[Question #1321] HPV

46 months ago
Hi Doc, I'm a 36 year old adult male. I was contacted by my ex girlfriend last night. She informed me that she contracted hpv and has worts. She is being treated. We were sexually active from December 2015 - June 2016. I have never presented symptoms.  Although I cant be 100% sure I gave it to her, I think it's reasonable to assume I've contracted the virus either way. Either I gave it to her or she gave it to me. I'm seeing my doctor tomorrow but I'd like your opinion on how I should proceed. Based on everything I've read, everyone pretty much comes into contact with hpv but in this case we are clear it's type 6 or 11 (feverishly doing research). So, here are my questions:

Should I get vaccinated?
Should I tell future partners?
Should she tell future partners?
How long should be rigorously self examining?
In the past three months, I slept with someone else.. should I tell her?

I've read a great deal about most hpv infections being asymptomatic. For types 6 and 11 specifically, are they always symptomatic eventually? How best do I protect future partners if I've never had an out break? If I'm subclinical, what does that bean in terms of exposing others to these specific types of the virus?



 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thanks for your question.

You are correct that you can't conclude one way or the other whether you were the source of your partner's genital warts. Most of the time the source of any particular HPV infection can't be determined with certainty. I'm not sure it's necessary for you to see your doctor about this. The official advice from CDC, which is also the advice of most individual STD experts (and my own), is that the partners of persons with warts or other HPV infections do not require medical evaluation unless and until they develop warts themselves, or otherwise have symptoms. Since you have not developed warts, having either infected your partner or being repeatedly exposed for almost two years (since 12/15), it probably isn't going to happen. You can safely assume you were infected; and with no warts after this period of time, the infection probably has been cleared by your immune system and will not cause you any problem.

To your specific questions:

1) HPV immunization is not recommended above age 26. And certainly there is no point in being vaccinated now against HPV 6 and 11. That horse is not only out of the barn but galloping over distant hills. 

2) My advice and that of most experts is that nobody has an obligation to inform partners of HPV exposures, only of their own active infections. You have no obligation to inform future partners. But more below about your current partner.

3) Same for your partner, once her warts have been treated and not recurred. In any case, this isn't your business at this point, only hers. If she freely asks your opinion, feel free to render one. But otherwise keep out of it.

4) Stop self examination now.

5) As noted above, in my opinion you have no obligation to tell your current partner anything. OTOH, some couples routinely discuss past sexual lifestyles, past STDs, etc, especially in relationships that have the promise of long term commitment. But this is a relationship issue, not so much one (in this case) of medical necessity or infection prevention.

I hope these comments have helped. There are many other excellent online resources about HPV that can also help address your concerns. CDC has excellent information (www.cdc.gov/std). Also the American Sexual Health Association, sponsor of this forum. Here'a a link (which also happens to include a couple of educational videos:  http://www.ashasexualhealth.org/stdsstis/hpv/

Let me know if anything isn't clear. Best wishes--  HHH, MD
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46 months ago
Thank you. The one clarification is the exposure period began almost one year ago, not two.  The last sexual to the partner who was immediately prior was in July 2015. 

I'm in full agreement that she doesn't have to disclose. She seems pretty devestated and after reading all the material out there, I personally believe it's immoral to subject someone to shame for an ancient microbe that we all essentially have... she is very concerned about passing it on. I understand that and that's her choice but I worry that it will stand in her way of being happy.   I'm going to stay out of it from this point forward, but I certainly don't think it's fair that she has to subject herself to future scrutiny just because she manifested warts when most cases are asymptomatic. It just doesn't seem fair.  My plan is to be diligent with using protection and limit partners
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Thanks for these additional comments. Don't get me wrong about your advice to your former partner. You obviously are concerned for her, and it sounds like she could use your help in working through her worries about HPV and warts. I just wanted to be sure you weren't taking a moralistic perspective and lecturing her about it -- which you obviously are not doing, but is not an uncommon reaction by some of the more anxious users of this forum. To the extent she is receptive to your advice and perspective and you're willing to provide it, I hope you can help her get through this.

One minor correction: Although true that the large majority of HPV infections are asymptomatic, that's not quite true for the main wart-causing HPV types. Some studies suggest that most people (60% or more) with new HPV 6/11 infections develop overt, recognizable warts.

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46 months ago
Interesting statistic. This makes me worry a little.  I don't want to be the Johnny Appleseed of genital warts. That seems awful. So, am I right in saying that being  a carrier of 6/11 means that there is a greater than 60% chance that a future partner of mine will develop warts.  I'm sure you have explained this a dozen or more times but can you help me with what "clear"  and "dormant" mean. I'm not of the opinion that I have to disclose to future partners, but I am struggling with this potential scenario of a future partner showing me what I did to her. It feels a little horrifying. I guess that's where the "relationship" question comes in play
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
First, you should not consider yourself a "carrier" of HPV. Once your warts are gone and don't recur, you can consider yourself uninfected. Second, transmission isn't 100%. A partner exposed to you won't necessarily catch it. (No STD is transmitted with anything near 100% efficiency.) And your partner might have previously been infected (knowingly or unknowingly) with the same HPV type(s), or will have been immunized against HPV, in which case she won't be susceptible.

"Clear" means the immune system has completely resolved the infection to a point at which recurrent warts won't happen and the virus cannot be transmitted. As I use the term, latent (or dormant) means the same thing. But don't get hung up on terminology. The point is that before too long, you won't be a carrier capable of transmitting warts.

That completes the two follow-up comments and replies included with each question and so closes this thread. I hope the discussion has been useful. If new concerns arise, I would suggest you re-read everything above, and perhaps also explore some excellent online resources about HPV, including CDC (www.cdc.gov/std) and the American Sexual Health Association (http://www.ashasexualhealth.org/stdsstis/hpv/). Best wishes.


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