[Question #5139] HPV Clearance and possibility infecting future partners

77 months ago

Dear Doctors,

Thank you very much for your time. I am located in Asia and had the 9 Gardasil shot before the case. No history of STI. Here is my story:

Last year 2018 August, I was having a bump near my groin area. Saw a dermatologist and a venereologist. The dermatologist though I was having folliculitis, while the venereologist wasn’t too sure - might be a skin module or a wart. He said what I could do was to take a swap near my bump for HPV DNA PCR analysis using Seegene Anyplex II 28HPV. After 2 days, it came back as HPV positive for a low risk type (forty three). The venereologist said you can still do a biopsy for confirmation, but it is 90% chance it should be a wart. Therefore, we perform cryosurgery to remove ii.

Advance 6 months to Jan 2019, I went to doctor for a follow up check. The venereologist did not pick up any new bumps when performing physical inspection. The venereologist mentioned the HPV virus might still present as subclinical infection, so asked me to perform HPV DNA PCR near my groin, penis and scrotum area. I think he had randomly swap my skin. This time, test turned out to be negative.

I was having doubt therefore I went back to the dermatologist on Feb 2019. He performed a similar HPV DNA test and the result was negative.

This month March 2019, I went back to venereologist to do the same test, it turns out to be negative. No recurrence of warts either.

The dermatologist and venereologist concluded that I have already cleared the HPV virus. I asked if I could still transmit the HPV to my future partners, their response was “The PCR test amplifies HPV virus on your skin swap copy 2^40 times. So if the test is negative, you clear the virus and won’t infect anyone if having unprotected sex later"

Question:

1. Have I really cleared the virus so I would not transmit HPV again?

2. Will there be chance the virus later becomes active and I become infectious ?Should I wait for 2 years without any sexual activities to wait for clearance ?

Edward W. Hook M.D.

77 months ago

Welcome to our Forum. Before I answer your specific questions, I feel it is important that I congratulate you on getting the HPV vaccine (as you probably know, HPV 43 is not in it and is a relatively rare cause of visible genital warts) and to wonder why you are concerned. Our perspective on HPV is that nearly every sexually active person who has not had the vaccine will have HPV, that their infections will lead to problems substantially less than 1% of the time, and that they are a nuisance. As a marker of having ever had sex with another person (HPV rates are about as high in monogamous persons as persons with multiple partners) most people already know that there partners have had other partners, hence, they are just not that big a deal. Most people will cause far more suffering among friend and contacts by transmission of the common cold or the flu than from HPV. This perspective, as well as the confusing and still being studied topic of HPV recurrence are also discussed in may other posts which you have access to on this site. I would encourage you to review some of them - it will show that your concerns are not unique as well as validate the perspective I've just provided.

Regarding your specific questions:

1. Research shows that after successful treatment to remove HPV sophisticated research tools may still show the presence of HPV DNA in tissue. Despite that most experts also feel that once a visible wart is no longer detectable, it is not transmittable and there is very little chance of recurrence after warts are gone for 4-6 months (in science, one can never say never as new information is constantly being discovered). It is not something to worry about and notification of partners of past HPV is not something we feel is crucial in part because the infections are so widespread and so misunderstood.

2. Thus I see no reason to abstain from sex at this time. Condoms reduce the risk for HPV as they do for all STIs but in terms of HPV (as opposed to other STIs), I do not feel that condom use is essential either.

I hope this perspective is helpful. EWH

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77 months ago

Dear Dr. Hook,

Thanks for your reply. Just several more questions. FYI - I am male. Some more questions:

1. CDC says there are no universal test for men to identify someone's HPV status, all it is done by visual inspection and biopsy. I am curious, in such case, why all research studies uses HPV DNA PCR tests to define if a person HPV status, if HPV DNA PCR tests are inaccurate ?

2. I am also curious why doctors in Asia uses HPV DNA PCR tests are used to determine if someone has genital warts, does this mean my venereologist might misdiagnosis my case ? He didn't perform any biopsy.

2. You mentioned "HPV sophisticated research tools may still show the presence of HPV DNA in tissue." I saw some research, such as https://academic.oup.com/jid/article/198/6/827/913963 suggests that a man will "clear" HPV if 2 consecutive test are "Negative". If these test are negative, does this mean the person has already cleared HPV and will no have any recurrence later ?

3. When we say "cleared the virus" just like Influzena, does this mean we have virtually eliminated all the HPV inside the body ?

Edward W. Hook M.D.

77 months ago

1. Research studies are conducted using PCR to be able to provide answers to the sorts of questions that you are asking. The tests are not inaccurate, just expensive and not useful for clinical management for all of the reasons I mention above and in other posts to other clients.

2. All too often health care providers do unnecessary tests. I cannot comment on why some would test for HPV. Visual diagnosis is accurate and effective for identifying lesions which patients find objectionable and want removed. Biopsy is expensive, unnecessary and may have complications.

3. Failure to detect viral DNA is tissue following clearance means that future recurrence is quite unlikely

4. Not necessarily as I explained earlier. The absence of visually detectable infection does not mean that there may not be small amounts of residual virus present. Better to think of it roughly like chicken pox- once the illness and rash is gone, the may still reside in the body and rarely recurs.EWH

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77 months ago

Dear Dr. Hook,

Thanks for your reply. Just some further questions:

1. Even not detected via HPV DNA test, the DNA material might still be present in my body. Can I say - the longer time I have no recurrence, the more assurance that I have the residual materials will eventually be cleared (say 2-3 years without recurrence) ?

2. If me and my future partner want to have babies, I will put her at risk of contradicting the HPV-43 virus, although the chance of she suffering with genital warts, probably is less than few percent ?

3. If I want my future partner to be absolutely risk free, the best case would be abstinence, then followed by protected sex ?

Edward W. Hook M.D.

77 months ago

1, Whether HPV is still present following infection, even if DNA is not detectable is a debated topic. The evolving consensus however is that virus is still present and quiescent. Quiescent virus however is of no consequence- no transmission, no progression.

2. No, No one would say that there is any reason to worry about having children in the future. As you point however there is a small chance that she will develop warts.

3. Correct although most experts would tell you that this is excessive. HPV is just not that big a deal. I urge you to read some of the other threads regarding HPV on the Forum. You are not alone in your concerns- reading other threads will help to inform you.

As this is my 3rd response, as per Forum Guidelines, this thread will now be closed without further responses. Take care. Please do't worry and try not to over react to the fact that you have HPV. EWH

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