[Question #2308] Mostly HPV concerns

44 months ago
Hi doctors, I'm concerned that I may have HPV. I recently found out that my childhood friend had to have surgery due to the HPV virus when she was 17 or 18 years old.  We were a part of the same friend group and I've slept with some people whom have slept with the same people that she slept with. She didn't sleep with very many of them; however, it still freaks me out because I don't want to become a walk carcinogen. The girl who I suspect could've  given me the virus from that was from a long time after, I think, so it might've cleared up? I'm not exactly sure how all this works. I just don't want to be a walking carcinogen.

Also, I get pimples around my lips often and pop them leaving an open sore and I also cut myself around my lips shaving.  My dad gets cold sores and when he does we still share drinks and food and even smoke a tobacco pipe together. However, sometimes I try to use the lighter to burn the edge of it, so that it might get rid of the virus, but then when i try to smoke it burns me, therefore worrying me that I am more liable to catch the virus since it is in a sense "massaged into the skin" that way.  I've heard two different things. Sometimes people say that this method of getting HSV-1 is only theoretical, while on the other hand I've seen a post by Dr. Handsfield where he claims that these types of transmissions do happen "fairly often" but not as often as through kissing. I'm not sure what to do in this situation or if testing is required etc. I roll this all around in my mind and also look up statistics on the races of the girls I've kissed before and how they have really HSV-1 rates, for instance with African-American women, Mexican women, and Asian women. Should I be tested for HSV-1 or am I just worrying far too much? I honestly can't tell.


Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Welcome to our Forum.  I'll be happy to try to help with your questions.  I and probably you do not have much detail about your friend and her circumstances but I would not let this worry you. 

As a sexually active man you have or will almost certainly have HPV in the future. Many studies show that when persons become sexually active they acquire HPV very rapidly and that within three years of a person's first sexual encounter well over 70% of persons, even those who have had only a single partner, have HPV.  Nearly all of these infections will resolve without therapy and do not progress.  HPV may be manifest as genital warts or may be asymptomatic.  This however should not concern you as virtually every other sexually active person who has not had the HPV vaccine will be infected too.  This is part of the reason that we do not feel it is necessary for everyone who has had genital warts or HPV diagnosed to tell sexual partners- the infection is too common for anyone to think that they are not infected, of little consequence, and poorly understood. The concern about HPV infections is their long term association with pre-cancerous lesions and cancer.  These problems can be address in two ways- first if you develop lesions on your genitals, get them evaluated and appropriate, treated.  Secondly, you could consider getting the HPV vaccine which, although costly (about $300-400) if you need to pay for it yourself, his highly effective for preventing genital warts and reduces the small existing risk for cancer by over 90%.  At the same time I want to acknowledge that sometimes knowledge of HPV infection generates disproportionate concerns and reactions, often based on misunderstanding of the science behind the infection and often fueled by mis-information commonly found on the internet.

In many ways the situation is similar for HSV-1. Here in North America over 60% of adults have HSV-1, whether or not they get cold sores.  In fact, most people with HSV-1 do not know it and do not get cold sores.  Further, because they are infected, at any time, whether or not the have cold sores present, small amounts of the virus may be present and can result in spread of infection to others.  Fortunately, only a tiny proportion of exposures (whether kissing, oral sex or other) lead to new infections and once a person has HSV-1 at one part of their body, they will not get another infection and another part of their body, even if exposed.  With a parent who gets cold sores it is more likely than not that you acquired HSV-1 during childhood and just don't experience cold sores.  My advice is not to worry about it and certainly not to seek testing.

I hope this information is helpful to you. EWH 

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44 months ago
Ah I see. That makes a lot of sense. I do have the vaccine, however I obtained it only a few years ago when I was 21.  The thing I worry about is having the kind of HPV that causes cancer, like my friend had, since we shared sexual partners in a way. But even if I did have it, it would've more than likely cleared up by now, correct? Or do some strains hang around longer and cause more trouble?

And supposing I did have genital warts or other HPV, would I then have to disclose that information to people who I believe aren't infected? Say, if I went to a country where their HPV rates were very low?

The same goes for HSV-1. Since my father has it and I've been exposed in such and such ways, does that mean I need to disclose to partners that I probably have it? Or again, if I were to visit a country with low rates of HSV-1, I should probably disclose? I'm not sure how all this stuff works. I guess the fear is about giving someone cancer or causing neonatal herpes and the like because of an irresponsible move on my part; however, I'd like to be able to live life ignoring all this and just embracing human affection naturally like everyone else seems to.
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Congratulations on having gotten the vaccine.  That realistically takes care of most of concerns, dramatically your risk for getting genital warts and preventing nearly 70% of the HPV infections that ultimately go on to lead to cancer.  even if you had acquired HPV before you got the vaccine or if you acquired a non-vaccine type HPV, more than 95% of infections would resolve on their own without therapy.

With most STIs including HSV-2, disclosure is a good idea and  we recommend it.  On the other hand, for HPV/genital warts we do not recommend disclosure as there is so much misunderstanding about what that means and just about everyone who has had sex and has not had the vaccine has probably had or has it, whether they know it or not.  With HSV-1 things are more complex and this is part of the reason we recommend against testing- with the blood test why open up this "can of worms".   The current blood test has problems with false positive and fails to detect up to 25% of infections.  We recommend that persons who get cold sores tell their partners.  If not, we suggest there is little to be gained from testing as the results of such tests can be incorrect and because so many people over react. 

By and large disclosure is the right thing to do but in some instances, there is little to be gained.  In your specific case, you do not know if you have either HPV or HSV-1.  You may but you may not and you have done the right things in terms of prevention.  Leave it there.  EWH

I hope this helps.  eWH
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44 months ago
I would've been exposed to the HPV from before since the sexual encounters I'm considering were long before I was vaccinated.  Does the strain that causes cancer ALWAYS or MOSTLY cause cancer, because that's what I'm most worried about, and does that strain, too, resolve on it's own most of the time?

And also, in theory, if I were to sleep with that friend, could I get the strain that gave her cancer?

As far as kissing someone when i have a cut on my lip and they have nothing on theirs (HSV-1 fears) -- this is nothing to stress about?
And also there is nothing to worry about that even when I have had cuts on my lip and he had a coldsore on his mouth we still shared drinks and pipes?

I've also read for both HSV-1 and HSV-2 that if it will change your behavior, then you ought to test. Is this true?

To be honest, I just want to forget all of this and be at peace.
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
There is a bit of redundancy in these questions.  As this is my 3rd and therefore, as per Forum guidelines, my final reply to your questions I will try to address your concerns again.

The VAST majority (well over 95%) of all genital HPV infections, including those associated with cancer, resolve without leading to cancer.  The concept that if you slept with someone and they were to get HPV and go on to get cancer (a process which takes years or even decades) is too linear.  There are many, still to be elucidated co-factors and genetic factors which contribute to the tiny proportion of all "high risk" HPV infections which contribute to cancer, as does the behavior of that person (even the tiny proportion of infections that go on to cancer do so slowly and are readily detected by recommended health care screening practices, allowing pre-cancerous lesions to be detected and treated).  By way of example, a tiny proportion of people who get flu go on to get pneumonia and a small proportion of those die but the person from whom they got flu is not responsible for the ultimate outcome either. 

Regarding HSV-1,  a cut from shaving is not a cold sore and should not prevent you from kissing someone.  You do not know that you have HSV-1 and odds are that the person who you are kissing will not know if they have HSV-1 or not.  further, I would hope you would not stop from kissing someone who knew that they got cold sores (and again, you do not know you have HSV-1). 

My sense is that you are overthinking this and getting far down a "what if" path.  While I appreciate and respect your concern for others, I would not worry if I were you, you are doing things right.  As you indicated you wish to do, I would urge you to "forget all of this and be at peace".

This thread will be closed later to day.  Take care.  EWH
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44 months ago
I know you don't allow any additional replies after the third, but I just want to be clear about one thing:

I have had a cut/pimple/open sore while sharing a drink with my father when he had a cold sore present multiple times. -- is this still nothing to worry about? That's all I'm asking
44 months ago
**drink / pipe/ food utensils etc.