[Question #2400] HPV Clearance / Disclosure

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97 months ago
Hi,

I am 30 years old and was first diagnosed with high-risk HPV around age 20/21 (I had a LEEP procedure).  When I was approximately 23/24, I had more abnormal paps (which eventually went away on their own) and warts  (which went away after treatment).  I have not had any additional abnormal paps or warts since that time.  

Particularly since the abnormal paps/warts approximately 6-7 years ago, I have been  very cautious about engaging in sexual activity with new people since there does not seem to be consensus regarding whether the virus is ever gone/not contagious.   My gynecologist has said he does not think I need to disclose it to new partners anymore, but friends who have had HPV think you should ALWAYS disclose. 

Ultimately, this leads to a great deal of anxiety for me  when I am with potential new partners; sometimes I even avoid sexual encounters to avoid an uncomfortable conversation/embarrassment.  Can you please tell me (1) whether you think I can consider my HPV "cleared" (and what that means); (2) your thoughts on whether disclosure to new partners is warranted in my case; and (3) what I should be telling a new partner? 

Thanks very much in advance.  This STI has adversely affected my personal life during my 20s, largely due to uncertainty from my doctors and online.  Any clarity going into my 30s would be much appreciated.   Thanks! 
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Edward W. Hook M.D.
97 months ago
Welcome to our Forum.  I'll try to help.  You have summarized the issues of controversy regarding disclosure of HPV infections wellWe agree with your gynecologist.  As you probably know, most sexually people who have not have the HPV vaccine will have had the infection - the current estimate is that about 80% of sexually active persons have or have had HPV infections with most people becoming infected relatively soon after they start to have sex and irrespective of sexual partner number.  Of those, a small fraction of 1% will progress to precancerous changes which can then be detected through regular sexual health checks for women and visual inspection for men so that if they do fall into that small proportion of persons with pre-cancerous lesions they have the problem addressed as you did with your LEEP almost a decade ago.   

Our knowledge of HPV continues to grow and consensus is increasing that most persons who have had and cleared HPV may still have small amounts of quiescent virus present but that the normal immune response which makes these infections go away without treatment also holds the infection in check.  Factors which decrease immunity can increase the risk of reactivation which is then manageable with routine care but most people with past HPV should not be particularly worried.  Our stance is that, because nearly everyone has the infection and because the large amount of mis-understanding of the (in-)significance of this fact for those who do know, that disclosure can hinder or damage relationships.  We do not feel the need to recommend routine disclose to sexual partners.  Thus in answer to your questions:

(1) whether you think I can consider my HPV "cleared" (and what that means).
I presume your PAP smears are now normal.  If that is the case, I would consider your prior HPV cleared and consider yourself non-infectious to others.

(2) your thoughts on whether disclosure to new partners is warranted in my case.
Please see above.  I do not see the need for disclosure.

(3) what I should be telling a new partner?
We do encourage persons entering new relationships to discuss whether or not they have been checked for STIs recently and whether there is a reason for concern (e.g. symptoms, partner numbers, etc.).  In such a conversation, depending on situation and circumstance, you might mention that you had abnormal PAP smears years ago but that this is no longer a problems and that you get regular check ups to insure your sexual health (presuming that this is the case.  If it is not, you should.)

I hope these comments and perspectives are helpful.  Please try not to let your abnormal PAP smears more than 5 years ago continue to hinder you in considering new relationships. EWH

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