[Question #5453] Liklihood of reactivating cleared hpv infection due to acute illness

21 months ago
This is a bit complex, and please be mindful that I have an anxiety disorder and I'm very scared. I read on a social forum that someone got their first genital warts outbreak after getting "mild pneumonia."

I've never had warts, but I used to have high risk hpv and abnormal pap a year ago. I've since come back hpv negative and a clear pap twice.  I really want to assume I'm fine and not contagious. However, now I worry that me getting something like strep or mild pneumonia will make me reactivate my infection and I'll be contagious without knowing it and accidentally infect someone.

My gut is telling me that I'm overreacting. I think the reason the person I mentioned above got their first instance of genital warts after a mild pneumonia is because it's easier for an illness to induce a first time hpv outbreak and less likely to cause a reactivation from an already controlled infection, since first time outbreaks don't have as strong of an immune control as an infection that's already happened and been cleared?? Can you please reassure me on this. I'm not sure how viruses work..

I know reactivation is a risk for people once they hit menopause or during pregnancy, but please tell me that simple ailments like getting sick wont make me reactivate and be contagious. I just want to move on with my life and not be so scared all the time.
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to the Forum.  I'll do my best to help.  I am concerned that this is something you got off the internet which, for matters related to STIs is an incredibly common source of mis-information.  So much of what it there is out of date, incorrect or taken out of context that I routinely ask, no urge, out clients to stay off the internet. That is precisely the wrong place for a person with an anxiety disorder to go.

The idea that an acute respiratory illness can lead to acquisition or reactivation of HPV has absolutely NO basis and should be discounted.  On RARE occasions as persons age or receive anti-inflammatory medications past HPV infections can recur but his is rare.  In your case, with two negative tests, I can think of no reason for you to worry about HPV reactivation or the potential of transmission to others.  

I hope my comments are helpful.  Please don't worry.  EWH
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21 months ago
You're absolutely correct, the internet almost always makes my situation worse. I sincerely appreciate the feedback; I'll ask a couple clarifying questions and try my best to let it go.

quoting you here: "The idea that an acute respiratory illness can lead to acquisition... of HPV has absolutely NO basis" So in this case the pneumonia didn't lead to the infection, it activated what was already there (according to this user that is). This was this person's first case of genital warts. My concern is that if a weak immune system can cause an initial activation, then it could cause reactivation as well.  --> What's your opinion on a temporarily weakened immune system causing reactivation?

According to this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3532821/ from NCBI, reactivation does happen. However, to your point, it doesn't mention anything about acute illness causing it. I fear that it's something that happens and we don't know about it due to a lack of  frequent enough monitoring after "clearance." I think most studies monitor from 4-6 months only over a 2- 3 year period.  That said, what's your opinion on short term reactivation that happens for a quick duration (maybe 2-3 weeks) every once in a while? Is that how HPV works? I know HSV does this, but to contrast, chickenpox (Herpes Zoster), does not do this. Each virus is different I guess.

Last but not least, my fears stem from accidentally giving a future partner Oropharyngeal cancer - It occurs almost as frequently as cervical cancer and there are no preventative measures to detect it early in men (which is probably why it occurs as frequently as cervical cancer). I know oral hpv prevalence is low. However, I have reason to believe that I might've been infected with HPV16 when I had the active infection (this strain is what causes OPC). I worry that oral hpv16 clearance is low because oral HPV prevelence is sooo much lower than genital HPV, yet we still have equal numbers of oral cancer and cervical cancer. Again, this could be because we now monitor cervical cancer.
My question is, does oral hpv16 have the same clearance rate  as genital hpv16 clearance? I cant find any studies on this so I'll default to your judgement. Can I assume that, in the rare case of reactivation, if I do infect someone that it will be at a low viral load since I'm "cleared" and they'll be able to fight it off?? I

I know this is a lot, but it's always on my mind and I've had almost no peace over the past year and a half because of all this stuff.

Thank you for your time.
21 months ago
Also, I was under the impression that anti-inflammatory meds were good for hpv since inflammation isn't good for neoplasia of the cervix
"but if the stimulus persists, inflammation becomes chronic and is strongly associated with cancer. This is likely to be due to the fact that the inflammation leads to a wound that does not heal, requiring a constant renewal of cells, which increases the risk of neoplastic transformation." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315066/

Are you referring to genital warts?
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Perhaps you missed it in my original reply which said "...acquisition or reactivation of HPV....".  forget about the idea that pneumonia would weaken your immune system (it would not) OR reactivate HPV.  Your fears, whether related to "reactivation" or clearance are groundless, internet fueled misinterpretation.  

Similarly, you do not know that you even have oropharyngeal HPV.  Clearance of oropharyngeal HPV is still a matter of study.  At this time there are no data to answer your questions about oropharyngeal transmission, clearance or cancer risk.  You are worrying about something that appears to be a minor problem and has not yet be elucidated.  If it were more of a problem, we'd have more data.  

Please stop searching the internet for data you then amplify and take out of context.  EWH
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21 months ago
Okay noted. That said, I have one last piece of potentially inaccurate internet intel that I need help de-amplyfing and putting into context.

I found this statement a week ago from a CDC article regarding latent HPV infections:

"Also, the high rate of HPV acquisition in 51-year-old women may be due to the reemergence of latent HPV infections caused by hormonal changes resulting from menopause or alterations to the cervix caused by hormone replacement therapy. A latent infection can be defined as one where HPV genomes are established in the basal cells but differentiation of the host cells does not take place (24). If such infections were below detection with increasingly sensitive PCR technology until the point of reactivation, then women could possibly become HPV positive in the absence of sexual activity. This possibility could also explain the finding of a second age-related peak in HPV prevalence in some South American populations after 55 years of age (6,25,26). However, less evidence for this second peak in HPV prevalence is seen in the United Kingdom and other countries where the risk of cervical cancer is lower."

If this is outside the scope of what I paid for, I can always purchase another question. Please let me know.

You all are the experts, so I hopefully that includes the  virology aspect of all this. If I'm indeed a latent infection as defined above, then what are my chances of transmission in this scenario? I ask because I've come to understand that latent HPV can still produce e6 and e7 proteins, is this true?  If so how does that affect my health and transmission risks? If my latency is constantly producing proteins and replicating, how does that not an issue since E6 and E7 proteins promote neoplasia. Would a PCR test really not pick up a latent infection, the above statement is from 2005 so can I assume that PCR testing has become more sensitive in the past 14 years? Please if you're not certain simply let me know. This is the last piece of internet intel I have, I want your help to interpret it as it applies to me. After this, I will take your advice and stay off the internet.

Kind Regards.
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Thanks for the follow-up.  Rather than deal with the specifics of your question, let me first comment about the issue of latency.  

I do not know your age or specific circumstances but I worry that snippets of information that you have found on the internet are leading you down a rabbit hole.  Sexually active persons who have not had the HPV vaccine are far more likely than not to have acquired HPV and in the vast majority of such cases, the infection will have become latent with HPV DNA present and detectable using sophisticated research tools but which is not shedding, is not infectious for sex partners and is far more likely to remain latent for the remainder of that person's life than not.  On occasions, more so in persons who undergo profound immunosuppression such as persons who receive transplanted organs, a small proportion of those (I emphasize, a small proportion!)  will reactivate and begin to shed the virus again. This is a rare event and far rarer still in persons who are not immunosuppressed (again, let me once again, getting and every day illness like pneumonia is not an immunosuppressive occurrence in most cases, its just bad luck) may reactivate as well.  To worry about such events is a major waste of time and a source of anxiety for persons such as yourself.  Far better to simply get your regular checkups (including dental care - dentists now regularly look for signs of oral HPV and/or pathology) and otherwise not let your tendency to worry about such things get the best of you.

More directly, simply because an article is from the CDC by no means makes it authoritative.   The quote which you provide (out of context) is an epidemiological observation regarding South American women, the issue of reactivation is pure hypothesis, nothing more.  Don't let it upset you.  

Finally, I am not conversant regarding the time sequence of E6 and E7 HPV protein production and cannot comment on this aspect of your question.  I can assure you however, that PCR tests for HPV have certainly become steadily more sensitive over the past  decade or so.  As a result, we now regularly detect things of questionable health import with these increasingly sensitive tests.

I hope this helps.  As you know, this 3rd response will complete this thread.  There will be no further answers.  I will however urge you to stay off the internet, it is my strong impression that this is misleading you and causing much undue concern.  EWH
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21 months ago
Thank you, Dr. Hook. This was reassuring. I'll stay off the internet.