[Question #6513] STI transmission in monogamous relationship

15 months ago
Hi, 
I began dating my fiance about 4.5 years ago- We had protected vaginal sex for the first 6 months, and unprotected for the next 2.5 years. Neither of us had ever been tested for STIs, with him having 10 previous partners, and me having 2. We broke up for a few months, during which time I had a different sexual partner. However, I learned how important STI testing is during this time, so I got tested once for HIV, syphilis, chlamydia, and gonorrhea after my break up, and then once 3 months after my contact with the different partner-being all negative both times. In June, my boyfriend (now fiance) and I got back together and started having unprotected sex again. I didn't think to ask him to get tested, because he did not have sex with anyone else during that time and I figured if he had anything, I would've gotten it a long time ago. However, a few months ago, I noticed a couple warts on his penis. I initially panicked- thinking I gave him HPV... but after reading this forum, I calmed down about it, especially since I got the vaccine years ago. However, a small cluster of 4 warts appeared on his inner thigh, and he got another wart on his foot and on his pinky. He self treated all of them (against my advice to see a doctor), and now has a new one on his stomach. He also can have stomach problems/ diarrhea from time to time. My main concern at this point is HIV, and that the warts are appearing relatively quickly due to immunocompromise. So my question is- how likely is it that he has had HIV, syphilis, chlamydia, or gonorrhea all this time and not transmitted it to me yet? Do I need to consider bringing up STI testing? I brought it up before, saying that one can be asymptomatic for years, but he did not want to talk about it. MY plan was to get tested every 6ish months for awhile and then yearly, if he does not want to test. But if there is a real possibility he may have HIV and have not transmitted it yet, I think I need to take this more seriously. I plan to get
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Welcome to the forum. Thanks for your confidence in our services.

My first advice is that your partner's apparent warts be professionally evaluated. Genital warts rarely are so widespread -- the penis of course is a very typical location, but thighs and abdomen are not; and certainly genital warts don't apepar on hands or feet (although non-sexually transmitted warts can). But there are plenty of skin bumps of various kinds that can appear wart-like but are entirely different. In the event the penile bumps indeed are warts, I'm glad to hear you have some understanding that this isn't a crisis, that you're not the likely source of the HPV causing them, and that you're likely immune due to your past vaccination. It would be prudent to have a pap smear in the not too distant future, but most likely it won't show anything.

Although it is true that immune compromise sometimes leads to appearance of warts, including warts in atypical locations, in the large majority of cases there is no apparent immune problem. And warts would never be the only indication of HIV related immune deficiency. Anybody with sufficient immune impairment to develop warts would be ill with numerous other, more serious health problems. In other words, if he is otherwise outwardly healthy, I would be even more confident this doesn't indicate HIV. But this too is something he can discuss with his doctor if and when he seeks professional care for diagnosis of the bumps.

Finally, the chance either of you acquired HIV seems low. If you have reason to believe your fiance has been having sex with other men, or might be an injection drug user, the chance of HIV would be a lot higher. Otherwise, I wouldn't worry about it. That said, it's not unreasonable for him to be tested for HIV. The chance is very low, but you can never know for sure without testing.

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

HHH, MD
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15 months ago
Dr. Handsfield, 
Thank you so much for your detailed response. My only follow up question is that I had a pap smear last year at this time and was told I did not need another for 3 years due to the results- but should I go ahead and get one this year too? 

Thank you so much again. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Thanks for the thanks. I'm glad to have helped.

I recommend you follow your doctor's advice about pap smear frequency. You don't need paps any more frequently than advised routinely for all women. 
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