[Question #4818] HPV risk for partner

26 months ago
I'm in my 50's now. For a period of twenty years I frequented prostitutes with probably 70 or so total interactions. This included vaginal intercourse which was always protected and me giving oral which was not protected. Most, but not all, were more higher end escorts. I stopped this practice 7 years ago when I met my current girlfriend. I have never had any symptoms of any STD's. I have tested negative any time I was tested in the past. I was unaware of HPV then,  only becoming more informed about this disease recently. My concern at this point in my life is passing this on to my girlfriend who is 20 years younger than me and a virgin until we met. We consistently use a condom. I know the vast majority of the population has HPV at some point in their lives. My three questions are: 1) Do my past practices put my girlfriend at greater risk for HPV currently (out of curiousity, considering my age, does my history put me more at risk than someone who had not used sex workers)?  2.) Is my 7 year break from this practice and lack of symptoms a mitigating risk factor? 3.) Should she increase her pap smear tests from every 5 years to yearly? She tends to be a very anxious person and I don't want to alarm her unnecessarily but HPV is something she is concerned about in general. I obviously would not want to put her at any greater risk for cervical cancer.  Thanks for this helpful service.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome to the forum. Thanks for your question. I'm taking the opportunity for a longer, blog-like reply that can be used for future replies as well as (I hope) relieving your concerns about HPV. It's rather long, but please read through it.

Some general information about HPV:  It is a normal, expected, and unavoidable consequence of being sexually active. In addition, some people who apparently have never been sexually active get genital HPV, either from quasi-sexual exposures (oral sex, genital apposition without penetration) or because they don't remember or aren't being completely honest about past exposures (think of the sexually abused child who has repressed the memory). But the vast majority are sexually acquired, and at least 90% of all people acquire one or more genital HPV infections. The large majority of these cause no symptoms and are cleared by the immune system over time, but delayed recurrences are not rare. Almost all abnormal pap smears are caused by HPV. The overall risk of having genital HPV is almost as high in people with average sex lives (relatively few partners) as in those with many partners. For these reasons, all young persons -- not only those likely to be at risk for STD -- should be vaccinated to protect against the 9 HPV strains most likely to cause health problems. And all women need regular pap smears, not just those at possible STD risk. For still more details about HPV, see the information offered by the sponsor of this forum, the American Sexual Health Association (http://www.ashasexualhealth.org/stdsstis/hpv/). (On that web page, you can also find link to my own comments in a video presentation. It was done several years ago, and some infromation may not be up to date -- but most of it remains accurate.)

As all this implies, you can be 100% certain you have had HPV, probably several times. You could still have inactive infection, or possibly even an asymptomatic, transmissible infection. However, this does not mean your partner is at significant risk for any important health outcome. And having been with your partner for 7 years, and presumably without her having had any genital warts or an abnormal pap smear, the chance these will occur in the future are very low. She has either been infected by now, without consequence; or not infected and unlikely to be infected now.

Those comments cover most of your specific questions, but to be explicity to assure no misunderstanding:

1) Your sexual history more or less guarantees you have had HPV, but your risk isn't much higher than if you had not had so many sexual partnerships. Even with 3-5 lifetime partners, you can be sure you would have had HPV at least once.

2) Yes, The longer you go without obvious symptoms, the lower the chance you (still) have an active HPV infection and the lower the chance any warts or other symptoms ever will appear. After 7 years, probably nothing will ever show up in either you or your partner.

3) Your partner should follow standard guidelines for pap smears. There is no need for her to be tested any more often than every 5 years. Even when active HPV involves the cervix, it typically takes 10+ years to progress to cancer needing treatment, so 5 years provides plenty of safety margin. And despite your concerns and your sexual history, she is at no higher risk of cervical cancer than any woman her age.

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

HHH, MD
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