[Question #6501] Possible RRP?

15 months ago
I (male) had sex (oral (receive and give) and vaginal) with a female partner 6 months ago. I showed no symptoms of warts, HPV, and tested negative for syphilis, HIV, and gonorrhea. This female said she was diagnosed with HPV over 15 years ago and has shown no symptoms from it since being diagnosed. 

I had sex (oral (give and receive) and vaginal) with a different female 3 months later and up to now, with regular sexual activity. She started developing a cough/voice weakens and sometimes cannot speak on three separate occasions within the last two months. In only one of these occurrences she has had a fever and associated symptoms of having a normal cold. The other two time she has either lost her voice or voice became very hoarse. Should I be concerned she is at risk of developing oral HPV or RRP? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Welcome. Thanks for your confidence in our services.

Several factors make it exceedingly unlikely that your parter with cough and voice problems has respiratory papillomatosis. (You may know this, but for other readers:  RRP = recurrent respiratory papillomatosis, meaning warts of the respiratory tract, usually the larynx. "Recurrent" is often a misnomer -- obviously the first episode isn't recurrent, but that's the common name.)

Adult onset RRP (AORRP) is very rare. I have no way to know whether that's the explanation of your partner's problem, but it is exceedingly unlikely. The odds are she's just had a couple of garden variety viral respiratory infections and her symptoms will clear up and not recur. Among other things, RRP symptoms don't come and go; if that were the problem, hoarseness etc would have continued the first time. If her current altered voice or other symptoms continue, of course she should see a doctor. But in my 40 years in the STD business, I've never seen a case or even heard of one among my STD clinic patients or their partners. I doubt this will be the first.

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

HHH, MD
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15 months ago
Understand all, thank you! 
15 months ago
Having trouble understanding how the body’s immune system can get rid of HPV.  If it’s a virus just like HSV, wouldn’t it reappear? I thought all viruses are present in a body after initial infection. Could the first female that I had intercourse with, have completely gotten rid of the strain of HPV she contracted over 15 years ago? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Thanks for the opportunity to expand on this. I'm afraid you're mistaken about the natural course of many viral infections. Some persist, but the immune system completely clears most viruses:  you don't have ongoing and certainly not lifelong infections with cold viruses, influenza, measles, mumps, hepatitis A, gastrointestinal infections like norovirus, and many others.

Indeed there are several viruses for which the immune system is not effective in clearing them -- although it does limit them and prevent symptoms most of the time for most people. Examples include all the herpes group viruses, which include HSV, Epstein Barr virus (EBV, the cause of infectious mononucleosis), and varicella zoster virus (VZV, the cause of chickenpox and shingles). All herpes group viruses are lifelong, with greater or lesser potentials for reactivation as the years go by.

HPV is in a middle ground. It's probably sometimes completely cleared by the immune system, although it takes a lot longer than colds, influenza, etc. In other cases HPV persists, perhaps for life, mostly latent and undetectable, but sometimes detected by DNA testing. Hepatitis B and C are similar to HPV in this way:  the immune system often clears them entirely, but some infections persist for life.
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15 months ago
Thank you Dr Handsfield for your responses.  I have one final question.  If an immune system clears any virus entirely (such as HPV for the case of the previously mentioned female in my original post) would it be within the realm of possibility that whatever particular strain she had, I could not have been infected with it?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
If HPV has been completely eradicated, that person cannot transmitt it. However, there is no way to know whether any particular infection has been eradicated or only suppressed, with a potential for reactivation. But it doesn't matter:  assuming you've had sex with at least a few partners, you can be sure you have been infected with HPV and could still have it. It's a normal, expected, unavoidable consequence of being sexual. If you remain concerned and are young enough -- for sure if you're under 26 and possibly up to age 40 -- you can be vaccinated to prevent infection with the 9 HPV types that cause 90% of HPV related health prolbems.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.
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