[Question #2718] HPV/Warts/STDS

41 months ago
Hello. Just want to say thanks for offering your expertise to all of us who need it. It is deeply appreciated. For background, I am a 26 year old female. I was recently told in July 2017 that I have HPV, but not strains 16/18 and my PAP was normal. I've always had normal paps. This news, to my gyno, is not remotely concerning. I asked if it was high risk or low risk and they said they only test for high risk and warts are through visual exams. 

Unfortunately, as someone who has generalized anxiety disorder and OCD, I have been stirring about this for 2 months. I guess I was shocked because, the last time I had sex was August 2016 , so I haven't been sexually active for nearly a year.  And I repeated my Gardasil shots last September 2016, a month after my last encounter. I was not protected with the partner I dated from June-August 2016, but we did exchange testing upfront. Otherwise, I've always used protection. I got a full STD panel this February (with Herpes IGG antibody test) and everything was negative, with the exception of HSV-1. I've had cold sores for years.  I'm just psychotic about STDs and a lot of it is my OCD. But I work with mental health professionals for help - so I do want to note that.  My questions are:

1. Should I worry about this HPV diagnosis?
2. I've read you can have internal warts, should I worry about that? How would I know if I have them? There are no warts on my exterior parts, and anything questionable was removed and sent off to pathology for confirmation (it was scar tissue from a hemorrhoid). 
3. Should I trust my STD test from February or take another one? Could HSV-2 show up to be positive? 

Sorry for all these crazy questions. Thanks in advance. 
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Welcome to the Forum and thanks for your confidence in our services.  I'll be pleased to comment.  The answer to your questions is, in part, related to the fact that there are over 100 different types of HPV and a number of them are somewhat associated with "risk" for genial tract PAP smear abnormalities and even cancer.  While the largest proportion of such HPVs are covered, not all are.  One such infection has been detected during your last exam.  We cannot say how long you have had it and to assume the it was from your recent partner would be a mistake.  Having said that, this is not something to worry about.  With regard to your specific questions:

1.   I would not worry about the diagnosis.  Most such infections resolve on there own without therapy.  Even if it were to persist, in the absence of PAP smear abnormalities, I would not worry.
2.  Similarly, I would not worry about internal warts.  They are uncommon and, if anything, they are a nuisance.  Your doctor would notice warts if they were pleasant.
3.  No, there is no need for further testing.  Your tests are reliable and there is no need to test with regard to your past relationship.this statement pertains to your herpes test as well as other tests for STI.

I hope these comments are helpful.  EWH

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41 months ago
Thank you, Dr. Hook- this information is  reassuring. There's a lot of misleading information on the internet and my OBGYN told me to stay away, but with my OCD- it's a hard battle. Which is why I sought out your expertise!

For future reference, if I had internal warts - would my OBGYN be able to see them on a Pap smear? I would think so?

Do condoms protect against warts? 

Do I tell partners about my HPV diagnosis?

Is it possible for warts to show up anywhere else beyond the vagina, say for example, inside/around anus even if I don't frequent anal intercourse? I read forums of women getting anal herpes and never had anal intercourse, didn't know if warts also occurred in the same fashion.  I've tried unprotected anal intercourse once in my entire life and it was many years ago with a monogamous boyfriend. Is that something likely to occur?

Thanks!! 

Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago

Your doctor is correct.  It would be a mistake to go to the internet as so much of the information there is incorrect, typically because it is taken out of context. With regard to your other questions:

 

Yes, if there were internal warts/HPV a PAP smear would most likely detect them.

 

Condoms reduce the likelihood of warts by about 60% but not perfectly. 

 

We do not recommend disclosure related to HPV diagnosis.  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 over 50% of persons, even those who have had only a single partner, have HPV.  It is now conservatively estimated that over 80% of sexually active Americans have or have had HPV.  Thus it is in no way surprising that you were found to have HPV. Virtually all sexually active persons get this chronic viral infection so, unless you are feeling guilty because you have had sex with more than a single partner in your life, for practical purposes, this is just part of being a sexually active person.  It is for these reasons that we continue to urge our clients not to get overwrought by the possibility of an HPV infection and to not feel a need to disclose of their infections to current or sexual partners who are likely to already have HPV.


Finally warts can occur at any site of sexual contact.  I would not spend a lot of time worrying about this for the reasons noted above.  EWH


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41 months ago
Thanks so much, Dr. Hook. I knew that warts can occur at any sight of sexual contact, but I guess I figured that the probability was low for my case, since anal intercourse only happened once. My consensus was that the transmission would not be super high for a one-time thing, perhaps, this is more misleading information I read. Do women need to get any type of rectal examinations if they engage in anal intercourse with their partners or is that sort of thing taboo?

Nonetheless, it seems that I have no reason to worry about my STD test, HPV diagnosis or the chance of warts - since HPV cases resolve on their own and warts are not a nuisance/do not turn into cancer. I know cervical cancer is EXTREMELY preventable, thus the existence of PAP smears.

I will continue to use protection until I am in a monogamous relationship with a partner that has also been tested and is in the clear. 

Thanks so much for all your help! 
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Unless they request them, most women do not have rectal examinations, even is they have engaged in receptive rectal intercourse. 

I would agree with your statement that most single exposures to partners with HIV do NOT lead to infection.

I agree with your statement that you do not need to worry about your HIV test or chance of warts.  In the meantime, as you point out, continued use of protection is a good idea. 

This third response will complete this thread.  it will be closed later today. Take care.  Please don't worry.  EWH
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