[Question #1904] Std concerns still

53 months ago
It's been 8 days since my exposure . No sores . Am I out of the woods for herpes ? 
I still have major concerns for HPV . How  little risk was this one time protected encounter ?   Ive read some studies that couples having sex 2 times a week with one of them having HPV , 20 % tranfer rate in 6 months . I understand everybody gets it but I am still concerned about this encounter .  Just trying to wrap my head around this . If the encounter with an active HPV infection is 100% transfer then a condom makes it 40% likely ?   
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome back to the forum. I glanced at your recent thread with Dr. Hook.

When one person has genital herpes due to HSV2, the average transmission risk for unprotected vaginal averages somewhere around once for every 1,000 or fewer expposures; it's much less for you, having used a condom; and 90% of new infections cause symptoms within a week. So at 8 days with no symptoms, the chance you caught herpes is nearly zero.

The risk of infection from any single exposure isn't known, but it's nowhere near 100%; probably well under 10%, and only if your partner were infected. For any particular exposure, condoms are probably better than 60% protective. And new HPV infections are uncommon after age 26 (which presumably applies, since you've been married 18 years). (That's why the HPV vaccines were not studied and are not recommended in people over that age.) In the event you were infected, it is unlikely you or your wife would ever know it. And in the minority of cases that cause symptoms (e.g. warts) or other abnormalities (like an abnormal pap smear), the problem typically shows up a year or more later. And HPV infections can recur from initial infections years earlier. So if you or your wife were ever to have an HPV problem, it would not be possible to trace it to this or any other sexual exposure.

So all things considered, HPV really isn't a serious consideration in this setting. Do your best not to worry about it.

Does that help? Let me know if anything isn't clear.

HHH, MD

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53 months ago
Thanks for the explanation . It definitely helped . I' still have a couple questions 
1 if the risk was 10% and condoms reduce 60%   Would. It be 4% chance of infection? Would you consider this a low risk encounter ?  Why is HPV so common if  this is the case ?

2 I guess my big thing is I really don't understand HPV that well . So the majority of infections don't cause abnormal Pap smears . I always thought that if you have HPV , you will have an abnormal pap until it clears . 

3  you mentioned that it is unlikely that myself or my wife will ever know , can you elaborate on this . Do they check for HPV at Pap smears and wouldn't she find out ?  

Thanks 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
1) No, nowhere near 4%. You also have to factor in the chance your partner had an active, transmissible HPV infection. That in turn depends on things like her age and whether or not she had been immunized against HPV. It's a lost cause to put a more precise number on the estimate. Let it go.

2) Probably fewer than 10% of HPV infections in women cause abnormal paps. It varies widely between different HPV types, of which there are more than 100 that commonly infect the genitalarea.

3) Most HPV infections never show up in paps or other tests. I've given you several of the reasons you probably did not catch HPV and, if you did, you'll never know; and even if that happens, it will not be possible to relate it to this particular exposure. For example, many (most?) abnormal paps in women are not from newly acquired HPV, but from infections they acquired years previously.

There are plenty of good online sources for detailed HPV information. Start with ASHA, the organizer of this forum (www.ashasexualhealth.org) and CDC (www.cdc.gov/std). However, I strongly suggest you not delve too deeply. It really isn't important in regard to your exposure, and it is clear you are obsessed and anxious about it -- and obsessed, anxious people tend to have difficulty putting complex information into context. For sure stick with professional agencies and their online resources.
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53 months ago
I've been doing some research and wondering if you contact the HPV strains that cause warts . How likely are you to develope warts ? Some place say your immune system will take care of infection before they develop and some say you will likely get them 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Thanks for doing the online research.

Although the large majority of HPV infections never cause visible abnormalities or other symptoms, this isn't true for HPV types 6 and 11, which cause nearly 90% of genital warts. Only women have been studied to evaluate appearance of warts after acquiring HPV 6/11, and the best studies suggest that 50-60% develop visible warts, typically 3-12 months after exposure. No data are available in men, but there is no reason to suspect a major difference compared with women. Whether or not visible warts develop, it is true that the immune system clears them up. However, this can take several months or longer, and visible warts should be treated to speed things up.

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53 months ago
Thanks for quick response . I'm still having a hard time wrapping my head around this .  What do you think my chances are of developing warts from one time protected sex if she had an active  infection ? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
There are no data by which to estimate the risk of warts from any single exposure to a partner of unknown HPV status. Undoubtedly low (well under 1%), but no more can be said.

Your online readings should have made it clear that getting and having genital HPV is a normal, expected consequence of being sexually active (even among monogamous people). CDC recently released a report showing that at any point in time, roughly half of all persons age 15-40 have an active HPV infection at any point in time. It is unavoidable and normal. Vaccination is effective in preventing infection with 9 of the most troublesome types of HPV. But beyond that, nobody should alter their sexual lifestyles in hope of preventing HPV or its consequences or lowering the risk of exposure. It won't work and in the long run will make no difference in health. As discussed above, if warts or other manifestations of HPV ever show up (e.g. an abnormal pap smear in your wife), it will not be possible to trace it to any particular sexual exposure either on your part or your wife's. And even though almost all HPV infections are sexually acquired, there are exceptions -- i.e. occasional genital infections in people who have never been an apparent risk. I strongly advise that both you and your wife be vaccinated, which is routinely recommended for all people below age 26, regardless of STD risk.

That completes the two follow-up comments and replies included with each new question and this thread is now closed. Please note the forum does not permit repeated questions on the same topic or exposure. You've asked two, and this will have to be your last one; future new questions about this exposure, testing, and your fears about HPV or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.
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