[Question #3742] HPV transmission & cervical cancer

35 months ago
Dear Dr's

About 2 years ago, I had a one time unprotected intercourse with a girl I was seeing for a short period of time ( I am assuming she was std free) .  After that I had few encounters with CSW ( expensive escorts and massage parlors). It was a protected intercourse and unprotected oral sex on all occasions.  After this phase, I had unprotected intercourse several times with another girl I was in a relationship, that ended six months ago.  Me and she, we both are not raised in the US and are not vaccinated for HPV.  We recently spoke and she said she's worried she may have cervical cancer thru HPV she may have acquired thru me.  She only had one sexual patner in her life 2 years before she met me.  She also has PCOS. Below are the questions I have. Please let me know

1) What are the chances that I acquired a HPV and passed it on ? ( We both are not vaccinated )

2) She has been seeing symptoms like long menstural period times, bleeding between periods,  ocassional lower back pain during periods, Ireggular periods etc. Is this HPV ? Will this lead to cervical cancer ?

Also, please excuse me for my bad english. Looking forward for your answers
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome to the forum. Thanks for your question. It's a common one among people with genital HPV infection or exposed to one. I'm happy to help.

The first thing is for your partner to get professionally examined to evaluate her symptoms. The ones you mentioned would not be caused by HPV unless it had already progressed to overt, invasive cancer. That is exceedingly unlikely in anything under 5-10 years. Even then, the symptoms are not typical for HPV or cancer.  HPV is not a cause of irregular menstruation, painful periods, back pain with menstruation, etc. These symptoms are much more typical for some sort of hormone balance problem, endometriosis, and STDs like gonorrhea or chlamydia. But not HPV. In any case, your partner should promptly seek science based (i.e. western style) gynecologic evaluation for her symptoms and take it from there.

Those comments address your second question. As for your first question, I strongly recommend we not go into details (and that you not worry about HPV in this situation) until and unless your partner has been professionally evaluated and turns out to have HPV despite my comments above.

However, I'll make a few general comments about HPV.  It is usually impossible to know with confidence when and from whom any particular HPV infection was acquired. Having had at least one sex partner before you, your partner could well have been infected before your relationship began. (25-50% of people acquire HPV from their first partner.) Your sexual history makes it virtually certain that you have had genital HPV, probably more than once. OTOH, you're no more likely than any other sexually active person to be infected, i.e. you are not any special "danger" to your current or future sex partners than anyone else would be. You don't need testing -- and there are no valid HPV tests for asymptomatic men anyway.

Going back to your partner, with now at least 2 lifetime sex partners, there's a 50:50 chance she has HPV, either from you or the other guy. If so, it will not mean it is the cause of her symptoms; and it will not necessarily mean she caught it from you.

I suggest you do some additional reading about HPV. Two excellent resources are the sponsor of this forum, the American Sexual Health Association (www.ashasexualhealth.org) and the US Centers for Disease Control and Prevention (www.cdc.gov/std).

I hope this information is helpful. Let me know if anything isn't clear. I would enjoy hearing more about your partner after she has been professionally evaluated.

HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I meant to add that both you and your partner probably should be immunized against HPV, although this depends in part on your ages, likelihood of a continuing (and mutually monogamous) relationship, and which vaccine(s) are in use in your country.

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35 months ago
Thanks for the prompt response Dr. Handsfield. I now understand that her symptoms are not due to HPV. We both are 27 years old, is it too late to get vaccinated?
To make sure I understood your answer. 
1)" These symptoms are much more typical for some sort of hormone balance problem, endometriosis, and STDs like gonorrhea or chlamydia" - Is it a possible high risk that she could get gonorrhea and chlamydia from me?  I never had any symptoms, OTOH never got tested for stds during that time when I had unprotected oral sex with csw's
 
2)"I strongly recommend we not go into details (and that you not worry about HPV in this situation) until and unless your partner has been professionally evaluated and turns out to have HPV despite my comments above" - As you mentioned, with my lifestyle it is certain that I had genital HPV when I was in the relationship. Since we both are not  vaccinated, wouldn't it be certain that she might have got HPV through me ( assuming she did not from the 1st partner)? In either case, is it curable if she contracted HPV?  Does it go away by itself in woman?

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Sorry -- I assumed you were concerned your partner's symptoms might be caused by HPV.

1) Chlamydia and gonorrhea rarely if ever persist 2 years; the immune system clears them up long before then, without treatment. And oral sex rarely if ever transmits chlamydia. So there seems no realistic chance either of these STDs is her problem, assuming neither of you has had other sex partners more recently.

2) Sure, it's a good bet you have had HPV. It's also a good bet that with no other sex partners in 2 years, your immune system has clear it and it will never cause you any problems. in any case, you are no more at risk for a serious HPV outcome, and neither is your partner, than about 90% of the US population. In addition tl your partner getting her symptoms checked out professionally, you should be on the lookout (as should all men) for unexplained genital area bumps or sores and see a doctor if something appears. Other than that, there is no need for further action and for sure no basis for worry.

Although you don't say it directly, I have the impression you and your partner are currently monogamous and likely to remain so. In that case, and at your ages, HPV vaccination is not necessary or recommended.

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35 months ago
Thanks Dr. Handsfield. Sorry about my wording, I was initially more concerned about HPV - you are correct.
 I understand I only have one follow up question left. I will try to ask the reminder of my questions effectively & briefly.

1) About our relationship - We both ended our relationship 6 months ago and she has not had any sexual partner since then ( Positive about it). Soon ( in 3 or 4 months) she is planning on getting into  a committed relationship to settle down and having kids with someone she likes ( Long story cut down to the point). Since we are still good friends, I am trying to make sure I understand our situation. Will this period of having no sexual partners ( about 8 months for her) hopefully cures HPV, gonorrhea and chlamydia ( If at all she contracted anything from me in our last encounter )? At age 27, do you still think vaccination is effective in men and woman?

2) Summarizing - We do not have to loose sleep about stds on either sides and can get tested with a peace of mind and hopefully ( in her case only - I had 2 encounters of unprotected oral sex in last 6 months ) expect to test negative on HPV,  chlamydia and gonorrhea ?

Thank you for the valuable service you are doing. If I am allowed to post another comment, I would be more than happy to let you know the std results in both our cases after getting tested next month.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
1) Whoa! Wrong question! Once a sexual relationship has ended, and if both partners have shared health information that might impact the other, that's it. You have no right, and should have no expectation, of future communication about this with your partner. If you develop warts, you should not inform her; and if she develops cervical cancer, you're out of the loop. Neither of these developments has any effect whatsoever on the other's health going forward, or on the health of his or her current or future partners.

HPV immunization is variably effective after age 26. The vaccine covers 9 of the most troublesome HPV types. If someone has had 8 of those infections, the vaccine can't help much. If only 2-3, it would be helpful. Even this depends on sexual behavior going forward, i.e. frequency of sex with what kind of partners. Unfortunately, there is no way to know for sure. You certainly could discuss this with your PCP, but in general I would not recommend the vaccine for people in your situation.

2) If there is any doubt about your mutual sexual fidelity in the last months you were together, and in view of your former partner's symptoms, it would be reasonable for both of you to have standard STD testing, i.e. gonorrhea, chlamydia, syphilis, and HIV. No other tests are necessary and I would not recommend any. However, since your relationship has ended, as implied above, you can do this for yourself, but should not say anything about it to your former partner.

That you "expect to test negative on HPV" is meaningless. A negative result does not prove someone is not infected with HPV. The available tests may miss up to half of all infections. Don't waste your money.

That concludes this thread. I hope the discussion has been helpful.
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35 months ago
Apologize for adding onto thread, I assume I may have given you a wrong impression. As I mentioned in my question , it was long story cut short.  I didn't want to divert away from the topic and skipped our detail plan. We are still in a relationship, its just not sexual because of the distance ( east coast and west coast). We both are currently not seeing any body else, since I didnt want to explain the long story, I didn't mention this -  there is chance that in 3 or 4 months one of us will  be moving to a different country there is fifty percent chance we may end our relationship ( not yet) and will be continuing it if there is no change in current  residing status.  We both are currently aware of this thread.  As I mentioned we want to know if abstinence from sex for 8 months will help the immune system to wash out HPV in both men and women.  It is a curiosity of what if we have to end the relationship and hence the question of 8 months abstinence, especially since we both are not vaccinated. Would help immensely to both of us in figuring out future decisions.  Once again, sorry about the prolonging thread - will not add on any more.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
This is more a relationship issue than one of HPV and other STDs. All I would do is repeat that if and when you're no longer together, and if either of you have had sexual contact with others up to then, it would be reasonable for you both to be tested at that time, as suggested above.

The time required for HPV infections to be cleared by the immune system isn't well known but is very broad and can be quite long. Many but not all infections would be gone by 8 mo., but others require 2+ years, and a few probably persist indefinitely. Once someone has had HPV, s/he rarely can be 100% certain the infection is truly gone. However, after several months, there are few reactivations and generally low risk for transmission to partners.

Best wishes and stay safe.
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