The whole incident which involved blacking out ( I can't be sure of the exact sexual.nature because of this) has left me extremely anxious and I am trying to move on.  My partner was a virgin when we met and has never tested positive for hpv. I previously have had anal warts but no other sti. My questions relate to hov and hsv which were answered but I could do woth further clarification on.

1. Regarding visibke genital warts, what percentage of cdw are likely to have an hpv infection causing warts at any time 

2. If they were infected whay percentage chance would I have of getting warts from this exposure?

I believe my hsv risk is low less than 1 in 1000?

1. At any point in time, up to 50% of sexually active persons have genital HPV infections. To my knowledge there are no data on this for female sex workers in particular, but we can assume at least 50%. Undoubtedly far fewer have visible warts.

2. However, the chance of virus transmission for any single exposure is low and the possibility of visible warts even lower. It is very unlikely you will develop warts, but of course nobody can say the chance is zero.

3. When genital HSV2 is known to be present and there are no symptoms of an outbreak, the risk of transmitting to a partner in a single episode of unprotected vaginal sex is roughly once for every 1,000 events. If we assume a 20% chance your CSW partner has HSV2 and that you did not use a condom, that would make your risk around one chance in 5,000. Having had no symptoms yourself further lowers that chance.

Your concern about HPV is misplaced. Assuming your past diagnosis of anal warts was accurate, you already have HPV -- and probably almost everyone with anal HPV also has had genital infection. Your wife is at far higher risk of HPV on account of your known infection than she is on account of your occasional CSW events. Regardless of her past sexual history (you have said you believe she has had sex with anyone other than you), like all women she should follow standard Pap smear guidelines.

HHH, MD

To.give more context, my anak warts was diagnosed in a gum clinic, treated with aldara and resolved over 18 years ago.  My wofe then partner at the time didn't develop warts. Thus is the only unprotectedor protected vaginal sex I have had outside.my relationship.in the last 5 year.s with my wife testing negative for HPV around 1 year ago. So I am confident sh doesn't have HPV and that based kn info provided on clearance I would hopefully also be clear of any infecrkn. Hence my worry about this incident being the potential.cause of an hpv or gential.wart infection. Whils give been sexuakky active it's mostly been one time encounters and I've only had 1 real partner. Does that change my risk? Does previous infection over 18 years  ago really confer some level of immunity? If so.thats great. I wasn't aware how much of the wart causing strains are in circulation in the UK by percentage of CSW?  I'm juat trying to gauge whether I shoukd abstain from.sex

Thank you 

There is no point in abstaining from sex with your wife. You've been having sex with her all these years and she hasn't had an HPV problem and probably never will. There is no point in abstaining now, regardless of your CSW adventures.

In summary to make sure I've understood

1. My previous HPV infection despite being 18 years ago can still reactivate and also offers some degree of protection against similar strain new infections

2. Genital.wart causing strains are not all all HPV infections? What proportional of active infections are likely to be gential wart causing ?

3. Hsv is very unlikely

4. I'll have built up potential immunity  to other strains? 

5. Does hpv infection decline woth age because of natural immunity ? 

6. If I get warts they'll likely come in the next 6 months? But likelihood frommlast encounter is low and more likely to happen from previous infecrikns?

Thank you 

1,4. Yes, your old infection can still reactivate. However, it provides little protection against future infections. There are 30-40 HPV types that commonly are sexually transmitted; your past infection eliminates the chance of infection with the same type and maybe one or two more, but has no effect on all those other types.

2. Two HPV types (type 6 and 11) cause 90% of genital warts. Most other types rarely cause warts.

3.  Yes HSV is very unlikely.

5. HPV is less common with rising age, but this is mostly due to reduced exposures not to "natural immunity".

6. Most new warts appear 2-6 months after exposure, but it can be a couple of years or even more.

Why are you are so concerned about HPV? It's the least important and least serious of all the common STIs, and easiest to explain without having to confess to sexual infidelity.