[Question #5814] HPV transmisson

20 months ago
Hi, I'm in my mid 30's and have some questions regarding HPV.  I know it's common and the body eventually fights it off in most cases. I dated two people that were rumored to have it and I still have anxiety about it because I've just recently started dating someone new. About two and a half years ago, I found something that appeared to be a wart on the shaft of my penis. I didn't have it treated and it actually went away in about two weeks. I've never had another one after that. Should I disclose this with my new partner being that there's a possibility I was exposed even with having no further symptoms after that one wart? I'm stressing myself out over it. I want to be up front with her but I don't want to possibly lose her over something I don't even know if I had in the first place.  On the other hand, I don't want to give her something  and then she hates me. Being that it was at least two and a half years, is it likely that I'm not even contagious at this point anyway? Thanks for any advice.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Welcome to the forum. Thanks for your confidence in our services.

That some past partners were "rumored" to have HPV is irrelevant. Since 90% of all people get HPV at least once, and at any point in time aroundf 50% of sexually active people have active HPV that can be transmitted, the chance those particular persons had HPV was probably no higher than in anyone else. Ignore and disregard any such rumors:  sex with such a person is no more likely to result in catching HPV than sex with anyone else. Assuming you have had sex with several partners over the years, there's a good chance you have HPV -- but no higher chance because of the partners "rumored" to be infected.

There are many skin bumps other than warts; and a single bump (as opposed to several) probably isn't a wart. Also, warts don't clear up in 2 weeks; probably it was something else. You have no obligation to future partners to say anything about that event or about HPV. Sex with you is no more risky for HPV than sex with anyone else. From an HPV prevention standpoing, I see no need to be "up front" wioth your new partner. (Many couples discuss such things out of mutual respect and caring. But as a relationship issue, not one of disease prevention.) And if someday your current partner has an HPV related problem, such as an abnormal pap smear, there will be absolutely no reasoon to assume you were the source versus some other past partner. It is rarely possible to know when and from whom any particular HPV infection was acquired, in in general people should not try ti figure it out.)

Having HPV is a normal, expected consequence of being sexual. Don't look for sources. With few if any exception, HPV transmission is blameless. If you have not had the HPV vaccine, consider doing it. It is one of the most effective immunizations ever developed, with 100% protection against infection with the 9 types covered by the vaccine, which together cause 90% of genital warts and cancers.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD


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20 months ago
Thank you for your response. I have a tendency to get inside my own head but you've alleviated a lot of that anxiety. I just would hate knowing I was responsible for someone else's misfortune. If you don't mind, I do just have some general questions. Some of the terminology is confusing to me. What does it mean to "clear" the virus, does that mean your body is rid of it or is it still dormant in tissue? Hypothetically, If the people I spoke of DID have it (one being over seven years ago and and the other at least five) are the odds good that I would have passed it anyway? Also, and I know you said it probably wasn't a wart and I agree, I read that after you haven't seen one in 6 months they'll probably not longer present or contagious.  These questions are out of curiosity and for knowledge at this point. Thank you for the vaccine recommendation as well, that was going to be one of my questions. I'll have that done ASAP and
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
These are good questions -- an opportunity for a blog-like reply that I can use in response to future similar questions. Bear with me!

Unfortunately the answers aren't certain. Some experts and data suggest that all HPV infections are permanent, that HPV DNA is never cleared and there is a lifelong possibility of reactivation. On the other hand, the immune system keeps most infections in check, and either clears them entirely (no persisting DNA and no potential for reactivation) or at least suppresses the infection to a point that there is little or no risk for reactivation or transmission. What seems clear is that most HPV infections are detectable only for a while (weeks or months), after which transmission risk is low or zero. But different experts use different terms for these situations:  "cure", "viral suppression", "persistent infection" and other terms all can be used with different intent or meaning. I often say things like "cured for all practical purposes", intending to waffle on the potential for reactivation.

My statements about infectivity lasting 6 months are based only on my clinical experience, and the need to give patients practical advice. But there is no sharp deviding line. I'm confident that if genital warts are treated and visually cured and have not recurred after 6 months, or if an abnormal pap smear has normalized after 6 months, both transmission risk and potential for recurrence are low. But not zero. Sometimes this might take only 2 months, in others a year or more (or never). The longer the time without recurrence, probably the lower the chance it will happen.

However, recent research indicates that recurrent warts and newly abnormal pap smears -- even several years after initial infection -- are more frequent than previously believed. We're also learning that new infections with previous HPV types are more common than once believed, i.e. the immunity against any particular HPV type after natural infection is less strong than once understood; new infections with the same type sometimes occur. Thus, when an unvaccinated person develops recurrent warts or a newly abnormal pap smear, it is often not possible to know whether it is reactivation of an old infection or acquisition of a new one. Happily, though, the immunity from vaccination is stronger that from natural infection:  once immunized, apparently immunity against those 9 types is complete and permanent.

So the current state of research, and these comments, leave a lot of uncertainty and hence anxiety by many infected or potentially infected persons. But the most important facts remain that 1) most people get HPV and can't do much about it (so why worry?); 2) most infections cause no harm and are cleared by the immune system to a point they cannot be transmitted and are unlikely to reactivate; 3) vaccination can prevent up to 90% of the potentially harmful effects of HPV.
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20 months ago
I really appreciate your time and detailed responses. I guess my last questions would be is if it is dormant or even possibly cured, will the vaccine suppress it further from being transmittable? If in fact it has "cleared" or "cured" the vaccine would prevent me from getting it again. I've had HIV testing done recently with a negative result as well as the Chlamydia, gonorrhea, syphilis, acute hepatitis and HSV2 (Results pending). I was actually worried maybe that bump was herpes but again, it was one bump that went away quickly, didn't appear as a blister, didn't hurt, no rash or anything like that. At this point I'm just trying to make sure I'm clean for peace of mind and so I don't have to worry about infecting future partners. I'd hate to be responsible for something like that. Do you agree with the time frame given of HPV being undetectable or cured in 90% of people? If that's the case, I'm well beyond that. I fully intend to start vaccination ASAP for HPV.  I feel like I'm worrying myself to death and I should and I should feel confident that I've done everything in my power to be informed. Would you agree, especially if all those tests come back negative, that I'm a healthy male that I should relax and enjoy life and my time with my partner? Thanks again for all your help, it's just so hard to interpret everything from the articles you see online. Your advice has already done a lot to ease my mind.
20 months ago
I should add that I have a history of anxiety, hence why I'm driving myself insane over this. I just want a good, healthy relationship with my girlfriend without worry.
20 months ago
Lastly, in your opinion, should I disclose any of my concern with her or just let it be? Thanks again.
20 months ago
I meant to add, the possible wart I thought I had was not treated, it just went away very quickly.  Based on your opinion I'm thinking it wasn't one though. Does that change your opinion on the fact that the chances of it recurring are very low. Like I said, it's been at least two and a half years since I've seen anything at all.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Recent research indicates that immunization might reduce the potential for reactivation of a previou sinfection, but only a little bit. Its only reliable benefit is in preventing new infection with the 9 types covered by the vaccine. Probably it also prevents new infection with previous infecting types.

Re "being responsible" for a partner's future HPV problem, if that happens, it will never be known (or possible to know) whether you or some other past partner is the source -- as I said above. 

The 90% figure probably is about right for suppression by the immune system, but later reactivation probably occurs in more than 10% (maybe up to 50%) of infected persons.

Assuming your tests for other STDs are negative, then regardless of your HPV history or test results, you indeed should "relax and enjoy life and my time with [your] partner". You should not have any more HPV tests, which are not FDA approved (and hence not necessarily reliable) for use in males.

Whether or not you discuss any of this with your sex partner is a relationship issue. Some couples openly discuss past partnerships, STD experiences, and concerns; others do not. From the standpoint of prevention or your partner's health, there is no need, especially since you've never had a diagnosed HPV infection.

That completes the two follow-up comments and replies included with each question and so concludes this thread. I'm glad the disucssion apparently has been helpful. Best wishes.
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