[Question #3564] General HPV questions

34 months ago

As I learn more about HPV, I have some questions that I would greatly appreciate some clarification on as this is somewhat new to me(specifically the genital strains like hpv 16/18). I'm a late 30's, heterosexual male

1. How soon would someone show up as positive after exposure, or when is ideal for them to be tested?

2. If you had it and your body clears it, does it ever come up again if you are a healthy person (could I pass it to someone months or years after?).  The last theoretical exposure was 4-5 months ago, I wonder if my body has cleared it enough so that it's not likely to be transferred (cumulative immune response).

3. Once you're a certain age, late 30's in my case, I've read that its more unlikely for new infections to occur in men? Is that because you've already been exposed to it, or it just doesn't happen for reasons unknown? 

4. If a women tested positive and you used a condom through most of the relationship, but did not use a condom a few times towards the end (10 months later) would the viral clearance hypothetically be so low that transmission would be less likely? I read that you wrote that clearance is cumulative. 

5. If you had multiple partners when younger, does that increase your chances for adapting immune response to future exposure. 

6. Can you be exposed to it and develop antibodies without an actual full fledged infection occurring, and is that common? Hopefully that's not too many questions all at once. I'm not as concerned about myself, but my concern is that I don't want to harbor genital/cancer causing strain hpv and pass it to someone else, unknowingly. I certainly don't want pass to my next girlfriend and experience problems in that relationship, or problems simply because i'm nervous and unfocused because i'm scared that I did. Since there's no way to know for sure as a man, my mind is unsettled on the matter. I greatly appreciate your expertise and understanding. Thank you for your time.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Welcome back to the forum.

HPV is complex. You ask good questions, but proper replies would require more time and space than practical. My comments are therefore pretty succinct, but I have suggested other resources at the end.

I'll start by saying that getting genital HPV is normal and essentially unavoidalbe with normal human sexuality; almost everybody gets it, often several times. Fortunately, most infections, even with the highest risk types like HPV 16 and 18, never progress to cancer or even pre-cancer and are cleared by the immune system. All young persons should be vaccinated, which is 100% effective against the 9 types in the vaccine, which together comprise about 90% of all HPV infections that will cause cancer or warts; women should follow standard pap smear recommendations; and beyond that, most people should more or less forget about HPV. Even the most common HPV related cancers are rare compared with common cancers like lung, colon, breast, prostate, etc.

1. Most exposed or newly infected persons never "show up" at all. The available tests for HPV miss most infections, and most people develop no symptoms.

2. The immune system normally suppresses HPV to a point it cannot be detected. HPV DNA may persist, and delayed, reactivated infections are not rare. However, they are not common either and most people have no late reactivations and do not transmit to partners.

3. Insightful observation and question. New HPV infections indeed decline dramatically with age beyond the mid-20s. Some of the reason clearly is prior infection with subsequent immunity to new ones. Some is because fewer partners of the same age are carriers themselves. And some may have something to do with age, but neither of these factors. So the reasons are not fully understood.

4. Condoms are not very effective against HPV. In the situation you describe, most partners become infected despite continuous and correct condom use. Research shows that for any one vaginal sex exposure between an infected and uninfected partner, a condom reduces the transmission chance by about 90%. However, over time the protection is under 50%, and if one partner is infected, most couples can be expected to catch it despite regular condom use. (Answered another way, the long term risk is reduced with consistent condom use, but by no more than 50%.)

5. Each infection creates immunity or at least resistance to that HPV type, but probably not to others. Having multiple infectionx when young reduces later risk simply because future exposures are often due to types the person has previously experienced. But the risk for each new exposure to a new type is not known to be reduced.

6. HPV antibody testing is a research tool, not normally used to diagnose patients. A positive antibody test to a particular HPV type is believed to always indicate past (or current) infection with that type, not merely exposure and development of antibody.

I hope these comments start you on a path of being less unsettled. For further information, I suggest exploring the HPV information provided by CDC (www.cdc.gov/std) and the sponsor of this forum, the American Sexual Health Association (ASHA, www.ashasexualhealth.org). (If you poke around the ASHA site, you can find a couple of videos I recorded about HPV, if you would like more of my own perspectives on the topic.)

HHH, MD
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34 months ago
Those are very helpful, thank you. In further reading on your forum, I also noticed that you, or one of your colleagues wrote  that we max out around 5-10 people for exposure? Was that in reference to that if we've had intercourse with 5-10 people we have most likely encountered most of the genital HPV strains? I've been tested twice with a reputable clinic who provides diagnostics as part of a research study that measures, both were negative (for fear of harboring something and passing on). That may be overkill and as you have well stated that there isn't as much to worry about for a late 30's male, but it's piece of mind due to the anxiety over this that wins over logic. The reason I'm concerned is that my previous partner was in her early 20's and although I used a condom for the majority of the relationship (sex about once per week), I didn't use one a few times and it's very likely she may have had one of the strains given the data. I've had the diagnostics as part of research tested twice and both were negative, so I would like to assume that's correct as they state that in other countries they are finding this information to be very valid and statistically accurate as compared to female testing. Again, thanks so much for everything.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Thanks for the additional information.

There are no firm data on "maxing out" on HPV likelihood after 5-10 partners, but it makes epidemiologic sense:  probably most people acquire most of their lifetime HPV infections from their first few partners. This follows from the high chance such (often young) partners are infected, and that infection to each type confers immunity or resistance to new exposures with the types that have already caused infection.

If you've only had the one sex partner described, it's hard to say whether or not you were infected with HPV. Assuming your research tests were DNA tests, the negative results make it unlikely you are currently infected with the types tested. But they probably don't prove it; probably not all infections show up on DNA tests, especially past infections cleared by the immune system. If you had blood tests that detect HPV antibody, in theory a negative result means you have never been infected with the types tested. However, such tests probably can give both false positive and false negative results. The researchers will be able to best tell you the meaning of your negative results and how reassuring they are that you do not have, or never had, the types tested.

As for the researchers' statements about HPV epidemiology in different countries, I imagine they know what they are talking about. You seem to be alluding to societies where pre-marital sex is less common than in most western countries, such as Islamic countries. And research in such settings indeed has shown lower rates of HPV infection than elsewhere. The providers you have been seeing in the research setting should be able to address all this in whatever detail you wish, and probably know more about it than I do.
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34 months ago
Excellent, thank you. Is the immunity that is established in men sufficient for future exposures? I did read somewhere that male immune resistance does not last as long as the female? Also, Does the likelihood of transmission decrease in relation to the length of time an individual carries the virus? For instance, if someone had the virus for 6 months and "cleared" it, would it be less likely to transfer as time accumulates? Can I women pass the genital strains onto her child? I believe that is every question I could ever think of :), so I greatly appreciate your time and expertise, once again. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Good question about immunty from prior infeciton. It was long thought that it was strong and durable, i.e. little or no risk of new infection with the same type. More recent data, however, suggest it's less protective than previously thought. Most people probably remain highly resistant or totally immune, however. Still, the is one reason for HPV vaccination in the presence of current or past infection with the 9 types covered by the standard vaccine (or 4 types, for the older vaccine still in common use in much of the world). If you have not been vaccinated, you should consider it:  I'm sure the research team at your clinic will be happy to advise you about it.

The longer the time since acquiring HPV, the greater the likelihood active infection has been cleared by the immune system and therefore the lower the chance of reactivation and transmission to partners. But no more can be said about it, and I'm not aware of data about male/female differences in this regard. Active genital HPV at the time of labor and delivery carries a small risk of infecting the baby's oral cavity, resulting in a rare condition called laryngeal papillomatosis, which can be quite serioius. However, it is generally a problem only for women with multiple, large, untreated genital warts at the time of delivery. It's not something anyone needs to worry about just because of distant past infection or current asymptomatic genital HPV.

All these questions, and any more that may come to mind, also are addressed at various websites, including the two I mentioned above.

That completes the two follow-up comments and replies included with each question and so concludes this thread. I hope the discussion has been helpful.
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