[Question #2521] HPV transmission to men and condom use

44 months ago

Hello:


I am a 61 year old woman with HPV, diagnosed about 7 years ago. Last month, I learned that I still have HPV. My pap smear didn’t show any abnormalities, and I was negative for the types 16 and 18. I have never had any genital warts. I was relieved to find this site. I have read many of questions and answers, and they have been very helpful. I do have a few questions, however.


  1. Is it possible to determine whether or not I have the type of HPV that can cause genital warts?
  2. Does my partner, a 69 year old man who has rarely used a condom in his life, need to wear a condom with me now?
  3. Since I haven’t had any genital warts, is it likely that I can transmit warts to my partner?
  4. Is there any way to “get rid” of my HPV? What is the likelihood that I will develop cancer?
  5. How and how often do men acquire cancer as a result of HPV?
  6. Other than genital warts and cancer, what are the other health consequences/impacts of HPV for men, if any?
Thank you for your time and assistance. This is a great service!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your confidence in our services.

Your story is a common one. HPV is unpredictable. Most HPV infections are believed to be cured entirely by the immune system, but HPV DNA may persist -- and recent research indicates DNA persists more commonly that previously believed. Up to half of all adults in the US, including people over age 40 and not at current STD risk, have HPV DNA detected on the penis, vulva, vagina, labia, etc. There is controversy about whether HPV testing should be done at all in your situation; it is clear that testing should be done if a pap smear is abnormal, but otherwise might not be wise if the pap is normal, especially at your age. This isn't meant to be critical of your doctor for doing the test:  she is following common guidelines. But with the new research about how extremely more common HPV is than previously realized, I imagine the guidelines will change as time passes.

Despite the very high prevalence of HPV, new HPV infection with symptoms (e.g. warts) are very uncommon after age 30 or so. Even with carriage of DNA, people might be immune to developing active infection that causes growth of warts (and perhaps of precancerous tissue as well).

To your specific questions:

1,3) Most HPV DNA tests check for only a few types, i.e. the ones most likely to progress to cancer (HPV 16, 18, and a few others), but many also check routinely for HPV 6 and 11, the two types that cause most warts. You'll have to check with your doctor's office or the lab about exactly what types are detectable on the test that was done. But even if you have a wart causing type, it's not likely to actually cause warts if you or your partner don't have them already.

2) Since you and your partner apparently have been together for some time, he has been repeatedly exposed to the HPV types you have and undoubtedly carries them himself. He could have been the source of your infection, or vice versa -- you'll never know. In any case, it's too late for changing sexual practices, which would not prevent either of you from any significant health outcomes. This would be closing the barn door long after the horse is galloping over distant fields.

4) Nothing is known to speed (or delay) clearance of HPV or prevent progression, e.g. toward cancer.  Well one thing:  don't smoke! Tobacco use increases the frequency and rate of progression toward cancer. However, the vast majority of HPV infections never lead to cancer. When it happens, it takes many years -- during which it is always possible to detect early changes and give curative treatment before it becomes dangerous. I imagine your doctor will advise you about follow-up pap smears and testing. Follow that advice, then forget about it.

5) Penile cancer is much rarer than cervical cancer in women. Here too, any cancer he would develop would first show up as a minor bump or sore on the penis, at a point of easy treatment. Invasive penile cancer requring drastic treatment (e.g. amputation) is exceedingly rare. This also is not a serious worry.

6) Add throat cancer and anal cancer to the list. Otherwise no known ill effects. And these cancers are rarer still. And again I will stress that his risk for these is no higher on account of your HPV than it would have been if you had never been sex partners with one another. Exposure to any particular infected person does not materially raise the risk of bad outcomes.

I hope this information is helpful. Please let me know if anything isn't clear.

HHH, MD
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44 months ago
Hello again:

I appreciate your prompt reply. I'm sorry I wasn't more clear. My partner and I have been together for a short period of time and have always used a condom. So I want to know:
  1. Whether or not we need to continue using a condom and
  2. If my partner has a different strain of HIV, I presume he can transmit it to me, right?
Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Thanks for the follow-up info. Condoms only modestly reduce HPV transmission frequency, because of substantial skin contact above male condom coverage. Over several episodes of intercourse, the frequency of HPV in partners is just as high in regular condom users as in those who don't use them. And assuming your partner is somewhere near your own age, the odds are strong he has been infected and likely might be immune to the type(s) you have. If I were in your circumstance (and in fact have been there in a somewhat distant past life), I would not feel a need for condoms.

I'm sure you mean HPV, not HIV. Yes, if your partner has an active infection with an HPV type to which you are not immune, you could be infected. But that wouldn't be a big deal, and my condom analysis and advice still applies. As long as the two of you are confident you have no other STDs, I would not recommend continued condom use on account of HPV in either of you.

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