[Question #4543] High Risk HPV

28 months ago
Hi guys, been suffering with some anxiety over an issue from 6 years ago where I had a red patch on my penis alongside one spot which was eventually diagnosed as pre cancerous cells, my dermatologist at the time said this wasn't a big deal and said the genital wart virus had been identified in the cells (I presumed this wasn't a big deal), around 3 months later after treatment with Aldara cream I was in my first year at University and had sexual intercourse with 5 girls over a 2 year period as well as hand to genital and oral with 4 other girls. Fast forward six years to present day I have noticed a red patch on my penis and got it checked out by the doc who wasn't concerned, however; when she looked at my notes she said previously I had Bowenoid Papulosis (from research I have done since I have been very anxious as HPV 16 is the strain related to this condition). I am in a four year relationship with my current gf and she has never had an abnormal pap and has also had the cervical cancer vaccine so am not concerned about mine or her well-being, I am more concerned of previous sexual partners who weren't aware of my HPV, I have actually since told the 5 girls just to get a smear to be on the safe side as it was playing on my mind, however; my doctor advised me not to tell anyone as it isn't necessary with HPV clearing in younger girls more readily and basically seemed very unconcerned with HPV as a whole as 'everybody has it'. I guess my main question is, should I contact the girls who I didn't have sexual intercourse with but i did take part in other sexual relations as mentioned above. My other concern is to do with my current partner and oral sex, is it safe to continue to have oral sex? I am awaiting an appointment with my derm as I wanted to get my penis double checked. Thanks for your help. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Welcome to the forum. Thanks for your question.

Congratulations for having a responsible, caring attitude about your past HPV infection and your past sex partners. However, there is absolutely no need to inform past partners of your infection; indeed, it probably would cause more harm than good. Here are three main reasons.

First everybody gets HPV -- at least 90% of sexually active people have at least one infection during their sexual "careers", and most of us probably are infected several times. And at any point in time, 30-50% of sexually active persons age 20-30 have active, transmissible genital HPV infections. Therefore, past exposure to any particular person, even one known to have (or to have had) HPV, makes no difference in the chance someone has HPV themselves. This is true of all HPV types, including HPV16 and other high risk types most likely to cause malignant or pre-malignant conditions, like Bowenoid papulosis. That you happened to be unlucky in developing BP doesn't mean the same fate awaits your partners; your particular strain of HPV16 is no more likely to cause pre-cancer than any other HPV16 strain.

Second, HPV16 is among the most common of all HPV types. Although cancer and precancerous problems are more common with high- than low-risk HPV types, it never happens in the large majority of people infected with HPV16 or other high risk strains. The immune system usually clears the infection without ever causing symptoms. So the chance your past, potentially exposed partners will have an adverse effect is slim. To the extent there is some risk, serious outcomes are prevented by simply following standard Pap smear recommendations -- which are independent of known HPV infection or risk of exposure to HPV. It is not your responsibility to assure your past partners and their doctors follow those guidelines.

Third, after this many years, if any partner acquired HPV from you (or whichever partner form whom you were infected), the evidence of it probably is long gone, since the immune system usually clears HPV.

So the main impact of telling your past partners might be to simply worry them unnecessarily, without having any benefit on their health or that of their partners. Finally, I'll point out that for all these reasons, the official advice from most experts -- such as CDC's STD guidelines -- is that even the partners of persons with known, recently diagnosed, active HPV infection need not seek medical care at all, unless they notice actual symptoms, such as genital warts. Such current partners should be informed, so they can be on the lookout for warts; or, if behind schedule on routine pap smears, to have Pap smear to catch up. But for sure no need to inform distant past partners.

Bottom line:  Don't do it!

I hope this information is helpful. Let me know if anything isn't clear. For further information on this topic, use the forum's search function and look for other threads on HPV. There are many other discussions about partner disclosure.

Best wishes--  HHH, MD
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28 months ago
Thanks HHH! That has reassured me regarding telling past partners. Presuming the chance of transmission was even lower as we didn't have intercourse and probably didn't have genital to genital contact (was so long ago I can't recall) but these were all one/two time encounters. I have read that transmission is more likely the more frequent the activity?

One other question I wanted to ask was around my current long term partner and oral sex, is this something we should stop until i get the appointment with the dermatologist to confirm whether or not the Bowenoid Papulosis has reoccurred? My doctor seems sure that it hasn't but has agreed to refer me due to my anxiety more than anything I think. 

Currently waiting for confirmation from my doctor whether or not it was a high strain of HPV which I had previously (he is contacting by dermatologist on my behalf as my appointment is a while away). Presuming it is but wanted to see if his advice would change regarding past partners, however; after seeing your reply am not confident it wont.

Thanks for your help, it's greatly appreciated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Yes, of course transmission chance rises with increased numbers of encounters.

You should not stop oral sex on account of HPV. There should be no limitations at all on your sexual practices together, as long as pleasurable for both and (of course) not coercive. Oral HPV infection occurs, but probably sometimes happens even without oral sex. And HPV doedsn't take well to the oral cavity, so on average among infected couples, even who regularly participate in oral sex, the frequency of oral HPV is about 15% of that for genital infection. And although HPV16 causes throat cancer, it's a rare outcome.

As far as I know, Bowenoid papillosis is due entirely (or nearly entirely) by high risk types of HPV, especially HPV16 (as you said yourself in your original question). But for the reasons discussed above, this doesn't change anything in regard to informing past partners or discussing HPV with your current partner.

Thanks for the thanks. I'm glad the discussion has been helpful.
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28 months ago
Thanks HHH. Appreciate this is my last follow up question so just wanted to clear up a few things around Oral HPV.

1) Does the HPV vaccine also protect from Oral HPV (thinking of my gf as she had this when younger).
2) Does Oral HPV usually clear within a period of time similar to standard HPV and not cause cancer?
3) Should I be concerned about ex sexual partners regarding oral HPV?
4) From research I have done, oral HPV seems to be very rare and something which is usually combined with other poor health behaviors such as smoking and drinking. Generally is oral cancer something which me and my partner should be concerned about?

Again, thanks for all your support.

 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
1) Yes, the vaccine prevents infection of any body site. 

2,4) Nobody would call oral HPV infection rare, but it's a lot less common than genital (roughly 15% as common, even in people who regularly perform oral sex). It is likely that most oral infections clear equally or even more rapidly than genital, but I'm not sure it's been studied all that well. Only one HPV type, HPV16, causes almost all pharyngeal cancers, but the large majority of infections never lead to cancer. As for your research, you misunderstood something. Smoking and alcohol may influence development of throat cancer, just as it does cervical cancer in women. It also delays clearance of genital HPV, and probably oral. But it has no effect on susceptibility to HPV. I see no reason for you and your partner to be concerned about oral cancer from HPV.  Don't be fooled by storeis you may see in the media about rising throat cancer rates due to HPV. Even with the rising rates, it remains a rare cancer. (Cancer causes roughly 40% of all deaths, so it could well be in your future. However, it's far more likelyt to be one of the far more common cancers like prostate, colon, lymphoma/leukemia, pancreas, and others than the throat.

3) As discussed above, you should say nothing at all to past partners, regardless of the kind of sex you had with them. 
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28 months ago
Hi HHH,

Appreciate, I asked you the initial question over 10 days ago but wanted to get your advice on the matter further.

I am having difficulty putting this to the back of my mind, my issue is worrying that I may have passed on high risk HPV to previous partners. I have been coping with this and have continued to go to work and go about normal life over the last few weeks, however; over the weekend somebody close to my age who I know (29) has been diagnosed with Cervical Cancer which has really set my mind going again on the whole subject and again an questioning whether it is worth telling ex partners and just generally how to stop myself from worrying so much. 

From research I have done it takes 10-15 years for Cervical Cancer to form from initial cell changes so if I were to tell them now I could prevent them not attending the pap test. The only thing stopping me is reading through your detailed response which outlines that I would probably be putting them through worry which is not needed, especially considering this was 4-6 years ago.

I am considering counselling to try and listen to your advice and my doctors advice to ensure I am thinking more rationally. Do you think that would be useful?

Thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Among all human beings, many -- probably most -- have "passed on high risk HPV to previous partners". Having genital HPV is normal and expected, and the high risk types, e.g. HPV16, are among the most common types. Your past partners are at no higher risk of having HPV (high or low risk) because of contact with you than if you had never met, unless perhaps you were their only lifetime sex partner. Even then, all women should follow pap smear guidelines; it is their responsibility (in conjunction with their doctors) to do so. This is none of your business, regardless of your past sexual relationships.

Whenever anyone believes they have a psychological issue or emotional situation that would benefit from counseling, usually they are right. And certainly these questions suggest you are abnormally obsessed about all this. Counseling seems a good idea.

We're beyond the usual cut-off of two follow-up comments and replies included with each question. I intended to close this thread after our last exchange, and am doing so now. Do your best to move on without worry about all this -- probably with the help of professional counseling.

I do hope the discussion has been hellpful.
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