[Question #317] HPV Transmission and Testing

35 months ago
IM OCD, to the point that I don't leave the house anymore. I uses to be happy, however 14 years ago I caught a genital wart and I have never stopped thinking about it. I have dated lots of women and those I have kept in touch with say they are fine...except 1.It had been four years since the wart when I dated this gal, we broke up and I met more women (who are all fine?) This gal and I got back together about 3 years latter, she had no abnormalities that whole time. So we were together for a year this time and at the end of the year she developed an abnormal pap/hpv. She was in her 30's and smokes a ton. 1) Did I cause that, I have read threads were Hunter and Hook say low-risk cause lots of abnormalities and others were the say the opposite (high risk do).2) Dr. Diane Harper wants to test me, do you think that's a good idea?3) If abnormal paps are caused by low risk types then why aren't women told to be concerned about spreading warts, and to a bigger point if low risk do cause warts and abnormal paps, does that mean low risk strains are everywhere? 4) I thought low risk strains cause visible warts about 68% of the time, so how come all these low risk are showing up on the cervix not turning into external warts?5) I know you've answered all this stuff before, however I have attempted suicide numerous times over this contamination I feel, and I just want to ask a few more question b4 I am put into another hospital:)6) Finally why are women given the all clear after treatment on the cervix, but with genital warts Dr.s will say things like, there could be pieces of wart left, or you might be able to spread. None of my friend girls have ever had a Dr. tell them that. Why would I go around telling people about HPV when for all I know they have it, will give it to me and then blame me for it, because I informed them.7) Is HPV even an STI. Seems like it's just part of sex, most kids get warts when that start to play with friends, aren't we just playing with adult now, whi

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome to the forum and thanks for your question. I'm sorry to hear you are so disabled by your OCD. As you probably understand, although HPV is your immediate concern and apparently an important focus of your obsessions, it is not the main problem here. I will of course answer your questions, but I suspect it won't help settle your concerns. That's the nature of OCD, and I hope you are getting professional care for it.

The chance you still have the HPV that caused your genital warts 14 years ago is very low and I doubt it has anything to do with your recent partner's abnormal pap smear. You were under no ethical obligation to mention your past warts to partners, once a year or so had passed without recurrence. I don't know the exact proportion of women who have an abnormal pap sometime in their lives, but I believe it's over 25%. Among those millions, in the vast majority of cases it isn't possible to know (and generally doesn't matter) where and from whom they were infected. To your specific questions:

1) As already noted, it is unlikely your partner caught the HPV causign her abnormal pap from you. Low risk (e.g. wart causing) HPV types indeed cause many abnormal paps, but usually low grade and with little or no risk of progressing to overt cancer.

2) I would definitely advise against you being tested now for HPV, and most experts (including CDC) agree. Nothing could be done if positive (without symptoms); the test misses many infections, so a negative result would not mean you don't have HPV; and neither a positive nor negative result would make any difference in your health or that of future sex partners. Dr. Harper has a reputation of controversy in HPV prevention and management. That doesn't mean she is wrong, but her atypical perspectives should be taken into account.

3,4) The large majority of pap smears, whether with low or high risk HPV types, don't cause warts. HPV types 6 and 11 cause 90% of warts, but are only two among 50+ low risk HPV types. Yes indeed, they are "everywhere".

5) No comment, except to reiterate my hope you are in professional care and if not to urge you to take that step now.

6) I can't judge or critique third hand information about what some doctors tell (or don't tell) their patients about HPV. The data on HPV continue to evolve; some issues are controversial and what's true today may change tomorrow; outlying views are not necessarily inappropriate; and not all patients correctly understand what the doctor said.

7) Both are true:  HPV is an STD, i.e the virus is sexually transmitted, and HPV is also "just part of sex". At least 90% of all sexually active persons are infected at one time or another, often several times. Fortunately, the most dangerous and inconvenient outcomes are easily prevented with vaccine; easily treated if warts or abnormal paps show up; and most clear up on their own without ever causing symptoms.

I hope these comments have helped a little bit. I urge you to try not to worry about either your past HPV or your partner's recent pap smear. And once again I will urge professional care for your OCD.

Best wishes--  HHH, MD


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35 months ago
Thanks for the info Dr. Handsfield.  One more quick clarification then I'm going to hang up this thought process for awhile. 
1) The ex probably had a more severe case of dysplasia, and was treated accordingly. It's been said that 60-68% of people that catch types 6 and 11 develop genital warts, then how are they able to show up as an abnormal pap as well? Obviously four years after exposure would conclude a high risk type caused her abnormal pap. But as you stated  "Types 6 and 11 often cause pap smear abnormalities in women, but of the milder sort that virtually never progresses to advanced stages or cancer. "  in another post you stated 6 and 11 show up as external warts 68%  of the time...well  I'm confused? How can the cause so many abnormal paps and not cause external warts? Seems to not add up? Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I don't understand the question. Why can't both be true: warts about two thirds of the time and abnormal pap smear? Note that two thirds (or 68%) still allows one third of infection to not result in visible warts. There is no inconsistency here. And I disagree it is "obvious" that an abnormal pap 4 years after exposure must mean a high risk HPV type. I don't see what doesn't "add up".

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35 months ago
Yes, I didn't pose the question correctly, and I certainly am not questioning your knowledgeable answer. I understand what you're saying, I know her abnormal pap could have been caused by any type of HPV. It could have been me or her or another sex partner, who knows:) I also understand that I'll probably date another women who will at some point test positive for HPV.  It seems that I worry so much about something that really is just a part of being human, mine was such a mild case the Dr. was really never sure, so I think I wasted enough time on this subject. I appreciate your time, and really do want to move on from this. Thanks again for your response, best of luck! Oh, and I have seen some great OCD doctors, they do not like me on the internet, ha!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Thanks for clarifying and glad you understand. I would certainly reinforce your doctor's advice about the internet!

That winds up the two follow-up questions and replies per forum policy, so this thread will be closed. Best wishes and stay safe.


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