[Question #3391] Follow up to 3281

35 months ago
Dear Dr.,

I hope you are well. As you might recall from my original post 3281, I had an exposure with a 25yo Latina escort in Las Vegas more than 3 months ago. The episode consisted in protected oral,  protected vaginal sex. At the 3 months mark, for personal reassurance, I tested the bloods again, all negative. 

Because of the great sense of guilt, anxiety of having contracted HPV is getting the best of me. My questions are:

1. the vaginal episode was very short (~30 seconds) , as I already lost interest due to the sense of guilt. The condom has been on the whole time, hasn't slipped and fully covered my penis. No touching of her genitals involved. The penetration happened gently in doggystyle (apologies for the details). I know by reading the forum this question might not have a precise answer, but I'd ask it anyway. What are the chances of contracting HPV by this single condom protected exposure? After 3 months I cannot notice any visible wart.

2. My negative tests (Clamydia, Gonorrhea, HIV, Hep B, Hep C, Syphilis) gave me some reassurance so I resumed unprotected sex with my wife. If by any chance I contracted high risk HPV, am I putting my wife at risk of developing cervical cancer? 

3. Will my wife find out in her pap smear (probably due by next year) and attribute it to my infidelity? Apologies if this last question sounds selfish, it's just that I am consumed by the guilt and fear that this one terrible mistake will haunt me forever.
35 months ago
Re 3 it's HPV I meant, not cervical cancer.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome back, but sorry you found it necessary.

Almost everybody gets genital area HPV, often several times; it is a normal, expected, unavoidable aspect of human sexuality (except in couples who only have sex with one another for life). And HPV recurs and often causes abnormal pap smears or, less commonly, genital warts years after the initial infection. For that reason, it is almost never possible to know when and from whom any particular HPV infection was acquired; and never justification for assuming any particular infection came from any particular infidelity or other indiscretion.

1) The chance you caught HIV is very low, and would have been even without a condom. 2) The chance you infected your wife even lower. 3) But if it happened, and if someday it were to show up (e.g. an abnormal pap smear or even cervical cancer), there would be no reason to assume you had other sex partners. In fact, if it happens, it probably would be from some distant past infection now reactivated -- maybe from you in the past, maybe from another partner before your marriage, etc.

So no worries at all. Do your best to move on, and don't conflate a sexual decision you regret with HPV or other STD risks from that decision. They aren't the same. Deal with the former as you need to, but the latter truly isn't a concern, whether from HPV or any other.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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35 months ago
Dear Dr. Handsfield,

thank you very much for your thorough reply. It is very reassuring indeed.

As a follow up question, would you be so kind to expand a bit on the answers you gave to 1) and 2)? Also, what are the chances that HPV will develop into cervical cancer? This last question is not necessarily related to this episode, it's just I felt overwhelmed by the information I found online on the topic, which is sometimes contradictory but also very worrying. Maybe I should stay off the internet. 

Overall, I feel like the major takeaway from your reply is that from a medical perspective there is no need to worry about HPV and I can move on with my life and leave this mistake behind me, and that given both myself and my wife had multiple sex partners in the past, 
 it is impossible to associate HPV with a certain specific sexual exposure. 

I look forward to hearing from you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
If we assume a 50% chance your partner had transmissible HPV, and a 20% chance of transmission for any single exposure if she did, then without a condom you had roughly 10% chance of infection. Condoms probably are around 90% protective, so now we're down to a 1% chance. We then have to factor in the likelihood that you had previously been infected with the type(s) she had and thus immune. So now we're down to maybe half a percent chance? These are very rough estimates -- precise data don't exist -- but you get the idea. Even if these figures are wrong, it's clear the chance you were infected was very low.

Most HPV types don't lead to cancer. Even with the highest risk types (e.g. HPV16, 18, 45, and a few more) the large majority of infections do not progress to cancer. And that's the whole basis of pap smear screening in women: those that do develop into cancer are primarily in women who never have paps. Pap smears done as recommended always detect pre-cancerous changes long before (typically several years) before they would progress to actual cancer.

Don't get me wrong. Rare events spread among a large population (320 million or whatever the US population is at the moment) translates to lots of bad outcomes, and HPV is not to be ignored. But the risk of a bad outcome remains low for any person or couple. That can and should be reduced further by vaccination (for all young persons, e.g. your kids) and adults under 26; plus pap smears for women; and maybe (someday) routine anal pap smears for men who have sex with men. But beyond these steps, most people should go through life with little or no concern about HPV.

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35 months ago
So given all my previous negative tests, and these considerations regarding HPV, can I safely consider this chapter closed with no worries of putting my wife at risk?

Dr. Handsfield, I just wanted to renew my best regards. I feel grateful for the opportunity to interact with dedicated professionals who made such a significant impact in the sexual transmitted diseases research as you did. It has been a real privilege to engage with you.
35 months ago
by the way - I forgot to mention our age, both myself and my wife are 33 years old (in case this affects at all your evaluations regarding HPV)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Yes:  You can and should "consider this chapter closed" and not worry about putting your wife at risk

The main important issue about your age is that it lowers your risk of HPV even more than my analysis above. One of the main reasons the HPV vaccine isn't recommended for persons over age 26 (and initially wasn't even studied in such persons) is that new HPV infections become much less common after the mid-20s. The reasons aren't entirely known:  partly it's because of less frequent exposure (less common partner change) and because of prior exposures with subsequent immunity. But it apparently goes beyond those reasons -- something about age itself appears to lower the risk of new infections.

Thanks for your kind words. I'm glad to have helped. Best wishes and stay safe.---