[Question #2430] HPV follow up

45 months ago
Good evening,

I asked a question about two weeks ago titled "Risk of HPV exposure". My initial question was answered by Dr. Hook.
My partner did the HPV DNA test and came back positive for the number 6 strain. I have received the Gardasil vaccine so does that mean that I am clear?

I'm really sorry if I am overreacting but unfortunately this incident was really unsettling for me.
Thank you again for this service you are providing.
Best regards,
SF
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
The HPV vaccine is among the most effective vaccines ever developed, virtually 100% protective against the types included in Gardasil. Dr. Hook mentioned 90% effectiveness of the vaccine. That's because the 9 HPV types covered by the vaccine account for about 90% of genital HPV infections, so vaccinated people remain susceptible to other types. However, the vaccine is 100% effective against the types are covered by the vaccine, including HPV6. You are immune from catching HPV6. 

None of this should be so upsetting to you. This particular partner told you of her past (and, it turns out, continuing) HPV infection. But all the other people you have had sex with in your life -- vaginal, anal, or oral -- had just as high a chance of having HPV as your recent partner did. At any point in time, literally half of all sexually active young people (age 15-30) have one or more HPV infections at the time. You can assume you have had, and may still have, HPV of types not covered by the vaccine. (There are over 100 sexually transmitted HPV types; the vaccine covers 9 of the most common.) Happily, the large majority of infections never cause any important health problems and are eventually cleared by the immune system. Having HPV is part and parcel of being a sexually active human.

Thanks for your kind comments about the forum. I hope these additional comments are helpful.

HHH, MD
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45 months ago
Thank you for your prompt reply Dr. Handsfield.
I've received 3 shots from  the first Gardasil vaccine which protected against 4 strains. It is my understanding that even this quadruple vaccine protected me from the HPV 6 strain. Is that correct?
Due to my stressful reaction to this incident I also took a HPV DNA test. They took swab samples from my genital area and my mouth. It seemed like an easy process, however everyone keeps telling me that "there is no HPV test for men". Won't this test work for me? Won't it show conclusively that I don't have HPV?
Finally,  I was thinking of boosting my HPV immunity and receiving the Gardasil 9 vaccine. Is the Gardasil 9 vaccine contraindicated in people who have received the quadruple Gardasil vaccine?

Thank you again for your time.

Best regards,
SF
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago

Gardasil 4 was equally effective against HPV6 as Gardasil 9.

The HPV tests were designed primarily for use in women and not formally approved (e.g. by FDA) for use in men. Many labs have developed their own tests, but without regulatory approval their reliability cannot be guaranteed. Mostly the results probably are reliable, but it's difficult to know for sure. In any case, a negative result never rules out HPV:  infected people can have negative results. (For example, if you had an infection involving only a surface not contacted by the swab specimens.) And if positive, usually there's nothing to be done -- no need to inform partners, and no need nor benefit from professional exam or to prevent later problems of significance. So there's really no point in testing, in the opinion of most experts. This is a bit controversial -- some experts may be in favor of testing. Anyway, don't be surprised if you have a positive result. Since over half of adults your age have positive results, it is statistically likely your genital and perhaps oral test will reveal HPV. But most likely it will mean nothing important from a health standpoint.

Gardasil-9 is perfectly fine in people previously immunized with Gardasil-4 and often administered to them, if cost is not an issue (around $500, not covered by al health insurance plans). It would protect you against 5 more types, and bring your overall HPV protection from ~70% (the 4 types in Gardasil-4) to about 90%. (But no protection against any types with which you have already been infected.)

 As you likely know, each question includes two follow-up comments/questions and replies, so you have one more coming -- and we don't accept repeated questions on the same topic or exposure, so this is your last question about these issues. Therefore, I recommend holding off on further questions or concerns until you have your HPV test result, in case you would like my comments or advice about it.    

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45 months ago
Dear Dr. Handsfield,
I just got my test results which were negative. I think that I can put this matter to rest. Reading about HPV online I find it statistically unlikely that I have never been exposed to HPV but at least I can be sure that from this exposure I was not.

One last question before I go : Is HPV a "forever" virus like herpes? The internet is filled with conflicting information so I would like your take on this.

Through this experience I realized that , when it comes to STD's, the stigma is worse than most diseases and that STD physicians such as yourself must combat not only diseases, but a misinformed general public as well. 
Thank you for supporting me and many other such as myself and may you have a great day.

Best Regards,
SF

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Permanent persistence of HPV is controversial, and partly an issue of terminology. It is clear that most infections are controlled by the immune system to a point that infection is not transmitted to partners, disease progression (e.g. cervical dysplasia, warts) is halted and reversed, and late recurrences are uncommon. However, HPV DNA often persists, and some investigators believe this is the norm. But if the infection can't be transmitted and causes no further health problems, and if it's only DNA without the complete virus, does that mean "infection" is forever? Opinions differ. In any case, it's definitely different than herpes, which indeed is permanent, with lifelong potential for recurrent outbreaks and transmission to others, given the right kinds of contact.

As for stigma, for sure genital warts are stigmatizing. All warts have had stigma throughout history, hence false associations and mythologies about hygiene, toads. etc, and genital warts carry a major "yuck" factor for many affected persons. But I don't think most people feel especially stigmatized by being told they have asymptomatic HPV infection. It's increasing with rising media attention, and with increasing awareness that has come about from vaccine recommendations, but still not the rule in my experience. Of course it's easy to gain the opposite impression online:  the majority of people not particularly bothered by having HPV don't go online about it, where stigmatized persons are greatly over represented. Anyway, one of our goals on this forum to to help reduce stigma for HPV and all STDs. They're all just bits of protein coated DNA that evolved to exploit human intimacy for their own propagation.

That completes the two follow-up questions and replies included routinely and so concludes this thread. Best wishes and stay safe.

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