[Question #3988] Tests and risk

31 months ago
Hi Dr. Handsfield, thank you for your great work and help. I'm the same person who posted question #3565, but I lost my username and could not login...  My questions are:
I have done a HIV 3rd gen antibody card test and VDRL card test, blood was taken from my arm vein, these tests were done 96 days after my last exposure. The tests were done in GP's clinic and they have a small lab. The GP and the lady who did my tests didn't seem to understand much when I was asking about which generation and window period, but finally she told me it's 3rd gen and 6month window period also the GP told me 6months to confirm it. Is this true? How reliable and conclusive are my results in the circumstances I mentioned ( I'm living in a developped middle eastern country).
I dvelopped a fear of HPV when I read that most people have it. I'm afraid I could have got it before my marriage or even during the last exposures and put my wife at risk of cervical cancer. I know there's no test for men, but 2 months ago, I had a little skin coming out from my anus especially after constipation, the GP told me its little hemorroid, it goes inside sometimes and other times it comes back. Can it be genital warts?
I could not test for other stds, but I'm afraid of genital herpes. I also had a small white pimple on my testicle that went away after almost a year it didnt hurt ir anything it looked like it was coming out from a hair point. What could this be? 
Thank you for your help
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Welcome back to the forum, but I'm sorry you found it necessary.

The tests you had are 100% conclusive and prove you did not catch HIV or syphilis. The window period for the 3rd generation HIV antibody tests is 6-8 weeks, not 6 months. And for sure all results are conclusive at 96 days, i.e. more than 3 months after the event.

As for HPV, everybody catches it, usually several times. Since you apparently were sexually active before you were married, you can assume you were infected. However, that applies to over 90% of all human beings, and your wife was at no more risk for an abnormal pap smear, or for cervical cancer, than she would be with any other partner. And if she also was sexually active before your marriage, she could have been infected previously. You shouldn't worry at all about HPV unless and until you or your wife develops evidence of infection, e.g. if someday she has an abnormal pap smear. In the meantime, this is nothing to worry about.

A hemorrhoid is easy to distinguish from anal warts, and your symptoms indeed are consistent with a hemorrhoid, not warts. Your doctor's diagnosis almost certainly is correct.

Pimples are common on the scrotum. So is folliculitis, i.e. inflammation or infection around a hair follicle. Almost certainly was not herpes.

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

HHH, MD

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31 months ago
Thank you Dr. Handsfield for your quick reply and help. Ok so I will trust the tests I've done and move on on that. Just a few clarifications.
1.  do genital warts caused by HPV appear only in the genitals and anus or it can be around the area?  I assume that a man or or woman can get pimples from different colors in the area due to things not related to std's correct? like shaving pimples for instance.
2. Since I learned about HPV I am EVERYDAY checking my genitals and anus to see if I have something and this makes things worst but I can't avoid it because I keep thinking I'm infected. ( just waiting for the signs)
3. Is the pap smear a routine test done at pregnancy or it may not be done? because she was pregnant more than once and I don't know if she did tests with her gynecologist. What is the best way to deal with it if we want to have another baby? if the pap smear is not normal that means it's cervical cancer? in that case, do doctors mention to the patient that it's because of HPV?
4. A year ago I was diagnosed with scabies by 3 dermatologists  (I don't know how I got it) and had extremely itchy rashes on the top of my penis. we took treatment and were cured. I just want to be sure what I had on my penis is not herpes. (the rashes I had were not painful just itchy, and doctors saw it and immediatly said its scabies and not herpes) Is scabies an std? if yes how did I catch it at that time?
5. is it true that 90% of HPV infected people will clear the virus without medication? is this for all kind of HPV also the risky one for cervical cancer? and last question Doctor, is cervical cancer treatable?

I know I have extreme anxiety and need to deal with it, but your advise is much appreciated.

Thank you.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
1) Genital warts can be anywhere in the genital area, e.g. scrotum, perineum (the area between scrotum and anus), etc. In heterosexual men, the large majority involve the penis and rarely the anus, scrotum, etc.

2) Stop checking yourself. If you ever develop warts, you'll know it without such close examination. Anything you don't notice in day to day normal observation (when using the toilet, bathing, etc) isn't worth worrying about. 

3) In western and industrialized countries, pap smears are routine in women, usually once a year or every 3 years,  starting at age 25-30 (different recommendations in various countries). Pap smears develop pre-cancer abnormalities usually many years before cancer itself develops. That's why paps are so important and so effective:  once an HPV abnormality appears, usually there is plenty of time (years) before there is a risk of actual cancer. That's why many countries only recommend testing every 3 years.

4) With 3 dermatologists agreeing with each other, I'm sure the problem was scabies. It can be exchanged between sex partners, but it's often non-sexually acquired. It's easy for a dermatologist to tell scabies from herpes; there is little chance of confusing the two.

5) Yes, the immune system clears the large majority of HPV infections. In fact, most infections never cause symptoms and are cleared up without the infected person ever being aware they had it. Even the high risk (cancer causing) types of HPV rarely actually progress to cancer. Early cervical cancer -- within the first few years -- is almost always easily treated and cured.

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31 months ago
Dr. Handsfield, just a few follow ups if you don't mind, I need to understand some things. 
1. If I or my wife develop genital warts or warts in other parts of body does that mean we don't have the high risk strain? 
2.  If someday she does a pap and is abnormal is that 100% hpv is the ONLY cause or it can be something else? And will the gyneco tell her that is caused by hpv which will open the page of being faithful or not? I don't know how to deal with that in case it happens knowing that I'm 100% sure she did not have hpv before knowing me. This is a fact.
3. I have done a urine test by my GP ( I had intestinal pain and constipation) 3 months ago and he found nothing unsual besides I had 2 on one thing (forgot the name scale in 1 to 6 I think) and which another GP told me that if you get 2 or over on it it would probably mean a UTI.  can chlamdya and gonnorea be seen on this urine test? I mean if I had them they would have shown on this urine test?
4. Is it possible that I had syphilis before I tested negative last week but was cured by antibiotics because I have taken it many times this year?

Do you advice I reset sex with my wife without any fear? 

Thank you Dr. Handsfield for your great work and time. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
This is all pointless speculation. You need to just forget about HPV. If evidence of HPV ever shows up in either you or your wife, deal with it then -- but not now. It's a waste of time and emotional energy.

HPV sometimes is diagnosed in virgins and others not at risk for catching it sexually. We don't know why. But if your wife ever develops an HPV problem, it won't necessarily reveal you have had other sex partners. If that happens, it probably would be best for you to be honest about it. But in itself HPV is not evidence of sexual infidelity.

1) Warts are not caused by high risk HPV types. However, many people with HPV have several strains at the same time., so someone can have warts and also have a high risk type.

2) HPV causes the large majority of abnormal pap smears. The most common abnormalities are only caused by HPV. If she ever has an abnormal pap smear, she will be told whether or not it is caused by HPV. See my comment above about HPV and sexual faithfulness. 

3) Sorry, I cannot say anything based on what you have written. But abnormal urinalysis findings are never due to HPV and rarely to any STD at all. For more information about the meaning of your possibly abnormal results you'll need to speak with the doctor who ordered the urinalysis.

4) When someone with syphilis is treated with antibiotics that cure the infection, some kinds of blood test usually become negative but others remain positive for life. Therefore, this depends on exactly what test was done. This also is something to discuss with the doctor who ordered the test. However, based on what you have said in this and your previous thread, the chance you caught syphilis is extremely low. In any case, your negative test results prove you do not have it now.

That concludes this thread. Repeated anxiety driven questions are discouraged; such questions have no educational value for other readers (and usually not for the person asking the question), one of the main purposes of the forum.  Please don't return with additional questions about HPV and your STD concerns unless and until you have new exposures, new symptoms, or a newly positive test.

I do hope the two discussions have been helpful. Do your best to move on without worry.

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