[Question #8565] HPV Latency
42 months ago
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I had a LEEP over 20 years ago. I have had no positive paps or HPV since. Am I completely free of the virus? Do I need to tell any future partners about this? Please advise.
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H. Hunter Handsfield, MD
42 months ago
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Welcome to the forum. Thanks for your confidence in our services. This question gets to the very core of why HPV is so stressful for some people and some of the basic biological facts of HPV infection. The occasional question offers an opportunity for a blog-like reply that can be useful in replies to future questions. So here it comes -- with maybe a bit more detail than you were counting on.
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There is scientific uncertainty (and a certain amount of controversy) on long-term persistence of HPV. What is clear is that some HPV infections persist for very long periods, perhaps for life -- and some experts believe this always happens. Others aren't so sure.
What is clear, however, is that the immune system suppresses almost all infections to a point that viral DNA -- the basis of the diagnostic tests -- cannot be detected. So the infection is at least latent (or "dormant"), not causing disease and not transmissible to partners. However sometimes DNA reactivates and can be detected once again. This may occur a few months, a year, a few years, or 30 years after the initial infection. The longer the time since the initial infection (or its diagnosis and treatment) without a recurrence -- in your case, no further abnormal Pap smears or positive HPV tests -- the less likely a reactivation will occur. After 20 years, it is unlikely you will ever have another positive result or that you will be infectious for your sex partners. (This is why regular Pap smears are no longer recommended after a certain age -- I think the current advice is age 50(?) -- plus the last 3 paps and HPV being negative.) You'll probably never know whether you have a dormant infection that has the potential to reactivate (but is unlikely to do do); or if the LEEP plus your immune system has totally eliminated it.
Given these uncertainties, it is easy to understand why different experts and different sources of advice may give out different information, ranging from "If your test is negative it's gone, no worries" to "You'll always have it and it can reactivate at any time, putting you at risk of cancer and your partners at risk of infection." (The last often is unaccompanied by perspectives on how rare or frequent the risk actually is, as if risk is an all-or-nothing, black/white situation -- which is never true.)
Even if you were only a few months from your last positive test, I would advise against informing partners. Since 90% of all people get HPV, often several times, and at any point in time up to 50% of sexually active young people have active, detectable virus, informing them does not reduce their risk of exposure or infection. At younger ages, getting vaccinated against HPV and encouraging partners to be vaccinated is a much more effective prevention strategy. And certainly there is no need for you to inform current or future partners of your distant past infection. That said, from a relationship perspective many prospective couples discuss their past partnerships and STI experiences, in the interest of connection and commitment. But there certainly is no need from a standpoint of preventing infeqfection or protecting a patterns health.
A bit more about vaccination: It is 100% protective against the 9 HPV types that collectively cause 90% of genital warts and 90% of cancers caused by HPV. But not against any of those types with which someone has already been infected. Hence the earlier the better, while still susceptible to at least some of the vaccine types. But at any age, it's a most more effective prevention than informing partners of past infections.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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42 months ago
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Thank you for the information. Would you suggest at 51, I get the HPV vaccine as I'm planning to reenter the dating world again? Also, what do you feel are the real risks of oral sex and HPV?
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H. Hunter Handsfield, MD
42 months ago
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HPV vaccine is generally recommended up to age 45 and no older, largely because by that age most people have been infected with some (often most) of the 9 HPV types covered by the vaccine; and because new infections are uncommon after age 45. Therefore, it's not covered by most health insurance (in the US) beyond 45, so it would be expensive. Oral sex is low risk for HPV -- oral infection occurs, but at around one seventh the rate of genital HPV; and oral sex infrequently transmits the virus. And assuming you'll mostly be seeing men near your own age, they also will be well beyond their peak HPV risk years and not likely to have active infections. I will add that you need not, and in my opinion should not, inform potential partners of your abnormal Pap smear 20 years ago.
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In summary, I really do not believe HPV should be the slightest concern as you resume dating. The only STIs of real concern to you should be the old traditional ones: syphilis, chlamydia, gonorrhea, herpes and HIV. And even these also are increasingly rare beyond age 35; probably your risks will be low here as well, again assuming reasonable care and age-matching of your partners. This is not to imply HPV risk is zero, but the chance you'll ever have a serious HPV health problem is very low.
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H. Hunter Handsfield, MD
42 months ago
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And best wishes for rewarding sex and romance going forward!---