[Question #4990] New Dermatologist HPV advice

26 months ago
Dear Dr. Handsfield-

Hope you’re doing well. Wanted to reach out with a couple questions based on some new happenings in my life. I recently saw a new dermatologist because of living in a new area. I went for a check up/screening of my genital region and spoke to them about my past warts. I went to them in particular because hpv happens to be one of their focuses. I had a small area of concern which the doctor told me that was not std related. He then proceeded to find a different smaller spot elsewhere that we wants me to come back in after two weeks to have checked out. He said it “might” be a small hpv infected bump.  I have a feeling it’s just an igrown hair as I shaved that area recently. We were chatting and he proceed to tell me that HPV never goes away and I’m stuck with it for life and that regardless if this little spot is wart related or not, that the right thing to do would be to talk to partners/my new partner about my past warts. This is totally the opposite of what I’ve believed/understood from reading your articles and speaking to you in the past. I am a bit conflicted and I’m a bit unsure of what to do here.  If this new bump is in fact a wart, I would have no issue to talk to my current partner, but I am sort of lost with what to do. Before this new partner, it has been six months since my last sexual partner, would I have to go back and alert her as well? Also, he encouraged me to get the HPV shot, I am now 27 and read that I may be too old, but he said it would protect me against other strains of the virus. What are your thoughts on this? This new information has been a whirlwind and I’m just trying to get some clarity. Thanks in advanced. 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome (sort of) back to the Forum.  As you probably know, Dr. Handsfield and I share the Forum and on this occasion I happened to pick up your most recent question.  In preparing to answer your question, I have reviewed your earlier interactions with both Dr. Handsfield and Terri and I agree with the advice they have already provided.  It should be no surprise that I agree with the advice they have already given you over the course of your six earlier questions over the past three months.  I do understand that have OCD on these issues and appreciate your concern for past (and future) sexual partners but I do feel that you are overly concerned about the possibility of transmitting past HPV infection.  The fact is that for all practical purposes nearly all currently sexually active persons who have not received the HPV vaccine will have HPV.  Fortunately, more than 99% of these infections are of no lasting health consequence to infected persons and for that tiny proportion who develop pre-cancerous lesions, early detection is reliably achieved by following routine sexual health maintenance recommendations which will permit early and effective management.  With that background, my responses to your questions and comments are below:

"HPV is forever".  Evolving science indicated that event will effective therapy, in many if not most cases of HPV infection, following effective treatment the infection is non-infectious but will not recur or be transmissible to others BUT the HPV DNA will remain detectable in some persons.  Unless the person then goes on to become profoundly immunosuppressed they will not have further problems ( and even with immunosuppression, most persons will not have further problems)

"Partner Notification".  I have little to add to what Dr. Handsfield has already said and suggest you review his earlier advice.  Because of widespread mis-understanding and the potential damage that that misunderstanding the fact that infections are widespread but that most people do not know they are infected, we do not feel strongly that all partners need to be informed.  We disagree with the advice that your new dermatologist has offered.  We also acknowledge that not all share our (or his) perspectives.  We do not agree that you need to inform prior partners

"HPV Vaccination".  Recently the FDA approved the HPV vaccine for persons up to age 45.  Whether or not your insurance will pay for it is another question however.  The vaccine is safe, highly effective for all nine types and, in your specific situation, I agree with his recommendation.  The age recommendation was based on the idea that after age 26 many people would have already gotten HPV and as a result the 4-valent vaccine would only have modest benefit.  The current vaccine however has 9 different HPV types and will protect you from future infections of those types.    It may cost you several hundred dollars but in my opinion, this would be a better use of your funds than repeated questions on this Forum.  

I hope these comments are helpful.  EWH
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26 months ago
Hello-

I appreciate the quick reply. I happen to agree with you and Dr. Handsfield in terms of past partners. The small spot that the dermatologist told me to monitor this morning came to a small head this afternoon, right out of a hair follicle and I popped it with a small amount of pus coming out. The bump was only there for a day or 2. I still don’t believe that sounds anything like hpv or a wart, nor does it look like any wart I have had in the past, but please correct me if I’m wrong?  I’ve been doing better with handling my anxiety on this issue, but I went to see him out of a general concern/check up before starting a new relationship. Unfortunately this Dr has confused me with different information and worried me with something that I have had in the past, these small folliculitis type bumps near the base of the penis after shaving/friction from sexual contact or tight clothes. I am going to look into the hpv vaccine a little more. Thanks again for your knowledge and understanding. 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
You are correct.  I will remind you that in an earlier interaction, Dr. Handsfield also pointed out to you that lesions of the sort that you describe, that are present for only a day or so, or that can be scraped off, are not HPV- HPV lesions/warts do not do this.  I will also suggest that the sort of hypervigilance you are describing is a classical manifestation of OCD and this is not something that most sufferers can manage without help.  I urge you to consider seeking professional counseling to help you with this.  Perhaps you could print out some of your earlier interactions, as well as this one to illustrate the issue at hand.

With regard to the partner notification issues, in an ideal world partner notification for persons with HPV is something that could be done beneficially.  Unfortunately, our world is far from ideal and for most persons in this day and age, just does not work the way it should.  Please do not feel bad about not informing partners.  EWH
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26 months ago
This makes sense to me. I know Dr. Handsfield had mentioned at 3 months it might be of good courtesy to alert a past partner, so I wasn't sure if there was any difference at 6 months. At this point, I don't even know what I would say/how I'd even tell that person. I understand what you are saying that it might be best to just drop it in the case of alerting this past individual. I have a follow up appointment in two weeks and the spot of concern is really almost cleared up a day after the dermatologist saw it. Really doubt it was anything. I'm ready to let this go and felt like I was making good progress until the Dermatologist sacred me a bit. I will continue with my therapy and working on not examining the situation with such attention. Thanks again. 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
The dynamics of who and who is not notified, as ell as the time frame used for notification is impacted by many, many variables.  I would think either 3 or 6 months may be reasonable IF the decision and circumstances related to notification are correct.  Once again, I think neither of us feels strongly that there is an ethical imperative to notify partners at all at the present time.

I (we) applaud your efforts to confront this problem.  Keep up the good work.

As you know, since this is my 3rd response, this thread will be closed later today.  Take care  EWH
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