Hello. I had a case of GW treated 18 years ago. No recurrence, and still none. Through 16 of those years, only 2 long term partners. Neither had GW, positive hpv, or abnormal pap ever.  Before I started dating again, i saw a dermatologist. Their advice leaned toward not disclosing, considering the length of time, and no evidence of transmission to partners. I've had 2 casual partners since, and in a serious relationship now. She is vaccinated. She just received a positive hpv and abnoral pap. All her previous tests/paps were normal/ negative before me. I feel guilty for not being transparent early on, and plan on disclosing to her soon. 

So my questions...The Derm claimed transmission/reactivation after this long would be "clinically insignificant" or near zero(which is why I didn't disclose). And I understand Hpv 6/11 arent known to cause abnormal paps. What are the chances this has anything to do with my prior case 18 years ago? Additionally, what is the most likely explanatiion for her abnormal pap? Im concerned she will jump to the conclusion this must be from my previous case, and blame me for not disclosing. Thanks

I agree with your dermatologist. In addition, our advice on this forum is that nobody ever needs to disclose past HPV infections to new partners, at least once they're a few months after the last confirmed diagnosis. Just as you need not have disclosed your distant past warts to your partner, once her abnormal pap has cleared up, she should not tell any future sex partners about it.

It is exceedingly unlikely your current partner's HPV and abnormal pap have anything to do with your distant past genital warts. Having been vaccinated, she probably is immune to the HPV that caused them (~90% of GWs are caused by HPV types 6 and 11, which are completely prevented by the vaccine). Even if she were not vaccinated, the chance you have an active and transmissible HPV infection that caused your warts so long ago is zero or close to it. The reason all women should have Pap smears is that everyone is exposed to HPV and 90% have been infected at one time or another, entirely independent of sexual activity risks.

I can't guarantee you weren't the source of your partner's HPV infection, but if you were, it's from an infection acquired far more recently. And most abnormal paps in women are not from newly acquired HPV, but from reactivation of distant past infection. All things  considered, you are at higher risk of having caught her HPV strain than the possibility you infected her. That's not to say this is important to your health. Everybody gets HPV, which should be viewed as a normal, unavoidable consequence of being sexually active.

My final comment is that disclosure about STIs is complex. All my comments above are in the context of a medical/risk standpoint, not a relationship standpoint. From the latter, many couples discuss and disclose their past sexuality in great detail, including partnerships, past STIs, and so on. But that's in the interest of mutual respect and relationship nurturing, not necessarily for the purpose of health, risk reduction, etc.

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

HHH, MD

I do have some followup clarifications. As far as transmission of a distant low risk strain versus a high risk strain: It's my understanding resolved past low risk strains(like 6/11), don't have the same latency or dormancy characteristics as high risk strains. And that low risk strains, after theyve cleared, don't integrate into host DNA. Making future reactivation/transmission near impossible. High risk strains, on the other hand, do fully integrate. Which is why reactivation of high risk strains is so common. Is this understanding accurate? Thanks