[Question #4596] Genital Warts Transmission

29 months ago
Hi, 

I  started a new relationship and was shocked when he told me had he genital warts in the past. We did not always use condoms. My partner told me he had not had any symptoms for 4/5 months at the point we started dating and continues to have no symtoms today (around 7/8 months since outbreak now) so he thought he did not need to tell me as the chances of transmission are low?! and he was advised by a medical professional and the NHS website after 3 months of no symtoms transmission would be very unlikely and condoms were not needed. Is this really true? It has been over 2 months since we had any sexual contact and I have had no symtoms yet. At what time can I consider I probably will not get any symtoms? And is it really true if he had no symtoms that it is unlikely to transmit to me? As soon as he told me I paid for the Garasil 9 vaccine, I only had the 2 strain one many many years ago. I know this will not help if it was already transmitted but it a great thing to get anyway. Any help would be greatly appreciated as this has taken over my life and I'm very depressed.
29 months ago
Doctor, I forgot to mention, due to another issue totally unrelated to HPV I have had to use steriod cream in the vulva area. I started using this after stopping sexual contact with my partner up until about 2 weeks ago. Steriod creams obviously suppress your immune system and I am assuming if I was a carrier of genital warts that may have triggered them to start developing? I check daily and I have no bumps of any kind. Could this be a good indication that it perhaps wasn't transmitted to be? In addition we only had sexual contact without protective a couple of times, would tbis also lower risk of transmission? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Welcome to the forum and thanks for your question.

Your "shock" is understandable and quite common. But it really is unwarranted, and I hope I can talk you out of it. Your reaction is primarily an indication of misunderstandings you apparently have about genital warts and sexually transmitted HPV in general. The bottom line is that the advice of the "medical professional" is correct.  Here are a number of facts you should find reassuring. (This is one of those questions that calls for a blog-like reply that I can use in responding to others. Sorry if it's more detailed than you were hoping for!)

Probably 25-30% of all sexually active men in North America or Europe are diagnosed at one time or anohter with genital warts. In other words, it you were to decide to exclude all such men as potential sex partners (and lifetime partners), you would exclude at least that proportion of all men you might meet. Going further, at least 90% get HPV at least once, and at any point in time at least 50% of all men and women in their 20s and 30s have active HPV infections. Assuming you have been sexually active with other partners in the past, you can safely assume you already have been infected and could have been carrying HPV yourself before this relationship started.

Condoms aren't needed because they don't work well against HPV. Although the transmission risk is reduced (by maybe 70-80%) for any one exposure, over time they make little difference, and the frequency of genital HPV is just as high in those regularly do or do not use condoms. It is true that once genital warts are successfully treated, infectivity -- transmission risk to partners -- is markedly reduced, probably within a couple of montns. But even If your new partner still had an active wart virus infection, after 2-3 episodes of unprotected sex you undoubtedly had been exposed and likely infected. Stopping sex at that point, or starting to use condoms, wouldn't make any difference:  that would be closing the barn door long after the horse had escaped!

I think your "2 strain" comment means you received Cervarix, an HPV vaccine that covers HPV types 16 and 18. Those types cause about 70% of cervical cancer, so it was a very good vaccine in that regard. But it had no benefit on 100+ other HPV types, including the two that cause most genital warts (HPV6 and 11). So you were wise to have been vaccinated with Gardasil 9, but it probably won't protect you against your partner's wart virus infection, to which you undoubtedly were exposed before immunization. But now you will be protected against 90% of cancer-causing HPV types and against future HPV6/11 infection, if you don't already have it. (Be sure and get at least two and preferably 3 doses of Gardasil. There is no significant protection until a month after the second dose.)

Two take-home messages seem appropriate:

1) Look at HPV as simply one of the hundreds of thousands of bacteria, viruses, fungi, and other microoganisms that live in and on our bodies. It is normal to catch and have them. That this particular virus is transmitted by sex doesn't make it special. Of course you still should take common sense precautions to avoid infection with, or serious outcomes from, the few important HPV types, i.e. vaccination and follow recommended pap smear guidelines.

2) You have absolutely no basis to be angry, upset, or disappointed with your partner. It sounds like he did everything right -- and he is no more a risk to your health than any other partner you might have hooked up with. There was no point in ceasing sexual ectivities with him after his disclosure, and you certainly should do it now. Depending on the nature of your discussions with him, maybe you owe him dinner with flowers and a nice wine, with a romantic and sensual conclusion to the evening!

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

HHH, MD
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29 months ago
Thank you doctor. Your advice has been reassuring. My last question before the tread closes would be in regards to the steriod cream question I added to my original statement below and also, I check daily with a magnifying mirror. Obviously women will have glands and 'spots' from shaving occasionally. If I was to start developing warts would it be obvious? I should be able to atleast see or feel a bump when checking? I do also attend my sexual health clinic regularly to see a consultant who checks too. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Your follow-up question probably was being written while I was writing my reply. Steroid creams probably make no difference in susceptibility fo HPV if exxposed. Conceivably it could result in more luxurient warts or easily visible warts, and perhap delayed clearance by the immune system, but only if the cream were continued for weeks, months, or longer; typical treatment for a few days now and then won't have any effect.

I strongly recommend not examining yourself to look for warts, even without a mirror and certainly not with one! As you say, you're far more likely to see variations in normal appearance of skin, mucous memranes, etc. Any wart or other lesion that matters will be felt before it is seen -- but even here, I don't recommend checking more often than maybe once a month (e.g. maybe set a schedule when your periods start and you start using tampons or pads for a few days).

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29 months ago
Thank you very much for your help. I guess my last question would be at what time can I maybe start to put this behind me? I know warts can appear years after infection in some cases but is there a general average after exposure? I am currently at 10 weeks after exposure. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Warts can appear as long as a year after exposure but usually show up in 2-6 months. But my view is that you can put this behind you right now. Genital warts are mnor inconvenience for most people with them, not an importatn health threat. This shouldn't be any big deal for you.

That concludes this thread. I hope the discussion has been helpful.
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