[Question #4718] HPV and disclosure

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80 months ago
Hi! I tested positive for high risk hpv 18 in Jan 2018 after an abnormal pap. I do not know when I got it, and have not noticed any warts or external signs. I received a colposcopy in May 2018 and a LEEP procedure in June 2018. My gyno recommended a follow up pap in December, but I had to postpone as I am working abroad through March. I am working in a wartorn country and would have to travel to a neighboring country to get a Pap smear if you recommend getting one immediately. This is a possibility, but would be difficult and costly to do. 

In 2018, I have had three sexual partners, two of which I had unprotected sex with. Only one was aware of the HPV (this was a long term partner and it was unprotected). The other two partners were in October and December of this year, with the unprotected encounter about one week ago. With this partner, we discussed stds and I said I was negative (I was thinking of others such as chlamydia, etc). I did disclose that I had not been tested since janiadidn’t think HPV was a big deal as so many people have it so disclosure is unnecessary, and that there was a difference between 18 and other forms.

Do I need to disclose that I tested positive for hpv last year, or should I assume that my body cleared the virus? I am a straight woman and 31 years old. I do not want to have infected someone if I am still positive for hpv 18 and they then carry it on to another woman as the two men that were unaware were very casual partners.

I did tell one of them after the fact in a casual conversation that I had had hpv, but did not say when and that I had not since had another pap. He did not seem to be alarmed and I think we had sex once more.

Do I need to call past sexual partners and let them know I tested positive in Jan 2018? I do not have any warts or other symptoms. Should I stay abstinent until I can get another pap as I know hpv can still be transmitted through condoms? 

Thank you - as you can tell i am very anxious and feel I was very unethical. 
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H. Hunter Handsfield, MD
80 months ago
Welcome to the forum. Thanks for your question.

You have done absolutely nothing unethical and should not feel the slightest guilt or shame over your HPV diagnosis or abnormal pap smear. Having HPV, including infection with the high risk types, is a normal, expected consequence of human sexuality. You may as well feel guilty when someone catches a common cold from you. Of course you don't want that to happen, and likely would apolgize if it happened. But that's the way HPV should be looked at -- nothing more.

Disclosure to partners of past exposures to HPV is opional. Although it seems to make sense, knowing you had HPV will not improve their health or reduce their risk of any important health outcome or help protect their partners. Why not? Because everybody gets genital HPV, and the high risk types like HPV 18 are among the most common types. If your partners have no symptoms, there is nothing they can do -- and the risk they'll have a significant problem from it is very low. Similarly, since their current or future sex partners also will have been exposed and undoubtedly infected with HPV, it won't have any effect on their health. All women should follow standard pap smear recommendations, and that advice -- or the frequency of pap smears -- would be no different based on this knowledge.

If you have an ongoing sexual relationship, there is no point in ceasing sexual contact, or using condoms, with that person. Undoubtedly he has been exposed repeatedly to your infection and future sex will not further raise whatever risk there might be for him. For future new partners, however, it is reasonable to wait either until a repeat pap smear shows that the dysplasia and HPV infection are gone. 

It is true that condoms are not highly effective, but not because HPV can pass through latex, polyurethane, or even natural membrane condoms. It's because there is substantial genital skin contact, and exposure to genital fluids, despite condom use.

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

HHH, MD
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80 months ago
Thank you so much Dr HHH and all you and your colleagues do to provide sexual health education.

I am beginning to get through my feelings on this issue, and I think what really bothers me is that I was very adamant with a partner that I had one week ago that I was STD free and we could have unprotected sex. I was really craving intimacy and it passed through my head that I should mention it at one point, but I didn’t feel it was important. This does however impact the amount to which he made a fully informed decision. Though I suppose he could have been lying too.

That being said, I have three more people quick questions if I may.

1) you said that it’s reasonable to wait for new partners till I have a new Pap smear which shows the HPV has cleared. Should I remain abstinent through March, when I can get the new pap, or simply inform new partners and hope they accept?

2) the man whom I’m concerned about was a very casual partner, and I don’t think we will speak again. If I did still have an abnormal pap in March 2019, would I still need to contact him? I don’t want to cause anxiety for him unnecessarily, especially as he cannot test for it.

3) what is the amount of risk for him in terms of penile cancer (or for throat cancer for another partner who performed unprotected oral sex on me?) What is the amount of risk for his future female sexual partners?

I’m sorry again for all my questions! For some reason I can’t seem to listen to reason, I think because I feel I lied and am now obsessing over this.
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H. Hunter Handsfield, MD
80 months ago
Thanks for the information. I can understand how and why this is bothersome. Still, no harm likely will come to him. But perhaps you would feel better by discussing it with him now. It might be embarrassing, but there's a good side too:  you were genuinely attracted to him, looking forward to the event and the romance of it all, which of course are flattering. (Enough said -- I'm an STD expert, not a relationship counseling expert!)

1. I should have clarified that I didn't necessarily mean abstinence, only disclosure. Many potential partners, as you have found, will be happy to have sex (or start a committed relationship) knowing you might have potentially transmissible HPV.

2. As implied above, there are no black and white answers here. If I were in your situation, I probably wouldn't say anything. Remember, he is having (or will have) other sexual partnerships, and in general they will be no more risky than sex with you -- i.e. nearly as likely to be exposued (yet again) to a high risk HPV type. Sax with any one partner, even one known to be infected with HPV, has little impact on any person's chance of having a significant HPV problem.

3) Under one chance in many thousand; both cancers are quite uncommon. And knowing of his exposure doesn't reduce that low risk.

A final thought this raises:  Have you considered HPV vaccination? You should do it -- for sure if you're under age 26, and perhaps even if older (discuss with your doctor). The vaccine provides 100% protection against 9 HPV types, excluding any of those with which you have already been infected. Think how much less stressful all of this would be if you and/or your partners had been immunized!
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80 months ago
Thank you Dr HHH,

Unfortunately the man in question really seems to not be into me and has not been responding to my messages, so I do not think he will find this romantic :). I’m also 32, but will talk to my Dr regarding Gardasil as this has been way too stressful! The one sexual partner I did tell (we were in a serious relationship)  was very unbothered by it.

I did mention to the man in question at one  point that I had had HPV before, but not that I had not had a negative Pap smear since. So maybe I did disclose in a way?

Perhaps this was more a lesson about learning my boundaries regarding safe sex and my limits - I think the right answer for me is disclosure in the future. I had not seen HPV as something I needed to alert partners to the same way as more serious STDs, but I think that this experience has been hard enough that I must change my behavior.

This has been enormously helpful, thank you so much for your time and consideration.

All the best holiday wishes 





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H. Hunter Handsfield, MD
80 months ago
You disclosed the important part, the HPV. Few males otherwise care much about pap smear results.

If disclosure or your past HPV, even after it's long gone, helps you psychologically, feel free. But my guess is that over 90% of women in your situation don't feel the need and don't do it routinely. (I'm talking about disclosure to new partners, not discussion with a partner as a relationship becomes committed or is evolving in that direction. Many couples in that situation discuss past STD experiences, and other aspects of their past sexual lifestyles. But this is primarily a relationship issue, not one of disease prevention.

That finishes the two follow-up comments and replies included with each question and so concludes this thread. I hope the disucssion has been helpful. Best wishes and happy holidays!
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