[Question #7655] Genital warts, HPV-16 and re-exposure

54 months ago

Hi doctors. Hope you are doing well.

About 7 months ago I got two little warts frozen from my groin and my penis. As you can see from my previous interactions in this forum, this happened after having problems with warts in some other parts of my body, so it wasn't clear this was genetic warts or not.Before I had the warts removed, I had a single episode of unprotected sex with a female friend of mine. At that time I had the wart in the groin, but I obviously didn't know it was a wart. After getting the warts removed 7 months ago, they never returned nor came back.

However, back in October my friend phoned me and told me that she had a PAP smear and that she got diagnosed with HPV-16. I thanked her, but didn't know what to think about it: I thought HPV-16 doesn't cause warts, so I concluded I should have been infected by several strands of HPV and passed them to her during that unprotected sex episode. She has not developed any wart. Needless to say I feel very guilty and bad about it :(

Told my GP doctor about this, and his stand was: forget about the HPV-16, it won't be a concern for you. Women have their periodic PAP smears, and other than that there is nothing you can do about it.

Anyway, a couple of days ago (16 Feb 2021) I had a single episode of unprotected vaginal sex with her.
Now I have three main concerns:

a) The possibility of having transmitted to her the warts-causing HPV strand. She has not had any wart, and its been 7 months since my warts were removed, but still I am beating myself for how irresponsible I have acted. If somehow she dodged the bullet the first time and didn't get the warts-producing strand, this second time may have done it. She has a long-term relationship with someone else, and I may have jeopardized that. Stupid stupid me :(

b) I always assumed I was the source of her HPV-16. In that case, I am concerned I may have been reinfected again?

c) Does this put me back in day 0 in terms of my own genital warts? Could I have acquired them again from her?

Thanks in advance.

54 months ago

Confused about the HPV-16 vs. warts issue, I found a recent paper (2019) that seems to show oncogenic HPV genotypes can indeed be found in genital warts. So maybe the HPV 16 detected in my friend's PAP smear is the same virus that produced my warts... seems to be the simplest explanation.

Link to the article:

https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-4005-4

H. Hunter Handsfield, MD

54 months ago

Welcome back.

First, rhere is no reason to believe or assume that you were the source of your partner's HPV16. Newly diagnosed HPV infections may have been present anywhere from 2 months to 20 years or more, and it is almost never possible to be confident about when and from which partner any particular infection was acquired. Assuming you have had several lifetime partners, it is fair to assume you have had (and could still have) a genital HPV16 infection, since HPV16 is one of the most common HPV types. For the same reasons, your partner could have acquired her HPV16 infection from any past sex partner she had. Fortunately, the large majority of HPV16 infections remain harmless and do not lead to malignancy.

There is nothing especially new in the research article you found. HPV16 and other high risk HPV types usually do not cause warts, but they sometimes do so. So yes is it conceivable that HPV16 (or another high risk type) caused your genital warts. However, over 90% of GWs are caused by HPV6, 11, and other low risk types. In addition, once someone has GWs caused by, say HPV6 or 11, if they now are exposed to HPV16, 18, or other high risk type, that HPV strain will be detected in any genital tissue, including preexisting warts. In other words, identification of an oncogenic HPV type in a wart doesn't prove it was the actual cause of the wart.

Putting together all the information you provide, it remains unlikely that a) you gave your partner HPV16 or that b) HPV16 is the cause of your warts.

To your specific questions:

a) Nothing in your story implies any irresponsibility on your part. Getting, having and transmitting HPV is a normal, expected, unavoidable aspect of human sexuality. If you were to knowingly have a newly acquired infection and have sex with a partner without informing her of the cirucmstances, some would agree that would be irresonsible. Otherwise no blame ever should attach to having or transmitting HPV, whether high or low risk. Looked at another way, your partner was no more at risk of getting HPV from you than from any other partner she may have had in the past or may have in the future.

b,c) People are immune to new infection with any HPV type they already had. (That's one reason the vaccine works so well.) So if you had past HPV16, you'll never catch it again. Similarly, if your partner were to catch genital warts from you, you would not re-acquire that HPV strain from her. Couples do not "ping pong" their HPV infections back and forth.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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54 months ago

Thank you very much for your reply, which is as always very clear an informative.

H. Hunter Handsfield, MD

54 months ago

I'm glad to have helped. Thanks for the thanks. I'll leave this thread open a few more days in case anything else comes to mind about your situation and my replies above.---