[Question #288] genital warts transmission

106 months ago

Hi, I am a guy and I was just diagnosed with genital warts. I now have visible warts but they are really really really small. I didn't acquire the infection from my current girlfriend. We had been having unprotected sex for about a few days and I didn't really notice the warts then except maybe a tiny one. I am worried I might have transmitted them to her and it is driving me crazy. I did tell her that I have them now but I want to know what are the chances that I gave them to her? And if so, when should she test? I didn't really find a window period to test for this virus. I have also read conflicting reports that once a person has it they have it for life but I also read that most peoples' immune system fights off the virus on its own and the virus is no longer detectable. Which one is it?? Once I noticed them fully I stopped all sexual activity with her immediately but I know there is still a chance and I am so scared!

H. Hunter Handsfield, MD

106 months ago

Welcome to the forum. Thanks for your question.

I cannot judge the chance you infected your partner. You don't say how long you have been together, but if more than 2-3 months, it's equally likely you acquired the infection from her as the other way around. In any case, the official advice from CDC and other experts is that your partner should not be tested at all. She should wait and see if she develops warts. If she notices anything, she should then be examined professionally. Until then, there is nothing anyone can do either to detect HPV or alter her risk of developing warts. That's why you can't find a "window period" for testing. No test for HPV is available or recommended in this situation.

As for present for life and no longer detectable: both may be true. Many experts believe HPV DNA persists in infected tissues indefinitely, although others aren't so sure. But DNA isn't the same as active infection. The immune system indeed clears the virus to a point at which active infection is gone and it cannot be transmitted. However, if DNA persists, the infection sometimes reactivates.

It was pointless for you and your partner to cease sexual activity when your warts were diagnosed. Assuming you had sex at least a few times before that, she undoubtedly was exposed and infected: too late to close the barn door -- by that time, the horse was galloping over distant hills. And of course if she was the source of your infection, it makes no difference now. Either way, there is no point in avoiding sexual contact now.

So there is really no justification for being "so scared". Nobody wants genital warts or other HPV infections. But warts are an unpleasant inconvenience, not an important health risk. Everybody gets genital HPV, an unavoidable consequence of human sexuality. But the large majority if HPV infections don't cause serious harm. I'm not minimizing their importance; women should have pap smears and/or cervical HPV tests to further reduce the already low risk of cancer. And all young people should be vaccinated to prevent infection with the HPV types that cause most real disease. But the chance of a serious outcome here really is low. Don't let an impersonal bit of DNA, which has evolved to exploit human intimacy for its propagation, to rule your sexual and romantic life.

I hope this has helped. Best wishes-- HHH, MD

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106 months ago

It has just been two weeks so not that long and we had sex during a three day period out of those two weeks. I know you say stopping sexual contact didn't matter but Isnt it logical to assume that the more an infected person has sex with an uninfected person the greater the chance of transmission??as with any disease or infection. For other stds like herpes a few sexual encounters creates a risk but even couples where one has it and the other one doesn't over the course of a year and regular sex between them the transmission rate still is not that high. I did read that a large study showed back in 2011 that there was a 20 percent chance of transmission over a 6 month period if one person had it and the other did not and the couple had sex four times a week for 6 months.

She had previously gotten her Pap smears and been tested for hpv so I am almost positive I didn't acquire it from her.

Thanks Doc

H. Hunter Handsfield, MD

106 months ago

Your "logical" statement indeed is correct. However, with active warts, the odds are very high the virus was transmitted by the first exposure, let alone three exposures. New genital warts probably are a lot more efficiently transmitted than herpes; that's an irrelevant, apples/oranges comparison. She chance your partner caught it isn't 100%, but in my estimation it's well over 50%. I can say that if I were in your and her situation, I wouldn't alter my sexual lifestyle at this point. Also, I'm not clear on what you mean by "two weeks or so". Does it mean since you noticed the warts? If you have been in this relationship for 2 months or more, it is likely that she is the source of your warts. In that case, of course there is no prevention value in stopping sex at this point. You can't transmit the infection back to her a second time.

Pap smears probably pick up under half of HPV infections in women. I don't know her age, but if she's 20-30, that alone means a 30-50% chance she has an active HPV infection. (Yes, it really is that common!)

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106 months ago

No we have been together/dating for 2 weeks total..we had sex Three days out of those 2 weeks. Prior to those two weeks we didnt have any communication,contact, or know each other so that is why I am almost positive she didn't give me the infection that fast. I believe it was another girl I had been intimate with three months earlier.When we had sex there was one wart present but near the base of my penis and it was extremely extremely tiny I even went to two family doctors who had said they weren't even warts at all and not to worry. The wart was only there for four days max before we had sex and again was extremely tiny. There might have been other ones in that four day period but they were small if anything.But a dermatologist confirmed them yesterday and that's the answer I will stick with.

So have you not heard the studies about transmission only being 20% over a six month period between one infected and one uninfected heterosexual couple? There's at least three out there one that was reported to the cdc with sample sizes of 200 plus and up and transmission rates never topped 20%..I know there isn't much wide spread data out there on transmission but still the studies seemed somewhat promising compared to over 50 percent and we had sex way less than those couples in the studies.

And if my logic is correct than isn't it correct to abstain from sex until my warts are gone?

H. Hunter Handsfield, MD

106 months ago

Thanks for clarifying the relationship. It is true your new partner cannot be the source of your warts, which typically appear 2-12 months after catching HPV.

The exact location of your visible warts doesn't help much in judging transmissibility. For each visible wart, a substantially larger area of skin has active HPV infection without visible abnormality. (Think of each wart as the tip of an iceberg, except that it spreads out on the surface, not deep inside.) The more recent the wart, probably the higher its ease of transmission. However, there are no studies of the percentage risk of HPV transmission, unlike the data you have seen about herpes. However, we do know that 25% of people acqure HPV from their very first sex partner, and that this often occurs after only 1-2 exposures. Hence my belief -- which I realize I cannot prove -- that the transmission rate is very high in situations like yours.

Or course all that depends on the accuracy of your diagnosis. This additional description -- two docs who reassured you before you saw the dermatologist -- raises the possibility that you don't in fact have genital warts at all. I've never seen warts that were almost too small to observe. Given the overall tone of this discussion -- with its evidence of anxiety out of proportion to the problem -- I have to wonder whether you're just examining yourself too closely and noticing meaningless variations in the appearance of your penile skin. Perhaps yet another professional opinion is in order. OTOH, you could sit tight for a couple of weeks. If they really are warts of only 2 weeks duration, probably they will grow substantially in the next 1-2 weeks. If in that time they aren't at least 1 mm in diameter, it will further argue against hte diagnosis.

In summary, I still don't agree that your logic is correct and my opinion and advice have not changed about sex with your partner.

We've reached the limit of 2 follow-up comments/questions, as explained on the forum home page. So that will end this thread. You're free to start another if questions remain. However, in that event, I would strongly recommend you wait a couple of weeks and see what becomes of the apparent warts, and/or get the opinion of another dermatologist or STD expert.

I hope this discussion has been helpful. Best wishes--

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