[Question #71] In a heterosexual relationship, chances of HPV transmission from woman to man

112 months ago

H. Hunter Handsfield, MD

112 months ago

Presumably a question is coming, beyond the title? Anyway, welcome to Ask the Expert. I was logged in to the forum when this came in; most users shouldn't expect nearly real-time replies!

Based on the title: Almost everybody gets a genital HPV infection, often more than one. It's more or less a routine, expected, unavoidable consequence of being a sexually active human being, except in the unsual circumstance of a mutually monogamous couple in which neither person has ever had (and never will have) sex with anyone else. Among non-virgins age 15-30, 20-50% of people are carrying genital HPV, so avoiding sex with a potentially infected partner is pretty much hopeless. Condoms help, but only about a 50% reduction in risk of HPV -- better than nothing, and condoms should always be used for any vaginal or anal sex with a new partner or a partner at high risk. But even consistent condom users can expect to get genital HPV.

All this is why all women need to follow standard pap smear recommendations, regardless of apparent risk for HPV or other STD; and why all young persons should be vaccinated against HPV, preferably as kids (age 9-12) or at least before first sex. If you are under age 26 and haven't been vaccinated against HPV, you should do it. Vaccination won't prevent all HPV infections, but it is 100% protective against the HPV strains covered by the vaccine, which cause the vast majority of important health consequence of HPV. Happily, though, the large majority of HPV infections -- even with the high risk types that can cause cervical and other cancers -- are harmless and cleared up by the immune system, without the infected person usually even knowing they ever had it.

Finally, in case you're asking about the risk for any single sexual exposure: that's much harder to answer. But it's probably quite high. I would guess that if a woman has a known, active genital HPV infection (such as untreated genital warts or a recent pap smear with a positive HPV result), around 50% for each episode of unprotected vaginal intercourse -- assuming the male hasn't previously been infected with the same HPV type. (He is immune if previously infected with the same type.)

Let me know if you need more information. Best wishes and stay safe; get vaccinated; then don't lose sleep over HPV.

Best wishes and stay safe-- HHH, MD

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H. Hunter Handsfield, MD

112 months ago

One more thought -- trying to interpret why you asked the question: If you are the regular partner of a woman who has had an HPV diagnosis (e.g., abnormal pap smear), you can assume you have been infected and may still have it; or had it and your immune system cleared it up. Depending on circumstances, you may be the source of her infection, whether or not you ever had symptoms to suggest HPV. But you needn't do anything at this time. CDC and other experts recommend there is no need for such partners to even see a doctor. Just get checked if you notice any new warts or wart-like bumps in the genital area. Probably this won't happen. And if and when you have other sex partners in the future, you need not mention your current partner's HPV infection, assuming you don't have warts or other symptoms yourself.---

112 months ago

Dr. Handsfield: I am responding to your question #71. First, thank you! Second, here are more details about the situation. I am in a heterosexual relationship. The woman and I are both over 70. WebMD says (with only vague documentation that is impossible to track down) that HPV strains that can cause cervical cancer in the woman are "usually" not transmitted to the man. In a separate document the CDC lists these strains. The analysis of my partner's latest PAP smear shows which strains she has, and they are all potential causes of cervical cancer. Ironically, this is good news for me if I cast my lot with WebMD's "usually" reassurance. However, the vagueness of this word troubles us. As a result, my partner and I have been cautious so far. Do you think continued caution is called for, or should we assume that "usually" means something like "nearly always" and stop worrying about HPV transmission from her to me?

This is a great service. Thank you!

H. Hunter Handsfield, MD

112 months ago

Thanks for clarifying. My last comment pretty much answers this question; please re-read it.

For more context: Whatever you found on WebMD is wrong, or you misinterpreated it. Sex partners often share the same HPV infection. Maybe what the writer meant is that few male partners develop any visible health problems from their partners' HPV infections. (Why was your partner tested for HPV anyway? She is far beyond the age for routine pap smears.)

Assuming you've had several different partners in your life, it's virtually certain you have had HPV, most likely more than once. And since the most common HPV types are, well, the most common, there's a good chance you've previously been infected with whatever types your partner now has. (Almost certainly she has delayed reactivation, not a new HPV infection.) If so, you are immune to catching it again. And even if you were to be infected now, probably it would never cause disease of any kind. Even the highest risk HPV types uncommonly actually cause cancer, and then only after many years. Sorry to remind you of a fact of life, but at your age, it's unlikely you'll survive long enough to have any kind of serious HPV problem!

You are fortunate to have a loving relationship (apparently a new one) at your age. For goodness' sake, don't let such a trivial problem like HPV interfere with romance, love, and rewarding sex. You should abandon whatever "cautions" you now are pursuing. Your partner's HPV does not imply any limitation on what you can do sexually, as long as it gives you mutual enjoyment.

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