[Question #12744] HPV Risk in Poly Relationship

5 months ago

I (36f) tested positive for high-risk HPV. Genotyping confirmed that it is not 16 18 or 45 which seem to be the ones with a higher risk of leading to cancer. I had my first dose of Guardasil a month ago.

I am in a poly relationship with Joe (45m) with partners: Jane (40f), who previously had HPV and an abnormal Pap (now resolved), and Sara (44f). All three are vaccinated.

After research, my understanding is that the risk of HPV transmission to Jane and Sara through Joe is very low, however Jane and Sara have concerns.

I’m seeking your opinion to clarify the actual level of risk involved and confirm that Joe and I engaging in sexual activity poses minimal transmission risk to Sara and Jane.

I am also looking for guidance on reasonable precautions we should take to further reduce risk (e.g., condom use, avoiding unprotected oral sex, etc.).

Could you provide a your thoughts on the risk of transmission and recommendations for best practices in our situation?

H. Hunter Handsfield, MD

5 months ago

Welcome and thanks for your confidence in our forum.

Perhaps my main recommendations will surprise you: I suggest you and your partners essentially ignore HPV and take no steps to prevent future HPV infections aside from vaccination and to follow standard Pap smear guidelines. It sounds like you've all been vaccinated, or will soon complete at least two doses of the HPV vaccine (Gardasil). (If you're in the US, that will be the vaccine version that covers the 9 HPV types that together cause ~90% of genital warts and HPV-related cancers.) If not, I suggest the un-vaccinated ones do so. Vaccination plus regular Pap smears for the women will be highly effective in preventing any significant health problems. Of course these steps will not prevent reactivation of prior infections, but all in all the risk of important health outcomes will be a lot less.

As far as "actual risk level", you're already in a pretty low risk category, if only because of age. New HPV infections and serious health outcomes from them are quite uncommon beyond age 30, still more so after age 40. The risk will increase if new members join the party, but only a little if you are vaccinated and the women get Pap smears; and also because most of you probably have already been infected and may already be carrying most HPV types likely to be infecting new partners in the group.

Condoms are not very effective in HPV prevention. They reduce the risk for any single encounter, but after time and multiple encounters consistent condom users have equal HPV risk and frequency as non users, probably because condoms allow substantial skin-skin contact above the condom. (Female condoms likely are more effective, but most people don't find them to be user-friendly.) That said, condoms can't hurt and are more effective for other STIs; I would advise their use for that purpose, if any of the group might have other outside sexual exposures.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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