[Question #7188] HPV/Genital Warts
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60 months ago
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Hello! I'm a 20-year old female and in February of this year I was diagnosed with genital warts. They cleared up with a TCA treatment and Aldara by the middle of March, so my question is in the next couple of weeks when I hit the 6-month mark of no warts, can I consider myself clear? I've heard a lot about people having recurrences after that period, so I'm not sure if I should wait longer. Also, what is meant by HPV clearance? Is it gone from the body, or does it lay dormant and wait to reactivate? Once I hit the 6-month mark, what is your advice on disclosure? I've been seeing someone for a couple of months, but we haven't had sex or oral. How would you go about starting that conversation?
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H. Hunter Handsfield, MD
60 months ago
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Welcome to the forum. Thanks for your conridence in our services. Apologies for the somewhat longer than usual delay in responding.
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I'm glad to hear your warts cleared up promptly. Six months probably is a pretty good estimate for assuming you're in the clear. It's highly variable, though: some people have recurrent warts a year later or even longer. But 6 months without reappearance is what I have long advised my patients as indicating they can safely have sex with new partner without disclosure of their past infection. This isn't sollid, however: transmissible infection can persist longer. Indeed, at a biological level, many (most? maybe all?) HPV infections are lifelong -- that is DNA persists and infection can reactivate even decades later. However, most such persons nevertheless are cured for all practical purposes: reactivation and future transmission are the exception, not the rule.
That said, there are two aspects to disclosure about past STDs. First is directly related to transmission: Will I be putting my partner at risk? Wouldn't he want to know? The second is more a relationship/commitment issue. When a relationship has promise for the long run, couples often discuss their past sexual lifestyles including past STDs (even those entirely cured with no chance of future transmission, e.g. treated chlamydia or gonorrhea) -- as an aspect of establishing commitment and communication. Another factor to consider is this: if your HPV does reactivate, what would be your partner's reaction to hearing about it at that time -- either because you are re-diagnosed or because he develops warts -- and not having been told ahead of time? On the other hand, all this may be a lot less important for an expected brief, non-committed relationship.
Another aspect about HPV in particular is that almost all your current or potential partenrs will have otherwise been exposed int he past and will be exposed again in the future. At least 90% of all people get genital HPV at least once, and at any point in time, up to half have detectable HPV infections. This is one reason that disclosure is less important than it otherwise might be. Sex with someone with a known past infection generally carries no higher risk of HPV than sex with anyone else. All things considered, I don't think most past HPV infections require disclosure from an infection prevention standpoint. The relationship rationale makes more sense to me. (Speaking personally and not professionally, if were much younger and still in the dating scene and had a known past HPV inection, I would discuss it with a potentially committed partner but usually not with hookup partners or other brief relationships.)
Finally, presumably you have not been vaccinated against HPV. If not, you should consider it. While it won't protect you very much against new warts, it will prevent infection with the most common types that have the potential to cause cervical and other cancers.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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60 months ago
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No worries! I appreciate the response, so when they say HPV is clear, they just mean it's undetectable? Is this the case even in those who didn't show symptoms? I wish that was clarified more. There's a lot of conflicting information online with most sounding like it's eradicated from the body so it's nice to get an expert's perspective. Is there a reason why they say it clears rather than it stays in the body? Maybe it's because I'm not a doctor that I interpreted it that way.
Yeah that's exactly what I was thinking. Everyone told me that I didn't need to disclose, but if for some reason the warts come back, I don't want him to think I cheated or lied to him. Do you have any tips or key information I should say during disclosure to lessen their worry?
Yes! I plan on getting it soon. Someone told me that I should get a low-risk HPV test to see if the virus is gone (the only one I found was on SelfCollect and they have paused services), but based on your response it sounds like that'd be really unnecessary especially since there's not even an FDA approved one.
Is there any way to reduce the risk of reactivation? Also, should I have used the full 8-weeks of Aldara? I still have a few left over. I stopped applying about a month after the warts went away. Should I start applying it again to finish it, or do I just hold onto it in case a new wart pops up?
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H. Hunter Handsfield, MD
60 months ago
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The distinction between cleared, cured, undetectable (but persistent), and so on often is semantic only. I often tell patients, and say in this forum, that if HPV is undetectable and remains that way for a few months, it can be considered cured "for all practical purposes" or with similar obfuscation. We really don't know what proportion of patients continue to have undetectable DNA, with expert estimates ranging from "always" to "well under half". Also, it used to be believed that people were immune to new infections with HPV types they already had, and therefore that re-detection always meant reactivation of prior infection. However, it's now known that new infection with previous types occurs at least some of the time -- so distinguishing between reactivation of an old infection or a new infection entirely is usally not possible. For those reasons (and others), much of the conflicting information online and even between qualified experts is because the data are unclear, and everyone brings they preconceived beliefs to the table. On top of which, a lot of people -- especially online -- just don't know the facts. But anybody can post whatever they like on the internet. I wish it weren't the Wild West out there, but in many ways it is!
It sounds like you've got a level headed, common sense perspective on disclosure. We seem to be on the same page. As to how to start a conversation, unfortunately one size definitely doesn't fit all. I think I would usually start with a general statement like "What do you know about HPV?" The tone and style after that can then be taylored to the reply, which probably would be different for someone who reacts in horror versus the majority who start out with "It's no big deal" -- with all sorts of reactions in between those extremes.
You can aassume you've been infected with some of the 9 HPV types prevented by the vaccine, but the vaccine isn't harmful in that case. So there's really no need to know, and HPV testing is not recommended by any expert to guide vaccination. I'd advise you not to waste your money.
Most people sto imiquimod (Aldara) sooner than you did. I'm unwaware of any data showing a need to take the full 8 weeks if warts are gone well before that time. Unfortunately, there's no known way to alter the potential for reactivation. The closest we can come is smoking, which is associated with higher risk of progression to dysplasia or cancer, and maybe -- only maybe -- with a slight increase in reactivation. So don't smoke. Otherwise, the best you can do is to maintain a generally healthy lifestyle (balanced diet, exercise, adequate sleep, etc) and hope for the best.
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60 months ago
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Wow, I was under the impression that you were immune to a specific type of HPV once you contracted it, but that's really good to know. Ahaha yeah. It's really crazy how common and prevalent HPV is, but there's just so much uncertainty about it. My school didn't even teach sex-ed, so I had never heard of HPV, only the basics like HV, herpes, gonorrhea, etc.
Thanks! I'll be sure to keep that in mind and hope that they've been vaccinated or are at least open to it.
Luckily I have a pretty healthy lifestyle, so I'm hoping that reactivation doesn't occur or at least not frequently. I guess for my last couple questions for this thread, I'll just write them as I have them in my notes.
- What's the risk of transmission like when using a condom once the warts have been gone for awhile? I know when the warts are present the viral load is really high and once they're gone the virus can still be present, but I'm just wondering if there was a general percentage for it.
- Would you recommend a dental dam for oral? I don't know much about genital-to-oral warts nor the typical transmission rate, but if it'll help keep my partners safer, I'll learn how to use one.
- How come so many people get HPV but so little actually get symptoms of it?
- Is there any way to tell whether the infection is active or dormant besides the physical manifestation of warts or lesions?
Those are the last questions I have. I really appreciate your detailed responses and the time you took to answer questions about this really confusing virus. Thank you so much. This thread has educated me a lot on what I have.
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H. Hunter Handsfield, MD
60 months ago
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To clarify your opening statement and my own: Probably there is substantial immune resistance to reinfection with the same type -- but short of the complete immunity once believed. Redetection of the same type probably usually means reactivation, but not always.
1. Male condoms aren't very good at preventing HPV because they allow substantial skin contact above the condom. For any one sexual exposure, they reduce HPV risk by maybe 60-80%, but consistent condom users overall are just as likely as non-users to catch and carry HPV.
2. Oral HPV is too infrequent, and when present too unlikely to cause disease, to warrant dental dams for oral sex -- my opinion for sure, and agreed by most if not all experts.
3. HPV is really no different than most human infections. For every person with strep throat, a hundred others are infected and don't develop symtoms. Same for staph on our skin. And as the world has been learning in the last 6 months, asymtomatic COVID-19 is more common than those who get sick. There is a wide spectrum, however, from >90% asymptomatic (like HPV) to almost no asymptomatic cases (e.g. ebola) or none at all (rabies).
4. A visible wart or other lesion, or cervical dysplasia, is an active infection, by definition. In absence of symptoms a positve DNA test implies the infection is probably active and transmissible. If no symptoms and no DNA, it's probably inaciive, but not necessarily.
That completes the two follow-up exchanges included with each question and so ends this thread. There are excellent online if you remain interested in more information on HPV. Two good options are the sponsor of thie forum, www.ashasexualhealth.org and www.cdc.gov/std. Best wishes and stay safe.
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