[Question #3924] sex after high risk hpv diagnosis?

31 months ago
I was diagnosed with hpv about 3 years ago. After two colposcopies and a cone biopsy, I just found out I have type 16/18/45.  Although my most recent PAP came back negative, the hpv is still present and my gyno recommended a hysterectomy. (I am in my 50's) My partner and I are concerned that he might be infected as well, due to the fact that these types are known to cause cancer  (we've had unprotected sex). What is the probability that he is also infected and if he isn't, how can we prevent him from getting infected but still continue to have an active, healthy sex life? It's really putting a huge strain on our relationship.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Welcome to the forum. Thanks for your question. 

Surgical treatment of HPV is beyond my expertise. However, hysterectomy would be an extreme solution to an asymptomatic HPV infection without documented cancer, or perhaps (rarely) for pre-cancerous disease. I have to believe the gynecologist has reasons other than HPV to recommend hysterectomy. If not, I strongly recommend you get a second opinion on that aspect of your care.

It is true that the HPV 16, 18 and 45 are among the highest risk types for cancer. However, even with these types, the large majority of infections do not lead to cancer (probably on the order of 1 in a thousand, maybe even lower). Also, cancer caused by virtually never develops out of the blue, but is preceded by several years of pre-cancerous changes of the type you might have had. (HPV alone rarely if never needs cervical conization.) If you do not currently have such an abnormality, or if it was successfully treated with conization, I do not understand why hysterectomy is a consideration.

Since you were first diagnosed 3 years ago, your partner clearly has been repeatedly exposed and probably infected. Most HPV infections in men never become apparent and are eradicated by the immune system. At this point, there is no need to alter your sexual practices:  he probably is immune. Condoms or abstinence will have absolutely no effect on his health or the very low risk of a serious problem due to HPV. He should keep his eye out for unexplained genital bumps or non-healing sores and see a doctor if any of these develop. But that's all. Your "active, healthy sex life" with one another and the romance and love it suggests definitely should continue without interruption!

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

HHH, MD

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