[Question #7323] HPV Incubation Time and Exposure

4 months ago
I have a question about HPV incubation time. A few months ago, I noticed a wart at the tip of the penis (an area always covered by a condom). I had that removed. A few days later I found a few additional reddish looking spots near the bottom of the penis, but the doctor and the dermatologist said they were not warts (doc said fungal infection, derm said follucilitis). They both looked at it without a microscope. I asked the derm to freeze them off anyway. Now, I seem to be having a recurrence at the top of the penis near the original spot (very small bumps that are hard to see without a light but which are definitely there and which I am freezing off). 

Exactly six weeks (minus half a day) before I noticed (or paid attention to) the first spot at the tip of the penis, I had protected oral and vaginal sex with a CSW. There was no oral or vaginal contact without a condom. (I vaguely remember seeing the bump at the tip of my penis before the six weeks, but my memory is hazy and I am not sure about that.) Around 3-4 weeks before noticing the initial bump, I had protected sex three times with a Tinder girl and a very brief unprotected oral sexual encounter with her. My question is: Is it at all possible that I got this wart from my protected encounter with the CSW six weeks prior? How likely is it that it would show up in an area totally protected by a condom? Or is it more likely that I had it beforehand? 

Reason why this is important: I am now back with the girl I was with 4 months before I first noticed the wart. Last time I had protected sex with her multiple times and one unprotected oral sexual encounter (blowjob).  This time, I have not yet had sex with her and probably won't as I don't want to expose her to anything or cause her to have mental anguish like I did. However, is it probable that I had it already last time I was with her and she was already exposed? If so, what would be your advice regarding having safe sex with her?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Welcome. Thanks for your confidence in our services.

You don't say if the diagnosis was professionally diagnosed, but if you indeed had a wart in that location, the underlying HPV infection almost certainly was acquired more than 6 weeks previously. Warts typically appear 2-6 months after exposure; 6 weeks is about the earliest possible. That the CSW event was condom protected also makes it very unlikely you acquired HPV in that location. Assuming this was a wart, however, you should have advised your Tinder partner:  HPV probably remains transmissible for at least a few weeks after successful treatment of genital warts.

As for your more recent spots, almost certainly they aren't warts:  an experienced clinician, especially a dermatologist, is unlikely to misdiagnose a wart as folliculitis. I trust you're not self treating these things with freezing yourself -- presumably not, since it is unlikely you have the necessary equipment, assuming you're not a health professional yourself.

Considering the available information, your partner from 4 months ago would seem to be a likely source of your wart. If she indeed was the source, there's no reason not to resume unprotected sex with her:  she has already been exposed, likely infected, and won't re-catch the same HPV strain she already has. In addition, you won't re-catch it from her:  by now your immune system probably would protect you from the strain(s) you already have had. On the other hand, there are no guarantees here. It is rarely possible to know when and from whom any particular HPV iinfection was acquired. My advice is that you and she have a conversation about all this:  you may mutually deccide to resume  your sexual relationship. Remember that at any point in time, 30-50% of healthy, younger (age 15-30) sexually active people have active transmissible HPV infections, and resuming sex witn your previous partner probably is more risky (in regard to HPV) than any other partner you might choose.

Finally, consider HPV immunization if you haven't been vaccinate. Same for your partner. It will protect you from any of the 9 HPV types covered by the vaccine, not couting any of the types you have already had.

I hope these comments are helpful. Let me know if anything isnt' clear.

HHH, MD
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4 months ago
Thanks for the quick reply. 

Yes, I'm having these removed in a professional setting. I'm also getting vaccinated. 

Some followup questions: 

1) As for the girl from 4 months prior to the wart appearing, who I am back with again, I actually never had unprotected VAGINAL sex with her. I always used a condom with her for vaginal sex. If we do resume having sex, it will again be always with a condom. (This isn't just for sexual health but also for birth control reasons.) I only had unprotected ORAL sex with her once. I'm not sure if this changes your advice or makes her a less likely source of the infection? 

2) The last time I had unprotected VAGINAL sex was around a year and a half before noticing the wart. I actually had unprotected vaginal sex with only one person in my life (the first girl I dated).  I stopped having unprotected vaginal sex roughly a year and a half before I first noticed the wart. However, I have had  unprotected ORAL sex various time after that, including encounters with two or maybe three girls in the six months prior to the wart appearing, not only the girl from 4 months prior to the wart appearing but another girl a month or two before I met her.  Obviously there are no absolutes here and it's impossible to know where I got it from. Is it more likely that I got it from an oral sexual encounter, since it is on an area always covered by a condom and I haven't had condomless vaginal sex for a year and a half? How common is oral transmission of HPV?  

3) Could it be that I got it from that first girl I dated, the only girl I had unprotected vaginal sex with? A year and a half seems like a long time, unless it was there for a while and I just never paid attention to it because it was so small. 

4) If the girl I am with now gets vaccinated, how soon after her getting the vaccine should we wait until having sex again, assuming we are relying on the vaccine to protect her? In other words, how soon does it take for the vaccine to be effective for her. 

5) Assuming I am having a recurrence, do most people get only one recurrence and then it goes away, or do most people who have a recurrence get only one recurrence? 

Thanks again for your understanding! 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
1) First, it's great you've both been vaccinated. Using a condom will only slightly reduce the risk of sharing HPV with your partner. (Condoms are no more than 70% effective against for any one vaginal sex exposure. After 10+ exposures, the risk of HPV is about the same in people who always or never use condoms.) If I were in your situation, with both having been vaccinated, I wouldn't feel a need for condom use (assuming other STDs also aren't likely). I also think you needn't be concerned about unprotected oral sex.

2) Well over 90% of genital HPV infections are acquired by genital/anal sex; oral acquistion is less common. Even with consistent condoms use, it's more likely you acquired your penile infection by vaginal sex, not oral.

3) Again, you're over-emphasizing your sexual exposues that were or were not condom protected. Your consistent condom use over the years has been wise, but the main beneift is protection against STDs other than HPV. A\s I said above, it is rarely possible to even make an educated guess about when and from whom HPV was acquired. I see no basis for your to assume acquisition from your first or any other particular partner. And at this point, I don't see that it matter. 

4) If I were you, I would not delay sex at all. But if you choose to further lower the chance of infection, you can assume the vaccine is protective starting about 2-3 weeks after the second dose.

5) I would not assume you are having an HPV recurrence. It doesn't sound like it. OTOH, having been treated only a few weeks ago, you may still have an active infection -- whether or not you have visible warts. However, this is a personal choice. As I advised above, discuss it with your partner -- but be sirue you have accurate facts and information and get beyond the emotional aspects that seem to be dominating your cvurrent thinking.

Get used to it:  getting and having genital HPV is a normal, expected, unavoidable fact of life. We all are colonized with innumerable bacteria and viruses. HPV is among them. Happily, the large majority of infections cause no health problems -- even more the case in those who have been vaccinated.
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