[Question #3172] Moving on after 6 months clear
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91 months ago
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Hi doctors,
Happy new year, I understand I have asked a question recently, but since then I have done a lot of research and would just like you to clarify my conclusions below or tell me if any are incorrect?
In terms of clear for 6 months after treatment why is it you assume that you are not infectious, is it because if you had a continuing infection, warts should have recurred/appeared by now?
Would you also agree that if after 2 years of (assumed) acquired infection and 6 months symptom free that a future partner is statistically more likely to carry a wart causing HPV than you?
Is it possible for stress to cause a delayed reactivation/reappearance, or is it just severe immune deficiencies which cause reactivation, such as ones seen in advanced cancer, advanced hiv and immune suppressants for serious illnesses? I know you have said that if no recurrence after 6 months you can be almost certain it's behind you and to do your best to forget it, I just want to ensure reactivation is not random and it is only likely, if serious immune changes occur and not just a period of stress or temporary illness?
My understanding of transient is temporary so my assumption is that, if a lifetime of recurrences was likely due to slight immune changes from stress and other infections then HPV would be considered permanent, correct or incorrect?
Many thanks again,
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H. Hunter Handsfield, MD
91 months ago
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Welcome back to the forum. I picked up your question this time. Although you don't say what infection you are concerned about, presumably you mean HPV, as in your question a few months ago.
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Six months for reliable clearance is a rough figure. In general, both I and Dr. Hook tell persons with gneital warts that once they clear up and have not recurred for 6 months, they likely will not have a recurrence and will not infected subsequent sex partners. But that's not a guarantee, only a ballpark figure. There has never been formal research, just the experience of providers who have cared for lots of patients. But by that time, it is likely that even if HPV DNA persists in the tissues, it is in insufficienty quanity for transmission.
"Would you also agree...?" If I understand, you are asking to compare the odds a random new partner has an active wart-causing HPV infection versus the odds that someone who acquired warts 2.5 yr earlier and was symptom free for 6 months still has an active transmissible infeciton, right? Sorry, but I haven't a clue. In both cases, I would say the chance is very low but not zero.
The relationship between stress and immune competence if really not well known. Obviously a lot of people think this is a big deal, but the science behind it is weak. In any case, there certainly is no evidence that stress, anxiety, etc have any effect on the strength of quality of the immune response to HPV, frequency of recurrence, etc. Advanced immune system damage clearly has such effects: for example, recurrent and transmissilbe warts, and progression of HPV to cancer, are more frequent and more rapid in people with AIDS, advanced cancer, major chemotherapy, and as a consequence of potent immmunosuppressive drugs.
However, such major hits on the immune system definitely are not the only things responsible for late recurrence of HPV. Depsite your hope for reassurance otherwise, such events appear to in fact be random. Of course there are solid reasons to maintain a healthy lifestyle (proper diet, exercise, weight control, stress limitation when possible), I cannot assure you or anyone else that doing these things will keep HPV at bay.
But do keep in mind the basic fact that although nobody wants HPV, it's a normal consequence of being sexual; unavoidable; and mostly never causes symptoms or important health problems. Its just something we all live with -- most of us without worry about it!
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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91 months ago
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Hi doctor Handsfield, yes I was talking about genital warts.
I guess my fear is that I'll just wake up one day and see a wart after a few years wart free and I'll never be rid of the virus. I understand once hpv is cleared, that the virus/warts cannot be transmitted and that as there is no test in men so you cannot guarantee as and when this will be for definite.
I know you and Dr hook have said previously that if after a few months a wart has not recurred and then one appears down the line it is more likely a new infection would you still agree with this?
My worry isn't necessarily the harmfulness of HPV as I know warts in and of themselves are harmless, it's more the pyschological effect this may have on a future partner and the amount of misinformation they may receive such as virus is always infectious and how this will effect their lives and potential children e.g. jorrp.
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H. Hunter Handsfield, MD
91 months ago
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I don't remember writing a statement comparing the frequencies of late wart recurrence versus later infection with new warts, and I'm inclined to doubt Dr. Hook has made such a direct comparison. Both scenarios are uncommon, but I suspect the former is more likely. New HPV infections are uncommon as people age beyond their late 20s, so new warts at, say age 40 or 50, probably are mostly late recurrences. But this is just common sense guesstimating in the absnece of data.
"my fear is that I'll just wake up one day and see a wart after a few years wart free and I'll never be rid of the virus." Nobody can say this won't happen, but the odds are low. At least you're not alone. In western countries, probably 15-30% of all people have had genital warts and thus the potential for recurrence. In other words, probably a quarter of all people you know are in the same boat. Fortunately, most such recurrences, like the original warts, are a relatively minor inconvenience, not an important health threat. Most people just don't worry about it. Your closing statment shows you seem to understand this -- so it's just a question of getting yourself to that point. I hope this discussion is helping you get there.
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91 months ago
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Thank you, final question I know there is no data to say for example for definite only 1 or 2% have a later occurrence as I understand that with sexual data and research of transmission of infections it is tough to get honest, reliable answers from people regarding their history. E.g. if say someone has an affair and 6 months later has a wart, knowing the science of HPV one could argue that they could use the excuse I must've always had it and it's reactivated. Without tests to validate this it makes it impossible to really judge who, how and when these things happen, but would the science and years you've practised suggest that the risk is low enough that to worry about a later reoccurrence is silly in terms of other more likely things to occur over the course of a relationship/life? And apologies if this is asking you to repeat yourself, but once cleared the likelihood of a late reoccurrence is very low and not the norm for most people?
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H. Hunter Handsfield, MD
91 months ago
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" ...would the science and years you've practised suggest that the risk is low enough that to worry about a later reoccurrence is silly in terms of other more likely things to occur over the course of a relationship/life?"
Yes, that's correct. I wouldn't worry about it because a) It is unlikely, and b) it would not be (or should not be) any sort of serious big deal if it happens. I recommend you also not ask future partners about past histories of warts or other HPV infections. No matter what responses you get, it will make no difference in your risk. (Don't get me wrong: many couples discuss their past sexual lives including STD history. But that's a relationship issue -- not one, in this case, that is important for disease prevention or other aspects of sexual health.)
That concludes the two follow-up comments and replies included in each thread, and so ends this discussion. Do your best to move on without worry!
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