[Question #6780] General HPV Questions
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65 months ago
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Hello, I just recently got diagnosed with genital warts. You can see my previous conversations with Dr. Hook on my exposure. I've already got them removed but I have some general questions regarding HPV
1. From most of what I have read it seems like HPV resolves itself over time, 1-2 years usually. If this is the case, then why did Dr. Hook mention many people have HPV already (if someone had it, wouldn't their body get rid of it over time)? And why do I see posts about people saying HPV can be in your body for years and you not knowing or spreading it (again, even if they didn't know they had it, wouldn't their body get rid of it in a year or 2)? Which one is true?
2. I asked about my partner getting a vaccine and was told no need because she was already exposed, but I was also told a 1 time exposure is not likely to lead to an infection, so why wouldn't she get the vaccine if it's unlikely she's been infected?
3. I've read that getting the vaccine might be a good idea even after being infected, especially for partners that share HPV. This is because if I rid the virus in a year, but it takes my partner 2 years to rid the virus, she can still infect me in the meantime. Is this true? Should we both just get vaccinated?
4. Are we ever able to give/receive oral sex again? Is there a danger of warts spreading to the mouth? Should we wait out at least 2 years before doing oral again (if it all)?
5. If warts spread easily, can I still masturbate? I'm trying to avoid sex for now until we figure out what we're going to do, but I'm not sure how to approach masturbating with warts.
6. I read that 99% of people will never get another wart outbreak after the first, is this true? And for those 1 percent, will get just a few more in their lifetime or will it constantly be reoccurring?
7. How long does the initial outbreak last? How long do I need to check myself for new warts?
8. How would this effect childbirth and pregnancy? I've read that hpv is unlikely to transfer to the baby and if it does they will simply get rid of it over time. Is this true?
9. I've also read that hpv should be seen more like a cold because your body will take care of it on its own, do you agree with this?
10. Finally, if hpv is not that big of a deal, then why do we have a vaccine for it? I'm guessing it's for the cancerous strands, but again, what's the worry if our body is just going to rid the virus itself anyways?
1. From most of what I have read it seems like HPV resolves itself over time, 1-2 years usually. If this is the case, then why did Dr. Hook mention many people have HPV already (if someone had it, wouldn't their body get rid of it over time)? And why do I see posts about people saying HPV can be in your body for years and you not knowing or spreading it (again, even if they didn't know they had it, wouldn't their body get rid of it in a year or 2)? Which one is true?
2. I asked about my partner getting a vaccine and was told no need because she was already exposed, but I was also told a 1 time exposure is not likely to lead to an infection, so why wouldn't she get the vaccine if it's unlikely she's been infected?
3. I've read that getting the vaccine might be a good idea even after being infected, especially for partners that share HPV. This is because if I rid the virus in a year, but it takes my partner 2 years to rid the virus, she can still infect me in the meantime. Is this true? Should we both just get vaccinated?
4. Are we ever able to give/receive oral sex again? Is there a danger of warts spreading to the mouth? Should we wait out at least 2 years before doing oral again (if it all)?
5. If warts spread easily, can I still masturbate? I'm trying to avoid sex for now until we figure out what we're going to do, but I'm not sure how to approach masturbating with warts.
6. I read that 99% of people will never get another wart outbreak after the first, is this true? And for those 1 percent, will get just a few more in their lifetime or will it constantly be reoccurring?
7. How long does the initial outbreak last? How long do I need to check myself for new warts?
8. How would this effect childbirth and pregnancy? I've read that hpv is unlikely to transfer to the baby and if it does they will simply get rid of it over time. Is this true?
9. I've also read that hpv should be seen more like a cold because your body will take care of it on its own, do you agree with this?
10. Finally, if hpv is not that big of a deal, then why do we have a vaccine for it? I'm guessing it's for the cancerous strands, but again, what's the worry if our body is just going to rid the virus itself anyways?
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H. Hunter Handsfield, MD
65 months ago
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Welcome back, but sorry you found it necessary. I'll be responding this time, but I reviewed your two previous discussions with Dr. Hook. I agree with all he said and advised.
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I would add that it is unlikely you acquired your apparent genital warts during the exposure you have described. Visible warts typically appear 2-6 months after acquisition, often up to a year. Your apparent onset seems too early, or barely within two months. Anyone who examines their genital skin closely enough will notice irregularities, especially when anxious and therefore looking carefully, and it seems likely the bumps you noticed were there before. And as Dr. Hook said, the chance of acquiring HPV from just one condom protected sexual exposure is very low. At least 90% of all people get genital HPV, some have active infections from time to time thereafter, and probably somewhere around a quarter of all people have genital warts diagnosed at one time or another. All this all adds up to a probable chronic infection unrelated to your recent sexual exposure.
Your questions cover the entire range of HPV infections, a complex topic. Many excellent resources are available, I would start with two: the sponsor of this forum, the Amercian Sexual Health Association www.ashasexualhealth.org and look for links and topics. (The HPV section includes a video I recorded a few years ago, but still mostly accurate.) And the US Centers for Disease Control and Prevention (www.cdc.gov/std). But perhaps the most important take-home message is this: getting and having genital HPV is a normal, expected, unavoidable consequence of being sexual. Not desirable, but normal. And serious outcomes are easily prevented by vaccination plus attention to symptoms that should receive prompt medical attention, which is just abou t100% protective against progression to a potentially serious stage.
1) Both things are true: usually cleared by the immune system, but often HPV DNA persists and the infection can reactivate. Sex with any partner at any time carries at least some risk of HPV transmission. That's life.
2, 3,10) HPV vaccine: It protects against 9 types of HPV (of >100 that exist). These nine cause ~90% of important health problems, including warts, cancer, and pre-cancer. Most people with HPV are still sussceptible to most of the types in the vaccine. Everybody with newly diagnosed HPV should be vaccinated, as should all sexually active young people. However, re-infection is not an issue: most people are immune, or at least highly resistant, to new infections with the HPV type(s) they already have. Serious outcomes of HPV are uncommon, but in a population of 360 million Americans, low percentage still adds up to lots of disease. Each year around 40,000 women get cervical cancer and 10-15,000 people develop throat cancer from HPV. In addition to preventing cancer itself and genital warts, immunization saves hundreds of thousands of women from the worry, inconvenience, and expense of having abnormal pap smears that need follow-up testing, examinations, and sometimes treatment to prevent cancer; and a similar number of people who experience lost time, expense and anxiety due to genital warts.
4) Oral HPV is common, but a lot less than genital. All sexually active people are repeatedly exposoed to HPV if they perform oral sex on their partners. You and your sex partner(s) are no more at risk for oral infection, or its very rare seious outcomes, than anyone else. There would be no point and no need to stop having oral sex (or genital sex) at this time.
5) Genital HPV is not "spread easily" to other body areas, and nobody gets genital warts elsewhere, regardless of masturbation.
6) Wrong information. Recurrent warts occur in a lot more than 1% of people with initial gential warts. The exact frequency isn't know, but at least a few percent notice recurrent warts in the future.
7) Assuming your warts were removed by the biopsy, probably you can consider yourself cured now. Deal with a recurrence if and when it happens, but for now I see no need for worry. You should be continuing sex with your regular partner.
8) There is a small risk of laryngeal papillomatosis (warts in the throat) in babies delivered vaginally to infected moms. It's rare. If and when pregnant in the future, your partner should tell her Ob of her possible past HPV infection. (But expect her to just smile and say something like "Same for all my patients. Don't worry, I'll be on the lookout for recurrent warts as your delivery date approaches.")
9) Maybe more like flu than colds. Inluenza on rare occasions is serious or even dangerous. Same for HPV, but not so much for the common cold.
I hope these comments are helpful. As I said, this is a complex topic, but let me know if you have additional brief questions.
HHH, MD
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65 months ago
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Thanks for your reponse!
Before my follow up questions, I want to clear up some things about my warts.
The first noticeable warts, which just looks like 2-3 small bumps, occurred at the 5 week mark, which prompted my biopsies. By the time I went back to get my results (2 months post exposure), I had my full outbreak with more lesions that the dermatologist suggested looked a lot more like warts and I had to get many frozen off. So while I did get 2-3 small bumps that did end up testing positive for genital warts, my outbreak really occurred closer to 2 months post exposure.
1. "Both things are true: usually cleared by the immune system, but often HPV DNA persists and the infection can reactivate. Sex with any partner at any time carries at least some risk of HPV transmission. That's life."
If I'm only having sex with the same partner for the rest of my life, is less likely that re-transmission and reactivation can occure?
2. "At least 90% of all people get genital HPV, some have active infections from time to time thereafter, and probably somewhere around a quarter of all people have genital warts diagnosed at one time or another. All this all adds up to a probable chronic infection unrelated to your recent sexual exposure. "
I'm confused by this, you say 90 percent of all people get genital hpv and then say 25 percent have warts diagnosed at one time or another. Are you saying 90 percent of all people get genital HPV but only 25 percent get diagnosed? Meaning 65% never get their genital hpv diagnosed? Or that 90% of ppl get genital hpv but only 25% get the warts kind of hpv? What would active infections be without warts?
3. "Oral HPV is common, but a lot less than genital. All sexually active people are repeatedly exposoed to HPV if they perform oral sex on their partners. You and your sex partner(s) are no more at risk for oral infection, or its very rare seious outcomes, than anyone else. There would be no point and no need to stop having oral sex (or genital sex) at this time."
If oral HPV is common and can have serious outcomes (you mentioned 10-15k people get throat cancer), why would there be no point in stopping having oral sex? Would we be safer waiting a few years in hopes the virus wears off before starting oral sex again? Would oral HPV cause warts or is it asymptomatic?
4. Can a baby get the virus while in the mother's womb? If so, will they get rid of it over time? I'm worried because I read that HSV is very dangerous to a baby, but it doesn't seem like HPV is a danger, is this true?
5. Is it less likely that I got more than 1 strand of HPV from this exposure due to the 'low risk'? How often does more than 1 strand get transmitted from 1 act of sex?
6. Will a vaccine help my partner from any of the cancerous strands if I already infected her?
7. Based on your opening statements it sounds like what I am experiencing is very normal and my partner and I should move on with life with little worries except with attention to outbreaks? Is this correct? I guess i'm reaching for some relief.
Thanks
Before my follow up questions, I want to clear up some things about my warts.
The first noticeable warts, which just looks like 2-3 small bumps, occurred at the 5 week mark, which prompted my biopsies. By the time I went back to get my results (2 months post exposure), I had my full outbreak with more lesions that the dermatologist suggested looked a lot more like warts and I had to get many frozen off. So while I did get 2-3 small bumps that did end up testing positive for genital warts, my outbreak really occurred closer to 2 months post exposure.
1. "Both things are true: usually cleared by the immune system, but often HPV DNA persists and the infection can reactivate. Sex with any partner at any time carries at least some risk of HPV transmission. That's life."
If I'm only having sex with the same partner for the rest of my life, is less likely that re-transmission and reactivation can occure?
2. "At least 90% of all people get genital HPV, some have active infections from time to time thereafter, and probably somewhere around a quarter of all people have genital warts diagnosed at one time or another. All this all adds up to a probable chronic infection unrelated to your recent sexual exposure. "
I'm confused by this, you say 90 percent of all people get genital hpv and then say 25 percent have warts diagnosed at one time or another. Are you saying 90 percent of all people get genital HPV but only 25 percent get diagnosed? Meaning 65% never get their genital hpv diagnosed? Or that 90% of ppl get genital hpv but only 25% get the warts kind of hpv? What would active infections be without warts?
3. "Oral HPV is common, but a lot less than genital. All sexually active people are repeatedly exposoed to HPV if they perform oral sex on their partners. You and your sex partner(s) are no more at risk for oral infection, or its very rare seious outcomes, than anyone else. There would be no point and no need to stop having oral sex (or genital sex) at this time."
If oral HPV is common and can have serious outcomes (you mentioned 10-15k people get throat cancer), why would there be no point in stopping having oral sex? Would we be safer waiting a few years in hopes the virus wears off before starting oral sex again? Would oral HPV cause warts or is it asymptomatic?
4. Can a baby get the virus while in the mother's womb? If so, will they get rid of it over time? I'm worried because I read that HSV is very dangerous to a baby, but it doesn't seem like HPV is a danger, is this true?
5. Is it less likely that I got more than 1 strand of HPV from this exposure due to the 'low risk'? How often does more than 1 strand get transmitted from 1 act of sex?
6. Will a vaccine help my partner from any of the cancerous strands if I already infected her?
7. Based on your opening statements it sounds like what I am experiencing is very normal and my partner and I should move on with life with little worries except with attention to outbreaks? Is this correct? I guess i'm reaching for some relief.
Thanks
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H. Hunter Handsfield, MD
65 months ago
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1) Yes, permanent mutual monogamy will eliminate the possibility of new HPV infections neither you nor your partner yet has had. It will have no effect on ptoential for reactivation of an existing infection.
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2) Most HPV infections don't cause warts, so overall HPV frequency -- and the proportion of people infected -- is higher for HPV overall than for warts. "Active" is not the same as symptomatic or noticeable. Active infection means the virus is present, detectable with DNA testing, and potentially transmissible.
3) The chance of throat cancer is extremely low; 15K cases per year in a population of 360M is a tiny drop in the bucket. People don't avoid vaginal sex because cervical cancer is a risk. Why avoid oral when the throat cancer risk is even lower? Decisions about sexual practices need not and should not be based primarily on health grounds, but on mutual sexual pleasure and satisfaction.
4) HPV is not transmitted to fetuses in the uterus -- only potentially during vaginal delivery. Same for HSV. Newborn infections are rare for both herpes and HPV. Herpes is by far the more dangerous of the two.
5) As I said above, it is unlikely you acquired HPV during the sexual exposure described above. Assuming you've had several different sex partners in your life, you can safely assume you have been infected with more than one strain (not "strand") of HPV.
6) Since you probably have had one or more HPV infections for months or years, including the high risk type, you can assume your wife has been repeatedly exposed and probably infected. If so, the vaccine won't help her prevent infection. If by chance you were recently infected and by luck your wife has not been infected, the vaccine would prevent it. But all things considered, I doubt the vaccine would help muchs. If I were in your shoes, I would not recommend my wife be vaccinated. But it's something you can discuss with your doctor. If you do, I recommend you print out this thread as a franework for discussion.
7) That's exactly what I recommend: Keep your eye out for recurrence of your penile wart(s), or for other unusual bumps or sores of the penis. But don't be obsessive about it: once a month is plenty often, and no magnifying glass etc. Whatever you don't notice when you urinate or shower doesn't matter. Beyond that, indeed go about your life without any further concern about any of this -- including no change in your sexual practices with your partner.
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64 months ago
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I know you have your doubts, but for these questions, please assume I got the warts from the encounter mentioned in my first post. Also, I have been monogamous for almost 10 years, and have had very little sexual encounters before this one.
This post ended up being longer than I thought, If you would like me to pay for another post I'll gladly do so. Sorry.
1. What are the chances I got more than 1 strain from this encounter? I'm not sure if my low risk means I'm at even lower risk of getting multiple strains in one encounter. My understanding is that warts are not the cancerous strains, so if this is the only strain I got then should I not be worried about cancer?
2. I know women have pap smears to check for cancer, but how/what would men check, especially if the cancer strains are apparently asymptomatic? And how would we check for possible throat cancer? And is this something we need to be checking for the rest of our lives or only for the first 2-3 years while we are likely infected?
3. Are the cancers treatable? I know cervical cancer can be detected and the cancerous part can be removed, but what would they do for penis/scrotum and throat?
4. What are the actual odds of cancer? I know your math for throat cancer led to something like .0004, but what about cervical and penis?
5. What are the chances I did not infect my partner during our one encounter post my encounter (it was 2 weeks later and I did not notice any warts at the time)?
6. How would a woman notice warts? It seems like it would be hard for them to check the area?
7. Any danger in passing the virus through breast feeding a baby?
8. If I was recently infected, and my partner either was or was not, would you recommend me both get vaccinated? What would be the benefit for me to get vaccinated after recent infection?
9. If most people clear the virus after 2-3 years, are those people still at risk for cancer/warts in the future (assuming no more new sex partners/hpv infections, and also assuming, like you said, that re-infection of same strain is not likely)?
11. Is there anything that can be done to help clear the virus?
12. You said oral HPV is common, does that mean it's a certain strain or would it be the same strain as the genital hpv? If so, does that mean my partner would get warts in her mouth? And if we don't have one of the cancerous strains does that mean the oral hpv won't lead to cancer?
12. Can my genital warts be transmitted without an active lesion?
13. What do you tell patients who are as worried as I am? It seems like I am in no different position than millions of people, but yet I have not been able to sleep since getting my diagnoses. I was initially relieved to find out my lesions were warts and not herpes, but now I question which is worse, considering HPV leads to cancer but HSV does not.
Thank you so much for your help and your responses. Again, I know this was lengthy, so if needed I will pay for extra posts.
This post ended up being longer than I thought, If you would like me to pay for another post I'll gladly do so. Sorry.
1. What are the chances I got more than 1 strain from this encounter? I'm not sure if my low risk means I'm at even lower risk of getting multiple strains in one encounter. My understanding is that warts are not the cancerous strains, so if this is the only strain I got then should I not be worried about cancer?
2. I know women have pap smears to check for cancer, but how/what would men check, especially if the cancer strains are apparently asymptomatic? And how would we check for possible throat cancer? And is this something we need to be checking for the rest of our lives or only for the first 2-3 years while we are likely infected?
3. Are the cancers treatable? I know cervical cancer can be detected and the cancerous part can be removed, but what would they do for penis/scrotum and throat?
4. What are the actual odds of cancer? I know your math for throat cancer led to something like .0004, but what about cervical and penis?
5. What are the chances I did not infect my partner during our one encounter post my encounter (it was 2 weeks later and I did not notice any warts at the time)?
6. How would a woman notice warts? It seems like it would be hard for them to check the area?
7. Any danger in passing the virus through breast feeding a baby?
8. If I was recently infected, and my partner either was or was not, would you recommend me both get vaccinated? What would be the benefit for me to get vaccinated after recent infection?
9. If most people clear the virus after 2-3 years, are those people still at risk for cancer/warts in the future (assuming no more new sex partners/hpv infections, and also assuming, like you said, that re-infection of same strain is not likely)?
11. Is there anything that can be done to help clear the virus?
12. You said oral HPV is common, does that mean it's a certain strain or would it be the same strain as the genital hpv? If so, does that mean my partner would get warts in her mouth? And if we don't have one of the cancerous strains does that mean the oral hpv won't lead to cancer?
12. Can my genital warts be transmitted without an active lesion?
13. What do you tell patients who are as worried as I am? It seems like I am in no different position than millions of people, but yet I have not been able to sleep since getting my diagnoses. I was initially relieved to find out my lesions were warts and not herpes, but now I question which is worse, considering HPV leads to cancer but HSV does not.
Thank you so much for your help and your responses. Again, I know this was lengthy, so if needed I will pay for extra posts.
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H. Hunter Handsfield, MD
64 months ago
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You're right -- these (and are too complex for quick answers. Follow-up comment opportunities are offered for the purpose of clarifying the intial response, not for entirely new questions. And I would disourage you from asking them in a new forum question. This is your second thread, and repeated question on the same topic are against forum policy, especially when anxiety driven as yours obviously have been. Repeated anxiety driven questions are at risk of being deleted without reply and withour refund of the posting fee. Even more important, all your questions can be answered more effectively by reading readily available resources, which go into more detail than is fesaible with the brevity required on this or most other online forums. To repeat the first part of my reply above, good ones include "...the sponsor of this forum, the Amercian Sexual Health Association www.ashasexualhealth.org and look for links and topics. (The HPV section includes a video I recorded a few years ago, but still mostly accurate.) And the US Centers for Disease Control and Prevention (www.cdc.gov/std)."
I hope this and your previous discussion have been hellpufl. Thanks for your understanding.
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