[Question #6050] high risk HPV

19 months ago
I asked a few questions a month or so ago about my relationship with a woman who had a high risk strain of HPV and developed cervical cancer. Dr. Hook provided the responses.  We broke up but have since got back together. We have never had sex and I am still uncomfortable with potentially exposing myself to a high risk HPV, knowing that she in fact had it 10 years ago and may still carry it. I am in my mid 30s and don’t want the vaccine due to cost issues. After being treated with surgery and chemo for the cancer, how likely is it she still has the HPV and can infect me? Regardless of my past sexual history and possible exposures, I still may have not been infected before, but I am sure that my current gf did have a high risk strain. Puts it into a different perspective.  I do not want to risk my own health or future partners by being too lax with this relationship and risks involved.  I’d like some closure on this.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome back. But I'm afraid you misunderstand some basic facts about HPV.

Assuming you have had a number of sex partners in your life, you can assume you have been exposed to HPV, probably several times. At any point in time, roughly half of all sexually active persons in their 20s and 30s have HPV, and the highest risk types, HPV16 and 18, are among the most common. Therefore, it's a good bet you have been exposed to these or other high risk types. This is one reason HPV immunization isn't usually recommended after age 26:  by that age, most people have already been infected with at least some of the 9 HPV types covered by the vaccine, so it does less good. (The recent approval up to age 45 is intended primarily for selected persons not previously at high risk. Think of someone with lifelong monogamy and now newly single and dating.)

For these reasons, you are at no higher risk of having or catching HPV on account of your new relationship than you were before. That she was unlucky enough to have been diagnosed and treated for cervical cancer doesn't significantly elevate your risk of either catching HPV or, if infected, having an important health outcome from it. Further, even with the high risk (cancer causing) HPV types, the large majority of infections do not result in cancer, and particular strains of HPV that cause cancer in one person are no more likely to do so in anyone else. Sexual contact with this person also will not materially increase the chance that you will someday infect another partner with HPV. And with your partner's infection and cancer now 10 years in the past, it is unlikely she still has an active, transmissible infection with the HPV that caused the problem.

In the decades before cervical cancer and pre-cancer pap smear abnormalities were known to be caused by HPV (30+ years ago), millions of the sex partners of women with these problems were simply told there was nothing to worry about -- if anything was said to them at all. They rarelly had any important health consequences. That remains true today, even though we know a lot more about HPV and that many of those partners were infected with HPV themselves. 

Don't get me wrong:  I'm not trying to convince you that HPV isn't an important public health problem or that people should not protect themselves. That's what the vaccine is all about. But the situation is not unlike any other immunization or health risk:  you should get flu vaccine annually, so that you're not among the unlucky minority who catch influenza, and especially in the tiny minority who die from it. But just as the large majority of people not vaccinated against flu don't suffer any consequences, so the vast majority of people exposed to HPV don't even know it or ever have a health problem.

I hope this puts you at ease in your new relationship. Dont let an impersonal bit of DNA with a protein coating (that's all a virus is) interfere seriously with love, romance, commitment, and rewarding sex! Let me know if anything isn't clear.

HHH, MD
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19 months ago
Thank you Dr. Handsfield for the quick and thorough response. The metaphors and relativity to things like the flu greatly help me understand better now. I am in a similar situation to the scenario you described with long term monogamy and then back into the dating scene with only a couple of partners ever. Another reason I was more so concerned and not just blowing it off.  I don’t want to blame her for things out of her control, but I also don’t want to risk my own health. So thank you for your detailed answer.  Since I get follow up questions, what is the approximate chance that she may have a reoccurrence of that same HPV infection and subsequently the possibility of cervical cancer again? Could this affect fertility or pregnancy health? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
There is never blame for having HPV:  it is unavoidable, and no less common in people who have been entirely responsible in their sexuality than in those who have not. So regardless of anything that may happen in regard to HPV in you or your partner, it will not be her fault any more than your own -- but really nobody's.

Recent data show evidence of more frequent late recurrence than previously believed, but I am unaware of any data on this in women who have had cervical cancer. In general, recurrence is rare at 10+ years, and I would think even lower in someone who has had surgical treatment of cervical cancer.

HPV has no effect on fertility, except that surgery for cervical cancer would usually involve hysterctomy. Are you sure she was surgically treated? Plus chemotherapy? I cannot imagine a case of cervical cancer requriing chemo that would not have also had sterilizing surgery. Are you sure you correctly understand her diagnosis and/or what treatment(s) she received?
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19 months ago
All I have to go on is what she told me, specifically, that she had “surgery” to remove the lesion or whatnot (definitely was not a hysterectomy) and also underwent chemo. Now she has Pap smears 3 times per year instead of once.  Within the last 3 months or so, she also had what the doc believed to be an ovarian cyst that was giving her some hip and abdominal pain. Seems to have cleared up lately. She also informed me that ovarian cancer runs in her family. I may be straying off topic at this point. I plan on asking her more detailed information at some point, but right now  I don’t want to keep asking her about a bad memory over and over. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
When ther time is right, you should discuss her prior diagnosis in treatment in more detail, assuming she is willing and doesn't feel pressured. I cannot imagine cervical cancer having minor surgery (e.g., removal of tumor from the cervix without hysterectomy) and also needing chemotherapy (although I'm definitely not an expert in cervical cancer treatment). Was "chemotherapy" maybe treatment of her cervix with a local chemo agent like 5-fluorouracil (5FU), i.e. not systemic chemotherapy?

Anyway, if she had a local surgical procedure -- usually a "cone biopsy" or "conization" of the cervix -- that's treatment for early cancer or pre-cancer that hasn't spread. It is intended to also remove all HPV infected tissue. Sometimes this can have a potential fertility effect; after conization, during pregnancy some women have cervical incompetence, with elevated risk of miscarriage or premature labor. But HPV itself has no effect on fertility. This is something the doctors who treated her (or any gynecologist) can better inform you and her about than I can. This si a gyn issue, not an STD management problem, taking it out of the topics covered on this forum.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful and reassuring. Going back to your original question, the bottom line is that there is little risk to you of catching HP; and if you do, even lower risk you will ever have any important health problem from it.
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