[Question #6795] Genital Warts and other strains
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65 months ago
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Hello Doctors,
My girlfriend and I lost our virginities together a few years ago and I made the terrible mistake of cheating on her with a prostitute recently. I was naive enough to think I couldn't get an STD because of condom use, but little did I know about HPV. About 2 months after exposure I got genital warts. I confessed to my girlfriend and she forgave me, but now doing all the research I see there are cancerous versions of HPV. I know genital warts are not the cancerous strains but I am concerned.
1. I know from reading other posts and replies that a single time exposure to HPV with a condom is very unlikely to lead to infection, but obviously I was not so lucky. With this supposed low risk, am I at lower risk of getting the cancerous strains (along with the warts i got)? Has there been any studies done on chances of acquiring more than 1 strain from 1 condom protected sex act? I supposed in my case specifically a wart strain + a cancerous strain
2. After a week after this exposure I stupidly thought I was clean since I didn't have any bumps and I had sex with my girlfriend. It's been 2 months since this happened and we haven't had sex since and she saw her obg yesterday and he confirmed she did not have any warts. What is the possibility I did not infect her from that 1 exposure (from either warts or another strain I may have got)?
3. I mentioned that she should get vaccinated just in case i did not infect her. She said okay but she really does not want to wait long to have sex again and I see that the vaccination takes 6 months. Can we start having sex again after the first shot? I read some reports that we should be safe 2 weeks after first shot, any truth to this?
4. My warts were frozen off, and 1 month later I do not have any reaccurance, can I assume I beat the virus after 2 months of no reaccurance or should i wait longer?
5. Would a females HPV test show us if she got the genital warts strain from me or would it only show cancerous strains?
Thank you!!
Thank you!!
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H. Hunter Handsfield, MD
65 months ago
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Welcome to the forum and thanks for your confidence in our services. Apologies for the longer than usual delay in this reply.
My main initial response is to reassure you that serious health outcomes from HPV are uncommon; the large majority of infections cause no meaningful health issues. Genital warts are an unpleasant inconvenience, but should not be viewed any more seriously than that. It is usually not possible to be confident of the source of any particular HPV infection, and two months is sooner than usual for appearance of warts. Exactly where in the genital area did they occur? If above the condom coverage of your penis, your recent sex worker encounter could be the source. If on the head or shaft of the penis, probably not. If before first sex with your girlfriend you had other sexual exposures without penetration, your HPV infection could go back longer. And assuming your GF also had non-pentrating sex, she also could have acquired HPV herself and is the source of your warts. It's good to here her gyn exam didn't reveal anything, but in itself does not mean she doesn't have HPV. Most infections cause no visible abnormality and no abnormal pap smear.
It would also be helpful to know more about the time frames here. i.e more detail than "a few years ago". When did your relationship with your girlfriend begin. How old are the two of you? Also looking forward to knowing the exact location of your warts.
To your questions:
1. Unfortunately, there are no data to inform this question. The high risk (potentially cancer causing) HPV types are among the most common, but they are not believed to be any more transmissible than other types, including HPV6 and 11, the main causes of genital warts.
2. As implied above, there's a good chance you (and your gf) have been sharing your HPV infection for some period of time. The chance of transmission during any single exposure probably is low, but not zero. But as noted above, it is possible you have both been infected before your recent outside encoutner.
3. You are correct: your partner should be vaccinated against HPV. So should you. I do not recommend the two of you hold off sex. It's smarter to assume the two of you already are mutually exposed and infected. That said, if you are confident in the long term, mutually monogamous nature of your relationship, I agree HPV immunization is optional. OTOH, it can't hurt, and will protect both of you from future genital cancers. Also, there may be some protection from recurrence of existing infection. Although not designed to prevent recurrence, studies show the vaccine probably reduces that risk.
4. Genital warts are like the proverbial iceberg: your HPV infection probably was (and maybe still is) more widespread on your penis than the visible warts. As a rule of thumb, in my STD clinic we advice patients that after 6 months without recurrence or development of new warts, the infection probably is gone and non transmissible. It's probably gone sooner in many, but longer in others. However, as suggested above, in monogamous couples it makes most sense to continue normal sexual practices as if nothing happened.
5. The standard DNA testing done in women along with pap smears detects several of the most common HPV types, including the two common wart causing types. However, a negative HV test dosn't prove she isn't infected. There are >100 types of HPV that commonly infect the genital area, and only10-12 of them are tested. And even with those types, a single test doesn't ncessarily detects all infections.
An important bottom line is that you and your gf should view genital HPV as a normal, expected, and for the most part unavoidable consequence of being sexually active. Appearance of infection in genuinely monogamous couples is not rare -- we don't know why this sometimes happens. The important thing is not to attempt to entirely avoid HPV, which usually is impossible, or to worry about the health impact. Get vaccinated, mostly to reduce cancer risk; and women should follow standard pap smear recommendations (including women who have never been at obvious risk). With those approaches, HPV should not be a cause of concern.
I hope these comments are helpful. Let me know if anything isn't clear. Apologies again for the delayed reply.
HHH, MD
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65 months ago
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The warts appeared on my shaft, maybe about 5, and balls around 3. I also found it weird because your posts seem to suggest the warts should have appeared on the area I got the virus so I'm not sure how it could be on the shaft or balls (I don't think there was any contact with the balls). The condom may have not covered my entire shaft but it probably covered at least most of it, and the warts are not close to the base so I'm not sure how they showed up where they did. The only thing I can think of is I didn't really clean up after as I was so disgusted and ran home as quick as I can to shower, so maybe when my penis shriveled up the entire area got infected, or when I showered I spread it.
We have been together for 10 years, and the only thing either of us did before we got together was get and received oral.
She is 27 and I am 30.
In one of your responses you mention that getting the vaccine can help prevent future genital cancers, even if we stay monogamous from here on out. If we aren't going to be infected with new strains, how would the vaccine help with genital cancers?
If my genitals and my girlfriends genitals are infected with HPV 16, but we don't perform oral until after getting the vaccine can we still get infected with HPV 16 orally?
We'd obviously try to stay away from oral sex during a wart outbreak, but would getting the actual virus (6 or 11) orally be any cause for concern?
I know your assumption is we are likely both infected, but if I didn't infect her already, would the first round of vaccine shots be enough to start having sex again without worry of infection?
We have been together for 10 years, and the only thing either of us did before we got together was get and received oral.
She is 27 and I am 30.
In one of your responses you mention that getting the vaccine can help prevent future genital cancers, even if we stay monogamous from here on out. If we aren't going to be infected with new strains, how would the vaccine help with genital cancers?
If my genitals and my girlfriends genitals are infected with HPV 16, but we don't perform oral until after getting the vaccine can we still get infected with HPV 16 orally?
We'd obviously try to stay away from oral sex during a wart outbreak, but would getting the actual virus (6 or 11) orally be any cause for concern?
I know your assumption is we are likely both infected, but if I didn't infect her already, would the first round of vaccine shots be enough to start having sex again without worry of infection?
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H. Hunter Handsfield, MD
65 months ago
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Thanks for the clarifications. "Not close to the based...not sure how they showed up" supports my suspicion you did not acquire the HPV causing your warts during your exposure 2 months ago but sometime in the more distant past. HPV can be transmitted and acquired by oral sex, so this fits with your past sexual history. It also fits with your partner's normal exam: she probably has been repeatedly exposed to and infected with the HPV causing your warts and could even be the source your infection, and/or now immune to it.
You misunderstood my vaccine comment. It reliably prevents new HPV infection, and hence any cancers those new infections may cause. It may somewhat reduce the frequency of reappearance of inactive HPV, but there is no evidence one way or the other on preventing cancer due to previously acquired infection. All things considered, if you and your partner are confident in the longevity of your relationship with no other sex partners, I agree vaccination isn't necessary or worth the cost.
Don't worry or obsess about HPV16. First, if either of you has it, it's not from your recent exposure. Second, the large majority of HPV16 infections do not progress to cancer, oral or elsewhere. You and your wife have absolutely no cause to alter your sexual practices at this time in any way. There is no need to forego oral sex at this time; that would not alter whatever small risk now exists for either of you, either for warts or cancer, oral or genital. Whatever sexual practices give you mutual pleasure are fair game!
New HPV in monogamous couples occurs all the time. You guys are in no different circumstances than hundreds of thousands if not millions of couples. Usually the origins remain mysterious, and usually no serious health problems result. Don't let this upset your sexual and romantic apple carts. LIfe is too short!
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65 months ago
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Thank you for your response. Your response here and another recent post in this forum has allowed me to sleep better at night.
Would you say the warts appearing the covered area means there is no chance I got it from this encounter or just unlikely? Because my Dermatologist told me it was perfectly normal to show up in the condom covered area. Also, if we both had the infection for years, wouldn't 1 of have had warts by now? And wouldn't she have had at least 1 abnormal pap? Though I will say, the warts came out at a time where I had the most anxiety and depression ever due to what I did (which I read can lower your immune system and bring out the warts).
I wonder if you have ever heard of anything like this. A week before I discovered the warts I had about 3 nights where my penis felt like it was on fire, and then a few days of my scrotum feeling swollen. I still occasionally get some weird feelings in my genitals but I suspect that's more due to anxiety. But those few nights I was in a lot of pain which led me to all the std screenings and UTI + extra screenings my urologist did which all came back negative. I couldn't find any information about this being normal with warts or HPV in general, and I wonder if perhaps I had some other sort of infection going on that either caused the warts or at least brought out the warts (they were confirmed warts via biopsy).
It's scary knowing I could have had this virus for a long time and it's just hanging around waiting for my immune system to die in order to show itself. I hope I don't have any other strain and I hope I didn't get any from this recent encounter. I'll continue on with my life as normal, though I dread the day my girlfriend comes back with an abnormal pap and the possible procedures that come with it.
Thank you for your encouragement and your responses.
Would you say the warts appearing the covered area means there is no chance I got it from this encounter or just unlikely? Because my Dermatologist told me it was perfectly normal to show up in the condom covered area. Also, if we both had the infection for years, wouldn't 1 of have had warts by now? And wouldn't she have had at least 1 abnormal pap? Though I will say, the warts came out at a time where I had the most anxiety and depression ever due to what I did (which I read can lower your immune system and bring out the warts).
I wonder if you have ever heard of anything like this. A week before I discovered the warts I had about 3 nights where my penis felt like it was on fire, and then a few days of my scrotum feeling swollen. I still occasionally get some weird feelings in my genitals but I suspect that's more due to anxiety. But those few nights I was in a lot of pain which led me to all the std screenings and UTI + extra screenings my urologist did which all came back negative. I couldn't find any information about this being normal with warts or HPV in general, and I wonder if perhaps I had some other sort of infection going on that either caused the warts or at least brought out the warts (they were confirmed warts via biopsy).
It's scary knowing I could have had this virus for a long time and it's just hanging around waiting for my immune system to die in order to show itself. I hope I don't have any other strain and I hope I didn't get any from this recent encounter. I'll continue on with my life as normal, though I dread the day my girlfriend comes back with an abnormal pap and the possible procedures that come with it.
Thank you for your encouragement and your responses.
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H. Hunter Handsfield, MD
65 months ago
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Dermatologists in general are experts in diagnosing and manageing warts, but not necessarily in their knowledge of HPV epidemiology, transmission, etc. I still consider that the location and appearance of warts only 2 months after a new partnership increase the probability that your HPV infection was acquired previously. (Usually it takes much longer for warts to appear, often up to a year. Most likely you have had recurrence of an infection acquired a long time ago, maybe years or decades. There are often gaps of many years between wart recurrences. Recurrent warts usually do not reflect any known or diagnosable immune abnormality, and no evidence of more frequent HPV reactivation in people with stress, anxiety or depression. If these have any such effect, it probably is minor.
HPV doesn't cause the genital sensations you describe and no other infections seem likely either. As you suspect yourself, anxiety or other psychological explanation seems more likely. (And whenever someone suspects their own symptoms have a psychological origin, usually s/he is correct.) Localized infections or inflammation of the penis conceivably could trigger reactivation of HPV, but here too there are no data that document such an effect. That said, it may be common for anxious persons with genital symptoms to notice warts that otherwise might not have been so apparent.
It should not be at all "scary" knowing you may have had the virus a long time. Amost all humans are carrying genital HPV silently, with chance of later reactivation. Having genital HPV is a normal, expected, unavoidable consequence of being sexual. And if your gf ever develops an abnormal pap, it won't necessarily be from your current HPV infection, or even from you.That's why paps are necessary for all women, not only those with known exposure to HPV.
That concludes 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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