Hello Dr, Handsfield and Dr. Hook

As in your previous question, you seem to hope we can confirm or refute a possible diagnosis of genital warts or other forms of genital HPV infection. That's not something this forum can do. For the penile and scrotal growth(s) you have had, you'll need to continue to rely on your dermatologist; I have no way of judging between warts, seborrheic keratoses, or something else entirely. Given your ongoing sexual relationship with a known infected partner, and presumably other sexual relationships in the past, you can safely assume you have had at least one genital HPV infection and perhaps more than one. Condoms are not very good protection against HPV; regular condom users usually have the same frequency of HPV infection as anyone else.

For sure you have been exposed to your current partner's HPV 56 infection; I cannot judge whether or not you have been infected with it. If your recent lesions were warts or otherwise related to HPV, then you also can safely assume your current partner has been exposed and perhaps infected with that HPV type. If so, however, it is unlikely ever to harm her. (Even the highest risk HPV types rarely cause cancer.) Although I do not know where you are located, at your partner's age, in the US the standard guidance is to have vaginal HPV testing and/or Pap smear every 3-5 years. It would be reasonable for your partner to speak with her gynecologist both about her past infection and her possible new exposure (depending on your diagnosis) and follow the advice she is given. Vaccination might be an option, but would be unusual at her age:  by age 42, most women have already been infected with the 9 HPV types prevented by the vaccine.

It would be pointless for you and your partner to abstain from sex on account of HPV. If your new problem was due to HPV, the infection probably was present and transmissible to your partner for several weeks before anything was visible.

Aside from following up as needed with your dermatologist, and your partner's question(s) for her gynecologist, I would suggest you and your partner forget about HPV in regard to your relationship. Catching and having HPV is a normal, expected, unavoidable aspect of human sexuality. There is no point in attempting to prevent it, except to be vaccinated (at a relatively young age) to prevent infection with the HPV types responsible for ~90% of cancers and warts. At this point there is an exceedingly low chance either of you ever will have an important health problem due to HPV.

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

HHH, MD