[Question #5365] Hpv disclosure to partners before infection showed.

22 months ago
I’m 45 and a male. My hpv (presumably 16) BP spot healed perfectly and I have felt fine about it for more than 2 years. Last week, I went to see my therapist again after more than a year and they randomly asked if I had disclosed my hpv to my past partner. Some background details: My infection showed up 4 months after a last encounter with a friend w/benefits. Not knowing what it was, and not knowing anything about hpv, I stupidly waited 10 months to have it looked at because it didn’t bother me. So, 14 months had passed from the time of sex before I realized I got HPV. I understand that she may not have been the one to give it to me. I was powerfully distraught at the time and was told that hpv was ubiquitous and informing past partners was unnecessary and could do more harm than good.  I had not spoken to that girl since that night 14 months prior and I was aware that she was engaged. I stood by my choice not to inform past partners.Fast forward 3 years to today, my therapist was taken back by the fact that I never informed her. I am susceptible to irrational shame btw. I’m having feelings of shame, but I would be devastated if that had ruined her relationship over something ubiquitous that has a 1% chance of becoming a concern. What are your thoughts on disclosure in this situation? I’m waiting until I’m in a committed relationship to have sex again. I just want to know that informing a past partner wouldn’t have been wise because it can do more harm than good. Especially since it’s possible that she may not have been the one that gave it me. Summary Timeline: had sex, 4 months later bp showed up, 14 months later found out it was hpv, 4 years later am feeling shame about not disclosing to past partner because I was catching up with my therapist. Thank you so much for what you and your team do. The girl is now happily married.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome back to the forum. I reviewed our discussion 3 years ago, including my own agreement with your dermatologists when your penile cancer was diagnosis. I still agree with myself! Your counselor would may not understand HPV infections; or perhaps you misunderstood the reason for her surprise. The chance you have continuing active, transmissible HPV infection at this time, 3 years later, is low. (The problem was necessaily due to HPV16. That's the most common but by no means the only HPV type causing penile, cervical, and other cancers.

All women need to follow standard guidelines for pap smears. That is all the protection they need from serious HPV outcomes, and it should be done regardless of their partners' known of suspected HPV status. For every partner someone might choose, 90% will not know their HIV status, yet at least half will be infected at any one time. Your partner's chance of having HPV16 (or any other type) is no higher because you are her partner than if you had never met. Assuming she has had at least a few other sexual partnerships over the years, it is fair to assume she has been infected and may carry HPV now. The same applies to your past partners. Not only do you have no obligation to inform them:  in my opinion, you have an obligation not to do so. The most likely outcome would be unnecessary alarm and fear, with no measurable health benefit.

I'll add that many couples in committed relationships discuss past STD status, including HPV, genital warts, and problems like yours. But this is usually in the context of an open, caring relationship, not for protection against infection. Perhaps this was the main concern of your current counselor, not necessarily protecting your partner from HPV. You should clarify that with her. But from an HPV transmission/risk standpoint, you have done nothing wrong.

I hope this information is helpful. Perhaps you will consider printing out this discussion as a framework for addressing it again with your counselor. Best wishes and good luck.

HHH, MD
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22 months ago
Thank you, Dr. Hansfield.  This is incredibly helpful. We met again yesterday and she was incredibly forward with the fact that she lacked education on the subject. We had a great session. I will print your reply for reference.
 You have a small typo In the second paragraph of your reply. You wrote HIV instead of HPV. I’m sure everyone knows it’s a typo, but you may wish to edit it or confirm it as a typo. 

Thank you so much again.
22 months ago
I’ve read that the new upper limit for Gardisil is 45 now. Is there any harm in my getting that shot? Does it reactivate past hpv? I want to do whatever I can to prevent another visible wart of any kind.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Correct about the typo. HPV, not HIV.

The HPV vaccine does not reactivateprior HPV infections. In fact, maybe just the opposite. For the first 15 years after HPV immunization became a relaity, the research indicated no effect of vaccination on prior HIV. More recent data, with more sophisticated epidemiologic research with larger numbers of subjects, indicates it may have benefit in modestly reducing reactivation and later onset complications, like abnormal pap smears. For sure vaccination is never harmful in any known way.

That said, the frequency of new HPV infections is quite low after the mid 20s, the reason for the previous cut-off at age 26. For those 27-45, I would recommend vaccine primarily for those at known risk, e.g. a new partner with a known high risk (cancer causing) HPV type, and those continuing a lifestyle with frequent partner changes (commercial sex workers, for example). My guess is that your risk of new HPV exposures is rather low, and may not justify the roughtly $500-600 cost, especially if not covered by your health insurance. That said, the benefit of reassurance also is a reasonable consideration:  sleeping better over the next decade may be worth the cost! Discuss with your doctor.
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22 months ago
Thank you. Even though my risk is low, I think I will get it.  My only remaining irrational fear is a VISIBLE recurrence of the thing from 3 years ago.  That’s all I have. Thanks, Dr.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Thanks for the thanks. I'm glad to have helped.---