[Question #3790] Persistent HPV-16 infection - 32 year old man

35 months ago

Hello doctors.

I'm a 32 year old man in good health. A little over 6 years ago, my girlfriend at the time was diagnosed with a mildly abnormal pap smear, caused by HPV. She had it treated, and within two years it went away. I was told that it was very likely that my own HPV infection that she transmitted to me would go away quickly as well. Since the end of that relationship, I have had several other relationships, and none of the women I was with to my knowledge had an abnormal pap smear.

I'm currently in a relationship with a woman who has never had sex with a man prior to me (though she had regular encounters with women).  She recently was diagnosed with a mildly abnormal pap smear caused by HPV 16.  It certainly sounds as though I gave it to her, which means it seems likely that my infection from years ago never went away.  I am I'm uncircumcised which I know raises my risk of a persistent infection, but I also do not smoke or drink.

Is it possible for an infection to be cleared, and then come back? My stress levels this past year have been very high because of my work, and it is certainly possible that my immune system is not as strong as it should be. If my infection is indeed persistent, is there anything that can be done about it? Are there any tests or treatments available for men? Do I have any options besides having regular cancer screenings and hoping for the best?  

I know the prevailing wisdom is that men should not worry very much about HPV infections, but I can't help but think that my chances of getting an hpv-related cancer are much, much higher than the average man considering this information.Is there any information on how many HPV infections that persist like this turn into cancer? It seems very likely that if I haven't cleared the infection by now, that I may never clear it.Any information or guidance you can provide on this issue would be welcomed. I feel helpless.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome to the forum. Thanks for your question.

First, we need to correct the first premise, that "It certainly sounds as though I gave" HPV 16 to your new partner. It is highly unlikely that you did. My guess is you had this thought because you think your new partner has been at low risk for HPV. She has not. The overall frequency of genital area HPV is the same in women having sex with women as in those whose partners are exclusively men. (Don't feel like the Lone Ranger. Until 10-15 years ago, most physicians and even STD experts wrongly believed that STDs in general and HPV in particular are rare in lesbians, including a belief they do not need regular pap smears. It's plain wrong!)

For those reasons, the likelihood your partner acquired HPV from a past partner is substantially higher than the possibility you infected her. Don't get me wrong:  that could have happened. However, even if you have HPV 16, it isn't necessarily a persistent infection from several years ago, or that it was acquired from the woman with the abnormal pap smear and HPV 8 years ago. That several subsequent partners never had abnormal pap smears (or at least denied it to you) means nothing at all. Among people in their 20s (taking a guess at your partners' likely ages), at any point in time 25-50% have active, transmissible HPV infections, including infection with high risk types like HPV 16.

Whether or not someone has a "strong" immune system, or one "not as strong as it should be" has absolutely no known effect either on susceptibility to HPV or will effectively clear an HPV infection.

No HPV related cancer screening is recommended in men, except those having receptive anal sex with other men, whom periodic anal examination (and, maybe someday, routine anal pap smears) may be worthwhile. In any case, your known sexual exposures with 2 women with abnormal paps over 8-10 years definitely does not mark you as having any higher risk of HPV than any other male your age, or any higher risk of cancer or any other serious outcome. The main thing all men should do is be aware of changes in the skin of the penis, especially bumps or unhealing sores, and get evaluated promptly if it happens. (At that stage, all penile cancer is easily curable without radical treatment, e.g. not requiring penile amputation or other surgery.)

In reply to your closing question, even with the highest risk HPV types, such as HPV 16 and 18, probably under 1 in 1,000 infections progress to cancer; and as just noted, almost all those are readily curable.

Bottom line:  Disregard your current and past partner's HPV infections and go on with life, without worry.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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35 months ago
First of all, thank you so very much for your reply.  Truly.

I am primarily concerned about the risk of oropharangeal cancer, and having a persistent infection in my mouth or throat.  I know that these infections and subsequent cancer diagnoses have been going up in years and are a bit more prevalent than penile cancer.  Is it likely that a persistent hpv-16 infection (if that's indeed what I have) will turn into oral cancer?  I've heard of test kits involving an oral rinse to test for hpv infections in the mouth.  Is that worth doing?  Should I have regular oral cancer screenings of any kind?

Thank you again for your reply, and any information you might be able to offer.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Although there has been much media attention to pharyngeal cancer caused by HPV16, and its frequency is rising, it remains a rare cancer -- 1-2% of the frequency of much more common cancers like colon, prostate, lung, etc. And note my estimate of the chance of developing cancer, even if you have an oral HPV16 infection, which statistically is unlikely.  Since 40% of all deaths are due to cancer, there's a pretty good chance that's what will carry you off someday. But the chance it will be pharyngeal due to HPV16 is very, very low -- and no higher on account of your sexual history than in any other comparable person.

Various online sources offer testing like you mention, but the tests are not approved by the FDA or any other regulatory agency nor recommended by health agencies like CDC.

Like all adults, you should be getting regular dental exams. Ask the dentist to assure nothing is seen in the throat that needs medical attention. (Most dentists probably do this anyway.) Otherwise, I don't recommend testing for oral HPV or any other action.

All this could change someday -- studies are ongoing to formally evaluate such strategies as oral HPV16 testing followed by professional exam if positive. But we don't yet have evidence that this is successful in earlier diagnosis, overall cancer frequency, or -- most important -- in reducing death rates due to pharyngeal cancer. So keep your antennas up for new developments. But for now I see no reason for concern.

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35 months ago
I saw a dentist today for an exam, and he said that currently everything in my mouth and throat that he can see looks normal.  He recommended that I just stay consistent with my examinations and that he would be happy to make a note in my file to be alert for oral cancer, but that it was (as you said) extremely rare and that they don't usually test for oral hpv.  He also said that they will typically visually see evidence of dysplasia or precancerous lesions in and around d the base of the tongue and tonsils (though not always).  He seemed to think there was not much cause for concern as well (which was encouraging).

I have just a few more questions for my future plan of being watchful for any hpv related complications.

1.  Should I begin to make regular appointments with an ENT specialist just to make sure nothing is developing in my oropharangeal region, or are dental visits every 6 months sufficient?  I want to be in the loop if there are any developments in this area of medicine.

2.  Can hpv infections become dormant or undetectable and return later?  Can they go back and forth?

3.  Is it very likely that if I have a genital hpv infection that I have an oral infection as well?

4.  Am I correct in inferring from your response that even in those with persistent or long-lasting hpv16 infections of either the oropharynx or genital area, that cancer is rare?  Is there any data on how frequently long-lasting infections lead to cancer?

My apologies for the barrage of questions - knowing more information helps me feel more confident in any kind of future plan of action to ensure this is never a problem.

Thank you again for your response, and for the expertise you provide.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I'm glad to hear your dentist is on board.

1) I see no need for routine ENT examinations in addition to your dentist's services. But assuming you go ahead, I suggest a frank discussion with the ENT doc. My guess is s/he will also say you are requesting a service that is not known to enhance detection or improve survival from pharyngeal HPV16 cancer, and that indefinite exams every 6 months is excessive.

2) HPV often is dormant and recurs later. But most cases are gone entirely once cleared by the immune system. As far as we know, repeated regression and relapse for many years is uncommon, but there is no research on this.

3) No. Most people with genital HPV do not have oral infections.  The overall frequency of oral HPV is about one tenth the frequency of genital. 

4) Yes, you are correct. As noted above, the overall rate of progression of HPV16 to cancer probably is on the order of 1 in a thousand. That rate might be higher in people with prolonged or recurrent infection. These are research questions not yet answered.

Thanks  for the thanks about our services. I'm glad to have helped. That completes the two follow-up replies included with each question and so ends this thread. Take care and stay safe.
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