt disease, such as warts, pre-cancerous lesions, or cancer itself. This is my own interpretation and advice based on the available evidence.

Those comments address some of your concerns, directly or indirectly. But for clarity (I hope):

1-3) Probably your immune system will clear your HPV infection entirely. In the absence of reappearance of visible warts, which is uncommon more than a year after clearance, you can assume it is at least "dormant" and probably gone entirely. However, there is no way to know for certain unless and until there is a visible recurrence -- and even then, usually no way to know whether the old infection has reactivated or a new one acquired. Without overt recurrence, transmission to partners is believed to be rare.

4) It is true that significant protection against HPV comes with the first dose, but it may not be very long lasting. I would guess that at two years your partner has a reduced risk of infection by one of the vaccine types, but not zero risk. There are no precise data on this.

5) There is no regulatory reason she cannot receive additional vaccine doses. However, different health insurers may have different policies on this. But if not insurance covered, there is no reason not to do it, unless the cost is an important issue to her. (And indeed, it's expensive.) In any case, in the past couple of years, the newer version of Gardasil has come into use, covering 9 HPV types instead of only 4. If she received the older version, she should start over with dose no. 1.

6) Condoms are only about 50% protective against HPV. So even consistent condom users usually become infected. Given the mild nature of the wart causing HPV types, my advice in committed couples is to continue unprotected sex, assuming other STDs aren't an issue. After all, warts are a pretty minor inconvenience, not an important health threat. Anyway, with your warts visibly gone after two rounds of treatment, the odds are strong you're no longer infectious. Also, assuming she has had an average sexual lifestyle (i.e. at least a few past partnerships), there's a good chance she has already had and is immune to new infection with the same HPV type you have.

Even for the non wart-causing, high risk (for cancer) HPV types, my general advice is for sexually active people to be universally vaccinated; for women to follow standard pap smear recommendations; and then forget HPV entirely. Deal with symptoms or problems if they appear, but they probably won't. And if they do, they typically are minor or, even if pre-cancerous, easily treated before they become serious. All things considered, people shouldn't let HPV or fears of it seriously interfere with romance and rewarding sex.

I hope this has been helpful. Let me know if anything isn't clear. Best wishes to you and your partner for a rewarding relationship-- 

HHH, MD

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50 months ago
Thank you so much!! This has been extremely helpful and I feel much more comfortable with the situation. 

I have a follow up question. I read somewhere that smoking/tobacco use can put you at a greater risk for recurrence. I chew tobacco from time to time (and believe me I'm trying to stop and I will in the near future). Is this a real risk? Or is it more so just discouraging the use of tobacco products? 

Thanks again for all your help
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
This is an insightful question. The interaction(s) of HPV and tobacco are mysterious and interesting, and appear to include delayed clearance. However, to my knowledge this has only been documented for high risk HPV infections of the cervix in women, not for low risk HPV or genital warts or for any HPV infection in males. I haven't heard anything about higher risk for late reactivation, i.e. recurrent symptomatic infection or warts. But it isn't just anti-tobacco messaging -- the data on cervical high risk infection are real. Further, those data are for cigaret smoking; I'm not aware that other tobacco products, such as chewing, confers any risk. All things considered, I don't think your chewing is a relevant factor in your infection, the risk to your partner, or the possibility of recurrent warts. I really wouldn't worry about it.

Thanks for the thanks. Take care.
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