[Question #7527] Genital wart exposure

3 months ago

I know there is no definitive answer, but in your professional opinion how likely is it that a 52-year old man with over 10 partners has been exposed to genital warts?  I’m confused by the fact that HPV is so common that everyone sexually active has it; but only 1% has visible genital warts.  Is that because the strain that causes genital warts is rare?  Or, is that because despite the fact that most people have been exposed to that particular strain and even though warts are highly contagious, warts rarely develop?  Five months ago I’m certain I was exposed to genital warts. I’ve developed a small white spot on my vulva and at this time, my OB/GYN cannot definitely say it’s a wart.  She said not to worry and since that time, I had a single encounter of unprotected sex.  Now I’m concerned that I may have passed the virus on.  I am sick with grief over it.  How likely is it that he has already been exposed before me and assuming for arguments sake that he hasn’t been exposed to the wart strain, is he likely to get it from me with that one exposure?  I'm not even sure I have it, just assuming I do.  Again, I realize there is no definitive answer.  I'm only looking for likelihood. Thank you.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome to the forum. Reasonable questions -- I hope you find my reply to be so as well.

There are over 110 differnt genital HPV types, of which around 15 are the most common. Two closely related types, HPV 6 and 11, are among the 15 common ones and cause around 90% of genital warts. I'm not familiar with the 1% statistic you cite, but it seems a reasonable guesstimate of the proportion of sexually active people who have visible genital warts at any pint in time. Probably around 50-70% of HPV 6/11 infections result in visible warts.

Warts (and HPV infections in general) are most common in people roughly age 20-40. If 1% is an average prevalence, I would expect it to be quite a bit lower at age 52. However, even up to age 60 or higher, as many as 20% to 50% of people have detectable genital HPV of one type or another. The proportion of these are transmissible to sex partners is lower. You don't say your own age, but assuming you're on the mature side -- in view of your recent partner's age -- and also assuming you'ave had an average sex life, with at least a handful of partners over the years, undoubtedly you have been infected yourself and might still be. You are immune -- or at least highly resistant -- to any of the HPV types which you're already had. So considering both your own likely resistance to some HPV types and the modest chance your 52 year old partner had active infection, the probability that you acquired a new HPV infection from that single exposure is quite low. And the chance of a transmissible wart-causing infection lower still, probably miniscule. It's really quite rare for people to develop new genital warts beyond age 40 or so.

All that said, maybe you've had more than one partner? Is the 52 year old fellow the same one to whom you were exposed 5 months ago? And do you have reason to believe he had active warts at the time? If so, it would elevate your risk of warts -- but perhaps not by very much. A "white spot" on the vulva could be a wart; or even a pre-cancerous lesion. But neither one of these need be from your most recent exposure. HPV often reactivates, and if this is HPV at all, it could be from an infection you acquired years ago. At your age (guessing, once again), most newly diagnosed HPV infections are reactivations of old ones, not newly acquired.

Finally, for all those reasons, fear of transmitting HPV really shouldn't be a concern. You can safely assume that any person with whom you have sex has already been infected, may be immune to the type(s) you may have, and his risk for any important health problem from any single exposure is near zero -- as it is for you.

Getting, having, and transmitting HPV are normal consequences of having sex at all. And the vast majority of infections cause no significant health problem and remain asymptomatic. Younger persons should be immunized to prevent infection with the two wart-causing types and 7 other types that together cause nearly 90% of genital, anal and throat cancers (the HPV vaccine is one of the most effective vaccines ever developed -- even better than the two available COVID vaccines, which are having so much media attention). But few people beyond early middle age can benefit from vaccination.

I think those comments address all your questions. But let me know if I missed anything on your mind, or if any of this needs clarification.

HHH, MD
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3 months ago
Thank you for your response.  To clarify, are you saying that by age 50 with over 10+ partners a person is likely to have already been exposed and become immune to genital warts?  Are you also saying that a single encounter is unlikely to pass genital warts even if one is present?  And, finally at age 50 how likely is a healthy person to clear genital warts? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
"To clarify, are you saying that by age 50 with over 10+ partners a person is likely to have already been exposed and become immune to genital warts?" Correct.

"Are you also saying....?" I didn't say that. Having detectable HPV DNA doesn't necessarily mean a transmissible infection is present. If an overt, visible wart is present, transmission is likely, even with a single exposure.

"...at age 50 how likely is a healthy person to clear genital warts?" The large majority of genital warts clear up on their own, although treatment speeds it up. There are no known differences in younger versus older persons.
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