[Question #3864] HPV / transmission / disclosure / non-monogamy
86 months ago
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I recently had a pap and was told I have HPV and one of the cancer causing strains at that. I have a colposcopy scheduled in about 5 weeks. My last pap was 2 or 3 years ago.
Generally speaking HPV does not scare me and I assume everyone has it or has had it at some point. I'm almost 50 now but in my early 20's I had a strain that produced visible warts and got it treated and it cleared.
Here is my dilemma.
I have a few regular sexual partners whom I have already told. The crowd I hang out with are all very good about regular testing and disclosing, people generally try to be good citizens. Sometimes I go to sex parties and I'm trying to decide if those are off limits for me for awhile. Or possibly I could go and keep my underwear on. Or this is an overreaction on my part? I was imagining I would abstain till I get a clear pap, although that could be a year.
I've read questions on this forum and know that generally you feel like HPV not only isn't a risk but it isn't necessary to disclose. Does the fact that its potentially a cancer causing strain change that at all?
Lastly, and I say this lightheartedly - there must be a sex advice person - and I mean around STI stuff specifically and not Dan Savage - for slutty people and if that doesn't exist it should. Maybe I should take up that mantle.
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H. Hunter Handsfield, MD
86 months ago
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Welcome to the forum. Thanks for your question.
To start, I'm glad you have an objective, level-headed perspective on your HPV infection. That's not all that frequent on this forum; as you probably have seen, most questions come from persons who are more anxious than you seem to be.
Of course it was the responsible thing to inform your several partners. On the other hand, in response to your later statement, you probably have overreacted, and informing them probably has had little or no effect on their risk. It is likely your infection was present a long time before the pap diagnosed it; the high-risk (cancer causing) HPV types are among the most common; and almost everybody with sexual lifestyles like yours, and presumably most of your partners, have already been infected with these types, especially if many or most of them also are relatively mature, as you are. (By your age, new HPV infections are quite uncommon; yours is equally likely a recurrence of a distant past infection as it is a new one.) Even with more conservative sexual lifestyles, most people have been exposed to HPV (repeatedly) and many (most?) are immune to new infections with the most common HPV types, including yours.
For those reasons, I don't think there's necessarily a need for you to avoid sex parties, and certainly not to attend but attempt to limit exposure (and pleasure for all concerned) by wearing clothing during sex. For prevention of HPV and its important consequences, it's much more important that people get immunized (if under age 26, sometimes older) and for women to get regular paps. Trying to avoid exposure (even with condoms) provides little if any benefit. Because many people are indeed worried about HPV, it would be a kindness to inform your partners, including those at sex parties, about your recent diagnosis -- but then let them make their own choices about whether to have sex with you. Many probably will understand it really won't have much health benefit for them, and others won't care (which actually can be a healthy attitude when it comes to HPV).
And no, whether someone has a high- vs lower-risk HPV type really doesn't make much difference. Even with the high risk types, the vast majority of infections never lead to cancer; and as implied above, preventing cancer depends more on paps, plus observation of genitals for unexplained bumps or non-healing sores, than it does on avoiding exposure.
Your comments about Dan Savage probably are tongue-in-cheek. I know Dan -- we're not close friends, but are 30 year acquaintances, since well before he became nationally known. I'm confident Dan would take it as a mark of pride that he is equally caring and pragmatic for "slutty" people as for anyone else. I'm also confident he feels professionally lonely, i.e. would agree there is a huge potential role for more advisers with your and his own attitudes and approaches. If your comments are not entirely tongue in cheek, I'm confident Dan would enjoy hearing from you, should you seek his guidance about whether and how to carve out such a role for yourself -- perhaps online advice and blogging? or even in print? (Quote this paragraph, if you like!)
I hope this information is helpful. Let me know if anything isn't clear.
HHH, MD
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