[Question #4535] Genital Warts

29 months ago
I have been diagnosed with genital warts a year ago (35 years old male).  I have been married for more than 8 years and we both been monogamous in this relationship. I may have had these warts prior to the marriage but never noticed them (my wife haven't had any relationship prior to marriage)!  Since the diagnosis, I have treated my warts and haven't got new ones. I have been through lots of emotional crises due to this diagnosis. My wife used to do pap test every year and she was normal for past couple of years. After this diagnosis, I talked to her and informed her about this situation and asked her to do both HPV and Pap tests. Both tests came back normal. Also, she talked to her doctor about my diagnosis and asked her doctor to look for warts. Fortunately, she was free of warts according to her OB-GYN.I still have the following 4 concerns which makes me worried almost all day long. Your answers are deeply appreciated.

1) I know that the warts are mostly due to low-risk hpv. That said, given her recent hpv and pap test results, what are the odds of her getting cervical or other related cancers? 

2) If my warts are coming from high risk hpv, can one says: her immune system suppressed the infection since her hpv test was normal? In this scenario, will having unprotected sex increased her risk of developing cancer. 

3) Genital warts: Given the fact that we used to have unprotected sex for the past 8 years, will she get wart eventually? Will continuing unprotected sex increase her odds to get warts?

4) Pregnancy: If she wanted to get pregnant, given the fact that she doesn't have warts for now, what are the risks for her and the baby? I read online that the wart can be transferred to the baby during delivery. What are the odds of that? 

4) My dermatologist told me that since she didn't get the warts for the past 8 years, she will not get it even during the pregnancy (which I believe the chances are higher for her to get warts). Is this correct?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Welcome to the forum. Thanks for your question.

Bottom line:  I doubt you'll ever hear anything again from your warts or the underlying HPV infection, and neither will your wife. This probably has no importance for her health or yours. Details to follow.

First a bit of perspective. It's only in the last 25 years that the knowledge of HPV as the cause of cervical cancer was widely understood by the medical community, and perhaps 10-15 since the knowledge reached the general population, including sexual transmission, delayed recurrence, and so on. Before then, you would have been told to forget it, don't worry about your wife. A need for her to have diagnostic testing or pap smear would not have been mentioned. And 99% of the time, it would have made no difference. In other words, the old way -- before we knew as much as we do now about HPV -- was the right one. Probably nobody died of cervical cancer, and few women even ended up with treatment for pre-cancerours Pap smears as a  result.

Even today, the official recommendation of experts -- such as CDC's STD management guidelines -- is that when HPV of any kind is diagnosed, sex partners need not be examined unless they notice something abnormal, such as appearance of warts, but otherwise don't worry and don't get examined. That advice is valid for you, especially since your warts are recurrent, not new.

To your specific questions:

1) Many people with HPV have simultaneous infection with more than one HPV type, so you could have a high risk HPV infection in addition to the low risk type responsible for your warts. But if you do, it's probably inactive; and anyway your wife is equally likely to have been exposed to, infected with, and perhaps still have such HPV types, either from you or past partners before you were together. Sexual exposure to you over the past several years has no measurable effect on her chance of having such an HPV infection. All women should follow standard Pap smear guidelines, which are based almost entirely on age, not exposure risk.

2,3) It's rare for genital warts to be caused by high risk HPV types. For sure your wife has been exposed (repeatedly) to the HPV infection you have. However, the odds are she was infected years ago, now immune, no longer carrying it, and can expect to never have a problem -- regardless of high vs low risk HPV type. Similarly, the odds are strong she will never develop warts.

4) Half of all pregnant women have active HPV, and the proportion with active (transmissible) infection probably rises as women approach their delivery dates. That's because pregnancy is a condition of immune deficiency. Despite these facts, significant HPV infections of newborns are rare. It can happen -- the main problem is rare cases of respiratory papillomatosis, i.e. warts of the upper respiratory tract, especially the larynx. But this is a rare problem and mostly in babies born to moms with large numbers of obvious, untreated genital warts. If warts develop in pregnancy and are treated, the risk is low. In other words, the answer to "What are the odds of that?" is "Extremely low, don't worry about it."

5) For the reasons discussed above, I agree with your dermatologist.

Back to the bottom line:  I doubt this will be any problem at all for you or your wife in the future. Your wife really didn't need to see her doctor about this, although I'm glad exam and pap smear were negative and that her own doctor reassured her. She should continue with normal recommendations for future Pap smears, as recommended by her doctor.

I hope this information is helpful. Let me know if anything isn't clear.

29 months ago
Thank you very much for the answers. It is really appreciated. 

The problem is, I am coming from a culture that having sexual contacts prior to marriage is not common. I was the first sexual partner to my wife and therefore any hpv infection is coming from me. That's the reason that I am feeling super guilty. I also had a very few sexual contacts prior to marriage (always protected). Anyway, I am glad that you mentioned "This probably has no importance for her health or yours". Two follow up question:

1) I am always scanning my genital area to see if I am getting new warts or not. However, the warts that I had was very small and I may not be able to find them for weeks. Do you think we should stop having unprotected sex to avoid exposing her? How about during the pregnancy where her immune system is weak?

2) I am very anxious about getting new warts and etc. Since we used to have unprotected sex for 8 years, will new exposures increase her risk of developing warts or cervical cancer?

Thank you again and have a good thanksgiving. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Yes, I was guessing you might be from such a culture, e.g. middle eastern. But you still have an "out". Some nonsexually transmitted genital HPV infections have always occurred. (Indeed, in past years -- when the dominance of sexual transmission was first established by solid research -- there were debates, with some experts feeling it shouldn't be considered an STD. The exceptions are rare, and the exact mechanisms of such infections are obscure. But it happens often enough that HPV sometimes appears in couples with genuine lifelong monogamy, and in persons who apparently have never had sex at all.

1,2) No, I do not think you should stop having sex. It's probably too late anyway:  you can assume you had HPV for weeks or maybe months (even years) before the warts themselves became apparent. Presumably you and your wife were having regular sex that whole time. Stopping now will make no difference in the chance that she someday develops evidence of HPV.  This actually should be reassuring:  if she were going to develop warts, it probably would have happend long ago. By this time she probably is immune to the HPV strain yoh have.

Really, don't let this be a bigger deal than it is. 

Thanks for the thanks. Have a great TG yourself!