[Question #806] Hpv related carcinoma in situ

51 months ago
Hello Dr.,
I have always worn a condom, but was unlucky. I was recently diagnosed with a small spot of carcinoma in situ at the base of my penis. In my ignorance, it took me 10 months to have it checked out. I thought it was a bruise and ignored it for a long time. Dumb.  After a biopsy, the dermatologists have put me on flourauricil to treat the cells for four weeks. The spot is slightly larger than an eraser head. After 4 weeks or less, they will inspect my progress and see if any excision is needed.
They are both adamant(they work together btw) that I am good for sex after the treatment AND that disclosure is definitely not necessary. I asked if I could give the Hpv to someone after the treatment and they say no. 
However, I got the classic caveat of, "We'll just keep an eye on it.", which is understandable.
I'm not having sex unless in a committed relationship. In situations involving carcinoma in situ from Hpv that are treated with flourauricil, what are the chances of the Hpv reinfecting and what are your thoughts on disclosure regarding penis carcinoma in situ? I don't want to alarm a potential soulmate. Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Welcome to the forum. Thanks for your question.

You were indeed unlucky, in that penile cancer is rare, but not especially unlikely in regard to condom use. Over time, condoms do little to protect against HPV. The risk is reduced for any one exposure, but most people eventually acquire genital HPV despite consistent condom use. The location of your cancer is consistent with infection above the condom protected area of your penis.

However, most STD experts have little or no experience treating penile cancer; in my clinic, we would refer persons with suspected penile cancer to a dermatologist. So you're probably under the nost expert care available.

I agree with your dermatologists' advice that there is no need to divulge your presumed past HPV infection to current or future sex partners. Most likely your HPV is gone entirely. And even if you have a residual latent HPV infection, sex with you will not raise your partners' risk of HPV any more than sex with anyone else. They also would not be at particularly increased risk of cancer.

Many committed or potentially commited couples discuss their past sexual histories, including HPV and other STDs. In that context, you might reveal your past problem with HPV and cancer. But this is a relationship issue, not one of medical necessity or risk reduction.

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

HHH, MD

---
51 months ago
Thank you, Dr.   Your answers are clear. This has come with a great deal of depression and hopelessness, for which I'm seeking therapy. My remaining hope is that I'm overreacting to how a potential girlfriend will react. (Reacting to the word cancer or high-risk fears) I don't want to be alone forever. These, of course, are relationship issues. 
If the spot heals well and I'm armed with facts, I hope it will be slightly easier to deal with.
Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
To be honest, I see no basis for any sense of depression and hopelessness about this. Everybody gets genital HPV, and a few get more serious complications of it. However, localized penile cancer like yours is virtually 100% treatable without dire procedures (like penile amputation). You were a bit unlucky, that's all.

Most people are blase about HPV, if they know anything about it at all, and most potential sex partners -- either casual or potentially committed ones -- are not likely to be very concerned about this. Anyway, all persons should be immunized against HPV, and your future life partner probably will have been vaccinated, in which case she probably will be protected against the HPV type that caused your problem. So there is no rational reason to fear that you will be "alone forever" on account of this issue. Truly, it's just not a big deal, or shouldn't be. My guess is that your dermatologist has said much the same thing.

Anyway, I'm glad to have helped. Best wishes.

---
51 months ago
Thank you for those encouraging words.  I have confidence that I will heal fine.  I truly believe I'm no more a threat to anyone's health than another person, like you said.  All of my depression is centered on how a woman will react in the future. I'll try to focus on the hope that they understand Hpv and be blasé about it when I bring it up. Roughly how many women over 30 are vaccinated? Thank you again and that's all of the questions I have.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
HPV immunization is not recommended over age 26, the vaccine has been available only about a decade, and in the first few years vaccine uptake was low. Therefore, it is likely that relatively few women over age 30 have been vaccinated. Still, that doesn't mean your partners will be at especially high risk. That you had carcinoma in situ does not mean that your particular virus is more likely to cause pre-cancer in others. Your future partners will be at no higher risk for catching HPV, or for having a serious outcome, than they would be from any other partners besides you. And that risk is low. On top of which, your virus probably is gone (or will be soon) and not transmissible. In fact, once your surgical site has healed, you will be under no ethical obligation to even mention this issue to future partners. If I were in your situation, I probably wouldn't do it unless and until I were entering a potentially long term, committed relationship.

Truly, this shouldn't be a big deal for you. Even without treatment, your CIS might have cleared up entirely and in any case probably would have taken a few years to progress to invasive cancer. (Some experts consider CIS to be a form of pre-cancer, not yet actually malignant -- although this is a largely a debate over terminology.) And the implications for future sex partners are no different than for any garden-variety genital HPV infection, i.e. minimal.

That completes the two follow-up comments and replies included with each new question, and so ends this thread. Best wishes and stay safe.

---