[Question #3212] My history of HPV

91 months ago

Dear Doctors,

Here's a brief history of my life with HPV, followed by a few questions.

15 years ago genital warts suddenly popped out, not long after becoming sexually active with my first partner. I went through one session of freezing. I might have been asked to come back for further treatment and / or was given some topical cream but I was so traumatised by the experience I simply buried my head in the sand and anyway the warts seemed completely gone. They haven't recurred since.

A few years later CIN 1 was found and resolved by itself within 6 months.

Five years ago I was diagnosed with high grade dysplasia and HPV was detected. I was successfully treated with LEEP leading to low grade abnormalities while I tested "negative" (undetected) for the virus (over the course of two years). More recently I went for a follow-up Pap and the cells showed as normal.

Now to my questions:

1. I've never really worried about it before but is there a chance that my warts weren't fully treated and led to my first CIN 1 diagnosis? Surely if I still had warts they would have been spotted during the Paps?

2. After I was discharged 3 years ago I had a couple of sexual encounters. This was followed by two years' abstinence. My last Pap 10 months ago was normal but I wasn't tested for HPV. How likely is it that I was reinfected or the virus reactivated since my last HPV test?

3. I have recently started dating a man who is separated from his wife of 15 years. I found the courage to tell him about my past abnormal Pap before we had sex. Was I wrong not to mention the warts episode of 15 years ago? I never thought of disclosing it to anyone before.

4. What are the risks to my partner in general and in relation to oral sex (oropharyngeal cancer) in particular? I am tempted to mention the low but existing risk to him... I wouldn't normally but I'm his first partner since his wife and therefore his first new "exposure" for a long time. I feel guilt at the prospect of him performing oral sex on me. And avoiding it will make the perceived danger more conspicuous…

By the way I am 42 and he is 52.

Best regards,

Edward W. Hook M.D.

91 months ago

Welcome to our Forum. I'll be happy to comment. Before I do, several comments. First, in addition to reading my responses to your specific questions, I would suggest that you read the responses that Dr. Handsfield and I have made to others with similar questions (we receive many questions regarding disclosure, persistent infections and the risk for oral cancer). We find that it is often helpful to see that others have similar questions and to have what I am about to reply to you confirmed though out responses to others who are in the same boat.

By way of background I would also add that, as I suspect you know, HPV infections are widespread, occurring in about 80% of sexually active adults yet only a very tiny proportion of infected persons go on to develop pre-cancerous findings and, when they do, monitoring and treatment are highly effective for preventing progression as appears to be the case in your situation. Now, on to your specific questions:

Wart-related HPV changes are typically picked up on PAP smears. Between the visual inspection that is part of routine gynecological examination and your repeated PAP smears, if there were persistent genital wart or wart virus infections, they would have been detected. I would assume that your warts and wart virus infection are no longer present.

If your tests are negative, it is unlikely that your were infected. HPV would typically be detected at this time.

I'm impressed that you chose to disclose and am pleased to hear that this has apparently not negatively impacted your relationship (all too many people over-react to hearing about HPV, despite its ubiquity and for this reason we typically do not recommend disclosure to sexual partners, except perhaps in the context of a more general discussion of sexual health). I see no need to continue to disclose except as part of a more general sexual health history exchange. Part of this relates to two facts- most persons with HPV do not know that they have it and most people have or have had the infection.

You are nice to be concerned for him but you have already disclosed your past HPV infection to him. At this time, my advice would be to leave it be and have a modest concern that if you repeatedly bring the subject of your HPV infection up, you may raise unnecessary concerns. You have already disclosed. At this time, I would simply go on and have your regular sexual health screening and check ups.

I hope my comments are helpful. After you after considered my responses and perhaps looked at a few other HPV-related questions, please feel free to use your up to two follow-up questions if anything I have said is unclear or you have additional questions. EWH

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91 months ago

Thank you for the quick response and useful comments.

In relation to question 2, I was asking if there was a chance of a new HPV infection since having had sex after my negative test 3 years ago...

I have two follow-up questions – if I may:

I understand that my CIN 3 was caused by a high-risk strain of HPV. Is it possible that I acquired both types (low and high risk) around the same time? After I broke up with my first long-term partner of 6 years I had a string of flings (protected sex 99% of the time) over a few years and one regular partner at some point. So I'm curious to know if repeated exposure with the same partners or casual sex caused my infection to high-risk HPV. I suspect there is no way of even venturing a guess...
In the context of disclosure of STIs, I have just disclosed to my partner by SMS (he is abroad at the moment) that I once had a cold sore two years ago. I know this is not the right section of the forum but I felt bad for not telling him when he asked me if I had anything that was orally transmissible. For my defence I simply forgot about that outbreak (the first ever and hopefully the last). I just feel so handicapped in my dating life. As if HPV wasn't enough I now also have to disclose oral herpes!! It is simply too much of a burden. I haven't heard from my partner... I suspect he is upset and / or angry at me. I do suffer from OCD and these things get to me more than the average person. Should I systematically disclose that one episode of cold sore every time I am about to kiss a new person? What about kissing friends, family member and children?

Edward W. Hook M.D.

91 months ago

You risk for further infection following your negative test two years ago is not zero but it is relatively low. As long as you are getting your regular sexual health check ups, were you to get infected, it would likely be detected.

With regard to your f/u questions:

1. There is really no way to know if you might have gotten infected with more than one HPV type from a single sexual partner. On one hand, virtually everyone has HPV (60% of women with a single sex partner have HPV within a year of beginning sexual intercourse) so there is a modest risk for infection with any sex partner (BTW, the prevalence of infection decreases with age once persons are over 30. This is because the body's own immune systems control the infection). OTOH, it is not at all unusual for persons to have more than one type of HPV infection at the same time.

2. Cold sores are tough. Cold sores are caused by HSV-1 and over 60% of U.S. adults have HPV infection although the majority (about 80%) of those with the infection do not know they have it. Transmission is far more likely when persons have cold sore lesions present and in the absence of visible cold sores HSV-1 transmission occurs at only a fraction of 1%. If you know that you have cold sores it is best to disclose this but I would also qualify it with the statement that you have not had an outbreak in years.

Hope this is helpful. EWH

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91 months ago

Many thanks, Dr Hook.

91 months ago

Hello again,

Sorry to be jumping back to my herpes question but I did pay for another question (#3222) on the subject and I'm now not quite certain it was answered correctly. Importantly I now have complements of information.

As I explained to Terri Warren I am trying to establish if I was first infected with herpes (I'm assuming hsv-1) when I developed my first cold sore 16 months ago, or many years earlier.

I trawled through my messages and was able to establish a time-line:

- day 1 (late in the evening): kissing that caused stubble rash (my partner later told me he has a history of cold sores but no visible signs at the time)

- day 2 (afternoon): sun exposure and definite prodrome

- day 3/4: cold sore starts to appear

- day 5-6+: cold sore develops, etc.

Is less than one day too soon for the first symptoms to appear, or even possible, therefore suggesting this was a recurrent outbreak? Say I am wrong by one day – how soon can symptoms start after a new infection?

Dr Handsfield wrote in a answer to a question on medhelp in 2011: "A single cold sore rarely is due to a new HSV infection, but actually is a recurrent outbreak" (https://www.medhelp.org/posts/STDs/Possible-HSV-1-exposure/show/1568351#post_answer_header).

Please can you comment, also in the light of my suspected herpetic intra-oral infection(s) in the past?

Many thanks,

Edward W. Hook M.D.

91 months ago

I'll be glad to comment. I did review your earlier interaction with Terri as well and agree with the sense of her post. The additional information you have provided is helpful. I hope that the additional information I will provide will be helpful as well.

In general, the majority of persons with HSV-1 acquired it in childhood, before they were sexually active and most of those persons do not know that they have HSV-1. The prevalence of HSV-1 in adults increases in age and at age 40+ the likelihood that an average American has HSV-1 is 66-75%. Some experience rare recurrences (cold sores), many/most do not. Only a small proportion of persons with HSV-1 experience frequent cold sores. For those persons stress, sunlight, friction and trauma all are associated with recurrences although not all sunlight exposures, stress, friction necessarily lead to recurrence.

In the timeline you provided, to have acquired HSV and experience an initial outbreak 24-36 hours afterwards would be most unusual. Thus, while one cannot be 100% sure, it is more likely than not that the outbreak you experienced was not an initial HSV-1 outbreak.

Finally, you are worrying a lot about your partner and chronic infections. Are you really 100% sure that the outbreak you reported was HSV-1? Many things can cause oral lesions of the sort you describe. Even if it was, personally, I would not worry and would not feel the need to disclose before kissing or having sex with another person- odds are that your partner, whether they know it of not, already has HSV-1 (and, in the context of our earlier interaction HPV).

This is my 3rd response as part of this interchange. Thus, as per forum guidelines, this thread will be closed later today. I will leave it open for a few hours in case you have additional comment but you should not expect a response, should you comment.

Take care. EWH

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91 months ago

Thank you, Dr Hook – your time and comments are very much appreciated...

I guess it somewhat reassures me that if my hsv infection is much older this means I've had it for all or most of my sexually active life without consequences to me or my partners. I am mostly concerned with the transmission risks..., especially when it comes to oral sex. I do have OCD and I am aware this incessant questioning and worriyng are compulsions in my search for reassurance and certainty. Herpes is a new theme for me!

I am no doctor but I am fairly certain this first outbreak was a cold sore (it very much ticks all the boxes).

All the best,