[Question #887] HPV, HSV2 Fertility

61 months ago
Hi Doc,

I have some lingering concerns regarding my last question and some more concerns about my future well being and fertility.

1. How can I make sure I don't miss any sore or bump that could be a risk for penile cancer. Will it always be obvious, I'm a little scared of the possibility that it's there but I don't notice it since different websites have different symptoms to check for like skin changes. Should I be daily/weekly checking my penis in detail? I'm scared of not noticing it till it has become invasive and a significant part of me has to be removed. Specially the underside of my penis, the skin is generally wrinkled there since I am circumcised. I do have some brown spots(2) on my skin, a little different just in color from rest of the skin, something of concern?. Or should I make weekly or monthly trips to the dermatologist or urologist?

2. My second concerns are about fertility given that I have HSV2 and probably HPV. I have read research papers how it affects sperm count and motility etc. How worried should I be? How reliable are they given the number of people who are affected by these two infections?

3. Assuming that these 2 infections affect sperm count and motility, what would be the affect when these infections are dormant. I have heard conflicting ideas about how HPV is always in your body or how it clears on it's own. How would them being dormant affect my fertility. If these infections are suppressed by my immune system how can they affect they sperm. What it sounds like is that they are always attached to my sperm producing testes and poking and damaging every sperm my body makes. Is that how it is or my fertility is normal/healthy when they are suppressed?

4) I am 24 years old. Will get married in a few years hopefully. If my girlfriend is vaccinated, she has no other partners except for me (we haven't had sex), and I also remain faithful to her in future, should I get vaccinated too?

Thanks a lot for your help!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
61 months ago
Like your previous questions, these reflect rather irrational worries.

1) It will always be obvious long before any "significant part" has to be removed for cure, regardless of where on your penis or skin wrinkles etc. You needn't look anywhere near as often as once a week. Once a year would probably be enough, but for sure no more often than once a month.

2,3) Neither herpes nor HPV causes infertility in either men or women. Stop searching the web for obscure research papers. That these viruses might alter sperm motility is irrelevant, because neither virus gets into the testicles or sperm collecting ducts.

4) If all those things play out the way you describe, HPV vaccination would not be necessary. And anyway, you're close to the age (26) after which HPV immunization is not recommended.

Your questions indicate you are really obsessed with these issues. If these worries dominate your life as much as your questions imply, you might consider professional counseling about it. Your worries about them are not normal. I suggest it from compassion, not criticism. 

Please think carefully before asking any follow-up questions. I'm not going to repeat answers that are obvious (either directly or by common sense interpretation) that have been given previously, in this or your other threads.

Best wishes and stay safe--  HHH, MD


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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
61 months ago
And by the way, if and when you examine your penile skin, do it under good lighting and don't use any magnification. Anything you can't see with the naked eye is meaningless.

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61 months ago
Thanks doc! You are right, these worries have dominated my life. The reason is that I did not grow up in the West so sex Ed was not something I got. I was completely unaware of these things when growing up in the Middle East and after becoming sexually active in the west all of these concerns hit me. I am working daily to handle these. A few lingering questions, that are not repetitive hopefully:

1. When u say yearly or maybe monthly do you mean self inspection or inspection by myself (obviously one takes a casual look when taking a bath etc) or by a urologist or dermatologist(which one would you recommend).

2. Can you comment on the relationship between these viruses and the immune system. Can the immune system really suppress them to the extent that they might not have an affect on your?

3. This is the article I read for affect on sperm
http://www.hindawi.com/journals/bmri/2014/230263/
. It would greatly help me if you can comment on it.

4. My girlfriend is 24 as of last February. She is. Planning to get vaccinated in a few months. Is that okay? Or should she get it done ASAP.
61 months ago
I just came back from my dermatologist. She looked at those barely visible "warts" and diagnosed them and genital warts. They are right under the penis head. My question: I always used a condom, maybe the unprotected oral? And that happened like 3 times.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
61 months ago
I understand the differences in sex education in the Middle East (and in Muslim countires in general). On the other hand, the STD situation isn't nearly as bad in most western countries than you might assume from media coverage and internet searching. It's something to be aware of and take common sense precautions against, such as condoms for new or non-monogamous sexual encounters. There is no way to be 100% protected unless you decide to not have sex at all. But with these precautions, most single persons with occasional new partners remain free 

1) Self inspection. If I were in your situation, I wouldn't inspect myself at all. The extent to which you naturally see your penis when using the toilet, showering, should be sufficient.

2) The immune system usually clears HPV entirely. HSV2 persists for life, with the immune system preventing new infections but not preventing recurrent outbreaks and periodic shedding of the virus, and not preventing transmission to partners. Herpes is far and away your more important STD problem. You need to inform any and all sex partners in the future, including commercial sex partners, that you have genital herpes and could transmit it to them. You can reduce this chance a lot by taking anti-HSV drug (e.g. valacyclovir) and using condoms.

3) On quick scan, this is scientifically weak research and highly theoretical. Trust me on this:  nobody has ever reported, and there is no theoretical suspicion, that HPV significantly reduces men's fertility.

4) I suggest she start the vaccine now. It takes 3 doses of HPV vaccine over 6 months to provide complete protection. She should start the vaccine at least 6 months before you and she have sex. She also can have a blood test for HSV2, to see if she is susceptible to your infection. You should also discuss your HSV2 infection with her so she understands the potential risk of catching genital herpes from you.

My final advice is that you stop searching the internet about any of this. Like most anxious persons, you are being drawn to information, much of it unreliable, that inflames your fears. It isn't worth the stress.

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61 months ago
Thanks doc, I guess I was unlucky in terms of HSV2. I have told my girlfriend about HSV2 and the implications. 

Thanks to you I am no longer stressed about penile cancer and fertility.

My last question(s). I was diagnosed with HSV2 on 18th March, no symptoms just a blood test with value 2.8. Till now I've had no outbreaks of any sort. Does that say anything about what kind of future I'm going to have with this infection? I've never had oral sex I.e performing cunnilingus but twice I have sucked breasts. Does that put me at risk for oral HSV2 or I'm primarily genital? What's sort of precautions should I take? I'm afraid of scratching my genitals while sleeping and then rubbing my eyes with my hands when I wake up, should I be concerned about reinfection in new places or even reinfection that could have happened previously. My major concerns are viral enciphilitis and ocular herpes. This is my last concern and I am trying very hard to not go online anymore.
61 months ago
I also meant to ask about what should be considered as abnormal. I have 2 very light brown spots and what's sees like a mole on the underside of my penis. They are not bumps and sores but skin with a different color. Smaller than an eraser head. So should I be looking for something that I can actually feel by running my finger over it? Or anything different. I've had these fir a few months given that I became sexually active in sept 2015
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
61 months ago
Looking back at your past threads, I see you had a discussion with Terri about your positive HSV2 blood test. As she told you, it is likely a false result and you are unlikely to have genital herpes or HSV2. She explained to you how this can be sorted out; re-read that thread, concentrate on it, and follow her advice.

You also have some serious misunderstandings about HSV2, for which you are not at risk, if I correctly understand your past sexual exposures. You also cannot self-infect your eyes etc by contacting your genital area with your hands.

That ends this thread. Repetative anxiety-driven questions are not permitted. Please do not post any more questions on this forum about any of the issues discussed in this or your previous threads. Any additional ones will be deleted without reply and without refund of the posting fee.


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