[Question #5894] In Need of Advice - Dr. Hunter Handsfield

19 months ago
was diagnosed with HPV and had a genital wart removed back in 2007 (12 years ago).  Since being treated (removal and Aldara cream for 3 months), I have never had a recurrence nor have I ever had previous partners (this includes a woman who was on immune suppressants with whom I had unprotected sex on multiple occasions) come to me stating they tested positive for HPV until recently.  My last girlfriend with whom I broke up with 4 months ago, contacted me about 3 months ago and claimed I gave her genital warts.  I fully disclosed to her my previous experience with HPV but tried to assure that given my remission of nearly 12 years, I likely did pass it on to her.  She claimed that her doctor told her that what she removed was genital warts (despite not sending it out for biopsy at a lab) and that despite having no symptoms for 12 years I was the one that gave it to her.  I thought that extremely and I haven’t developed any symptoms to date (nearly 3.5 months since we last had sex).  Note, my ex was not the most mentally stable and was clearly hurt by the breakup as I ended things, so I’m not so sure I believe her story anyways as she started dating someone new two months later.  Also, I did get screened for all other STDs and I tested negative after she disclosed this to me.

My questions for you are as follows:

1.  After 12 years of remission what is the likelihood I passed it onto her?  I know that HPV strains can lay dormant for many years but more than a decade?  Seems strange, particularly since I have been in multiple long term monogamous relationships with girls who have never reported an issue.  One of which was on immune suppressant drugs for a autoimmune kidney disease.  

2.  Is it more likely that her infection occurred from someone else prior to us dating and she is just now manifesting symptoms?  Should I be worried about developing a new occurrence from a new strain?  Again, I am 3.5 months removed from last sleeping with her.  Can I consider myself ok?

3.  Lastly, I have started seeing someone new, with whom I have been intimate using condoms, and had sex once without using protection.  I find myself in a moral dilemma in choosing to disclose to her an issue that may or may not exist (thus jeopardizing the new relationship and causing her unneeded worry/stress) and disclosing her the issue to protect her sexual health.  What are the risks / percentages to her of contracting HPV from a one time, unprotected sexual encounter with someone in my position?  I know this is extremely complex, but I’m worried I will scare “the one” away by telling her about this.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome to the forum. Thanks for your confidence in our services. FYI, it is by chance that I am answering and not Dr. Hook. I happen to be up for new questions, but as clearly stated in the forum introductory comments, users do not have the option of selecting the moderator who responds.

Bottom line:  I very much doubt you are the source of your former GF's genital warts. 

It is rarely possible to be confident where, when, and from whom any particular HPV infection was acquired. It is conceivable your infection from 12 years earlier was still active (or reactivated), but not likely. Visible warts usually show up from 2 to 12 months after acquring the HPV causing them, but it can be several years later. Assuming your GF had other partners before you and she were a couple, those are equally or more likely as the source. Also, somewhere around 20-30% of all people get genital warts at one time or another -- i.e. frequent enough that many persons with newly diagnosed warts will have a current or past partner with warts, by random chance -- i.e. not implying the transmission source. On top of all this, in view of your sexual history, I agree that if you were infectious, one or more of your other partners also would have been likely to acquire genital warts. (However, the kind of immune suppressive drugs your kidney disease partner took probably don't increase the likelihood of catching HPV or developing overt warts.)

Those comments pretty well cover your specific questions, but to be explicit:

1) It's possible but quite unlikely you are the source of your fomer partner's warts.

2) Yes, this is the more likely scenario.

3) I see no need to mention your past warts to your current partner or to use condoms. Of course condoms may be reasonable for a while regardless of HPV, depending on her sexual history; the two of you could consider being tested for common STDs (gonorrhea, chlamydia, syphilis, HIV) before going unprotected. But condoms don't work well to prevent HPV anyway. (Having said no need to discuss past warts, that's from a prevention/transmission/medical perspective. Many new couples discuss past partnerships and STDs as a relationship issue, not necessarily for STD prevention resons.)

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

HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
I should add that because HPV infections are nearly universal -- just about every sexually active person gets HPV, often more than once -- and because of uncertainties about transmission source, there is never any blame associated with HPV, unlike some other STDs. Even if you should be the source of your former GF's warts, it shouldn't mean anything special to either of you.---
19 months ago
Well I consider myself fortunate that you happened to be next in line!  Thanks very much for your prompt response.  I greatly appreciate it.  My last question stems from your below analysis and is purely hypothetical.  So presuming my former partner did in fact have HPV, I presume (unless it was a strand I already contracted) I would be susceptible to reinfection and/or new symptoms if she was indeed infected by a previous partner?  Ergo, do you think if I am not symptomatic 3.5 months removed from the relationship (we were intimate for a total of 6 months) that I am basically "in the clear"?  Again, thank you so much for helping put my mind at ease for your thoughtful and quick reply. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Thanks for the kind words. But Dr. Hook's knowledge about all this is equal to mine; you would not have heard anything different if he had replied.

Any new relationship carries some risk of HPV; it's just so common, and for the most part no less common in those with only a few vs many past sex partners. However, people are immune, or at least highly resistant, to new infections with the HPV type(s) they already have had. Two types, HPV6 and 11, cause 90% of genital warts, and those two types are related to one another, so that prior infections provide at least partial cross protection against both types. Therefore, once someone has had genital warts, probably it is rare to ever catch a second case. When warts reappear after many years -- which sometimes happens -- it is believed to usually result from reactivation of the old infection, not a new one.

So probably you will ever develop warts again; and if you do, it probably won't be because you infected your GF and then were reinfected. HPV is complicated and knowledge continues to evolve, and I can't say these current beliefs will hold up. But that's the current state of knowledge.

That completes two follow-up questions and replies and so concludes this thread. I hope the discussion has been helpful.
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
I miscounted -- you have one more follow-up comment/question available (for clarification of the above, not an entirely new topic). I'll leave this open a couple more days, then close it.---