Dear Experts,

I'm male and some time ago a girl I've had sex with told me she found out that she had genital warts and it was likely HPV. I've never had any genital warts in my life, but still I went to the dermatologist to have it checked. He also couldn't find any warts, but sent me to do a smear test on the glans and it turned out HPV39-positive. So he told me that the virus usually goes away on its own and to go and do the smear test again in 2 month. I did that and was still HPV39-positive.

So about 3 month after that I thought it might be a good idea to get checked again and do another test, but this time I went to another dermatologist to send me to do the smear test. But he then said its useless to do the test, as HPV stays in the body for life, so checking for it if I had it once wouldn't make any sense. He also said that I wouldn't be contagious if I don't have any genital warts and use a condom.

So, does HPV go away its own, like the first doctor said (and most sources on the internet say), or does it stay in the body forever, like the second doctor said? If it does clear on its own, it would make sense to do regular testing, because its the only way for me to know if I'm still contagious (as I've never had a genital wart), and then I wouldn't have to disclose to future partners anymore, if I'm right. Or what would the best way be to determine if I'm still contagious/have the virus in my body?

Your situation is a good illustration why HPV testing isn't recommended and should not have been done by your first dermatologist. The reasons will become clear shortly.

Does HPV go away on its own? Yes and no. HPV DNA persists indefinitely in some people, but the science isn't clear whether it always or sometimes is cleared entirely. In most people, infection (i.e. DNA) cannot be detected on repeated testing. Whether that means it's gone or just suppressed cannot be determined with currently available technology. Once undetectable, usually it never reappears, but sometimes it does. Probably the infection is not transmissible to partners if DNA cannot be detected, but this also isn't certain. It's easy to understand how these uncertainties can lead to differing advice from various physicians or even HPV experts. 

Everybody gets genital HPV -- well, at least 90% of sexually active persons -- often several times. Many of these infections persist indefinitely, whether or not DNA can be detected. Assuming you've had several sex partners, you can be sure you have been exposed and probably infected, in addition to the HPV39 infection detected on one occasion. Indeed, HPV39 doesn't usually cause warts, so that was unrelated to your past partner's genital warts. (By the way, your partner's statement that her warts were "likely" HPV shows its own misunderstanding:  all warts are caused by HPV, no exceptions -- but 90% of the time it's HPV6 or 11. At any point in time around 50% of people age 20-50 have positive HPV tests if tested vigorously (e.g. 6-10 swabs from all over the genital area), which is why you can assume you have been repeatedly exposed and probably infected.

Some bottom lines:  Getting and having genital HPV is a normal, expected, and for the most part unavoidable consequence of human sex. There is little or no point in tested, except in women having Pap smears -- in which case having a high-risk (cancer-causing) versus low-risk HPV type can make a difference in treatment and follow-up. But otherwise there is no need and no benefit from testing for HPV. (So I agree more with your second dermatologist than the first one.)

Perhaps most important, consider HPV vaccination. It will protect you from infection with the 9 HPV types that cause 90% of genital warts and HPV-related cancers (not counting any of those types you've already had). And recent research suggests that immunization also may help prevent reactivation of longstanding HPV, further reducing the chance of visible problems and transmission to partners.

And now to your closing question, "what would the best way be to determine if I'm still contagious/have the virus in my body?" The answer is that there is no way to accurately make this determination. Just assume you have been infected, could from time to time have active transmissible infection, but in that case no harm is likely to come to you or your sex partners. Of course if you see a skin problem in the genital area, particularly a wart or wart-like problem, see a doctor to check it out and perhaps have it treated. Beyond that and considering vaccination, just don't worry about HPV. The large majority of infections are non-problems and not worth any worry or concern.

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

HHH, MD

Dear Dr. Handsfield,

thank you for the very informative reply.

I can now also see why testing for males who have no symptoms isn't recommended. The only use the test had is putting me in a moral dilemma - do I disclose or do I not disclose with a future partner?

With my last partner I disclosed before we did anything, but I think it might have done more harm than good. After some months it didn't work out and she then found out that she also got in contact with HPV and is convinced that she got it from me, because she was only with me for that time and the tests she got before from her gynaecologist never mentioned anything about HPV. Of course she then was also a bit worried about it. She doesn't know the strain number though, and I think it could have been the first time she ever got tested for HPV. As far as I know women dont automatically get tested for it under the age of 30 and she isn't 30 yet. So technically it would have been possible that she had it before and just found out because she was tested the first time. Either way, what bothers me is that the fact that I disclosed to her seems to have made her worried that its "something you have to tell" and therefore "something to worry about" when in reality its just nothing to worry about (as doctors say). In a way for some knowing about it is more of a curse and psychological burden than having it and not knowing about it (unless you have unusal pap-tests).

For a single 31 year old male who will probably have sex with 1 or more woman in the future, would you recommend getting the vaccine?

If it's probable that the infection isn't transmissible anymore after its cleared, would you recommend having it tested again to see if it was cleared? Also maybe for more peace of mind.

I certainly agree that one of the downsides of testing is the inclination to inform partners, which usually doesn't benefit their health and just creates anxiety.

At your age, you can assume you have been infected with some but not all the 9 HPV types covered by the vaccine, and it sounds like you're likely to be reexposed to HPV given your dating expectations. Being vaccinated makes sense -- something to discuss with your doctor.

I don't recommend you be retested for HPV.