[Question #9211] HPV Questions

35 months ago

Hi Doctors

I have been in a relationship for 2 months with a girl I’ve know for a some time. Since we began dating 2 months ago, we’ve engaged in unprotected sex (unprotected oral too) many times every time now. Ive never had any STD as I’ve been tested many times, and I’ve never had herpes or HPV lesions appear (that I could tell).

Last week on Tuesday, my partner and I had unprotected sex as usual, and the next morning she noticed a small bump on her lip which got worse throughout the day and turned into what looked like a coldsore. She states she’s never had one and has never had anything STD related. I’ve never had a coldsore either but I examined myself just in case I had any developing herpes lesions caused from her cold sore or if I have not to her. Nothing was there herpes related but I noticed a small bump at the end of my penis shaft where it meets the public hair area. I thought maybe an ingrown hair but went to an urgent care for confirmation. They said it didn’t look like a wart or herpes and sent me home. I went to a dermatologist and they couldn’t tell either from a visual inspection and decided to do a biopsy since it was a single small bump that was not wart like (no cauliflower look or cluster). The results came back today and they said it was a wart cause by HPV but I’m confused as I’ve never had any type of lesion before.

1. Could this wart be the cause of my partners cold sore or vice versa?

2. Am I required to disclose this information? I’m going to anyways but I’m not sure if it’s needed.

3. Do I need to stop unprotected sex with my partner for any amount of time? The dermatologist said I did not need to stop as long as it’s with the same partner, which it is.

4. I did not have sex with anytime other than my partner from a few months and that was protected, so could my current partner be the cause of this wart?

5. Do I need to worry about infecting her or continuing to reinfect each other?

6. I had the wart cut off for biopsy, does this mean it was

35 months ago

treated effectively and thus I can continue my sexual life with my partner as though nothing happened or do I need to wait for clearance or use medication for a true treatment?

7. I was given the HPV vaccine when I was a lot younger (I’m 27 now) why didn’t this prevent this wart from appearing?

8. She states she has not had many partners also, does this mean she is probably not the source of my infection if that’s to be true?

9. What’s the overall seriousness of this? I’ve read that it’s not a big deal but it seems like it’s made out to be when I hear people talk about it.

H. Hunter Handsfield, MD

35 months ago

Welcome to the forum. Thanks for your confidence in our services. You ask good questions -- all of them typical among people with newly recognized HPV, so this discussion might be quite helpful to other readers (one of the forum's main goals, in addition to serving the questioners themselves).

Your partner's possible oral herpes (cold sore) and your penile wart are entirely unrelated. As for the wart, welcome to the club: Nearly all sexually active people have had genital HPV, of when many infections persist. And the best data suggest that a third of all people get genital warts at least once (not counting people who have been vaccinated against HPV, which everybody should be). In any case, your wart probably is not from your current partner; most warts show up later than 2 months, often up to a year, after acquiring the HPV infection that causes them. To your specific questions.

1. Nope. Not related in any way to your partner's possible oral herpes.

2. There is no uniform answer to this question. On one hand, as noted above, everybody has (or has had) genital HPV; it is universal and for the most part unavoidable. On that basis, one can assume everyone should know they are at risk, regardless of whether or not their partners disclose their known infections to them. On the other, warts have a special place in most peoples' psyche -- a sort of "yuck" factor. Most of your current or future sex partners would expect and want to be informed of any current, as yet untreated warts. Once they have gone away, though, most people would agree there is no need for disclosure.

3,5. Your doctor is current. Your current partner has been repeatedly exposed to your wart and its underlying HPV infection, and by now probably infected (or perhaps immune, if previously infected with the same HPV type). Either way, stopping exposure now will make no difference in her risk of being infected, her future health, or anything else. She should be told, and should be on the lookout for warts herself. But that's all. As to you being reinfected from her, the answer is no: people are immune (or at least highly resistant) to new infections with the HPV strains they already have. HPV infections are not "ping ponged" back and forth in couples.

4. Your current partner is not likely the source of your wart, as noted above.

6. Removal or medical treatment of warts probably reduces but may not entirely eliminate the virus. Transmission risk thus likely is reduced but not eliminated. But as discussed above, this is irrelevant for your current partner.

7. Excellent question. One of two possibilities: you were infected with the HPV strain causing your wart before you were vaccinated; or the wart is caused by an HPV type not covered by the vaccine. The standard HPV vaccine protects against 9 HPV types, including the two (HPV6 and 11) responsible for about 90% of genital warts. That's good, but obviously not complete: vaccinated people remain susceptible to other strains that sometime cause warts.

8. At least 50% of all sexually active persons acquire HPV within their first three lifetime partners. The frequency of HPV is almost as high in people with, say, 5-10 lifetime partners as in those with hundreds. The timing of your relationship and onset of your wart suggests your partner is not the source, not her sexual history.

9, What you read is exactly the right perspective: for the vast majority of people with genital warts, "it's not a big deal". The people who "talk about it" are not necessarily representative of how most people react. As I said above, warts tend to stimulate emotional reactions -- all those stories about toads etc when you were a kid -- but for the most part they are a minor inconvenience with no serious consequences. I don't mean to belittle those who are affected and worried; some cases keep recurring, and many can be psychologically debilitating. Nobody wants warts. But by and large they should not be a serious concern.

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

HHH, MD

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35 months ago

Thank you Doctor for you quick response, here are some follow up questions.

Should we use protection? Or is it safe to continue unprotected sex after a wart is removed and the wound is healed for the most part?

I read surgical excision is the only treatment with close to 100 percent success rate here https://www.ncbi.nlm.nih.gov/books/NBK547667/

Is this true and does this apply to my biopsy?

Can this be transferred to her orally and ultimately to me orally if we continue oral sex?

My dermatologist told me it’s unlikely for the wart to reappear but it’s possible sometimes, is this true and if so would removal be best or would the Imiquimod 5 % Topical Cream they provide me be better for clearance?

Strains that cause warts are not likely to cause cancer from what I read, am I correct on believing this?

Are most people able to clear strains that cause warts within a year like just like the high risk strains?

Assuming her coldsore was not from me and my wart was not from her, is it likely we already infected each other with these 2 things? If so, would me catching herpes (cold sores) from her be worse than her getting HPV and possibly developing warts from me?

Apart from the possibility of warts, would we still be able to have a normal relationship if we continued dating in the long run?

What would you recommend I do from this point on after receiving this diagnosis as far as sex life is concerned?

H. Hunter Handsfield, MD

35 months ago

Protection, oral sex, and sex practices: I already said you are immune to re-catching the HIV strain you already have. That is true for any and all anatomic sites (e.g. oral infection) and it means without condom protection. You and your partner can safely participate in any sexual practices of any kind that give you mutual pleasure, without condoms or other protection. Going to your last question, the answer is definitely yes, you can have a normal relationship in every respect. (If you were to decide you could not have a sexual and romantic relationship with a person with either HSV1 or HPV, you would exclude at least two thirds of all potential partners.)

You cite a good resource about warts. I didn't read it completely, but on quick scan I see no statement about surgical excision being 100% effective. For sure warts can recur after any and all available treatments, including surgery. Most experts advise topical (applied) treatments as the first step, or cryotherapy. However, if your biopsy removed the wart completely, you don't need additional treatment now. However, you should look at warts as iceberg-like: the wart is the tip, but HPV infection usually also involves surrounding skin, and therefore removing the wart is not a cure of HPV. However, as I said above, removal probably reduces transmissibility, but does not necessarily eliminate it. Your dermatologist is correct: your wart might recur, or others might appear, but probably it won't happen. If it does, imiquimod seems a good choice rather than surgical removal.

It is believed that the wart-causing HPV strains are cleared by the immune system at the same frequency, and over the same period of time as high-risk (cancer causing) types, maybe somewhat faster. Correct that separate types typically cause warts and cancer.

We don't know your partner has oral herpes, although it is likely if she was experiencing a typical cold sore. Has she had them previously? Is she aware of an oral herpes diagnosis? If she has it, you may or may not be susceptible: half of all adults in the US have been infected, mostly in childhood (which likely is when your parter caught HSV1). Not having cold sores yourself doesn't mean anything; you still could have been infected. If so, you are immune to catching it again, anywhere your body. Your partner should avoid kissing you or performing oral sex when having an outbreak. That will largely, but not completely, protect you against being infected yourself (if you haven't had it already).

Whether HSV1 infection (whether oral or genital) is "worse" than HPV is a meaningless question: it depends entirely on what symptoms occur, how severe they are, etc.

I would advise you to continue with your current relationship and sex life with no changes of any kind, except to avoid kissing and her oral contact with your penis when she has cold sore outbreaks.

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35 months ago

Thank you for your help Dr. Handsfield, your responses and the feedback from my dermatologist are the same and have really helped calm me down. Initially when I got the results, I was practically frozen in fear as I’ve never had any type of lesion in that area. I spoke to my partner about my diagnosis last night as I felt it was the right thing to do regardless of the prevalence of HPV. She took it well and is supportive and agreed that we probably already infected each other with coldsores and HPV. I was scared she might have thought I was dirty or infected with all kinds of things (which I’m not I’ve been tested recently and I’m all clear for all the testable things). I gave her all the information I was given and agreed we didn’t need to change our sex life at this point, in fact we had unprotected sex shortly after as we felt it was safe (my biopsy wound is healed and there is no other sign of anything that was easily visible).

I may have misread the information about surgical removal, I’m assuming it meant it has a higher success rate at removing more of the wart than other methods, I thought it meant a higher success rate of it not reappearing.

So since I have a wart causing strain, is it safe to believe that cancer is not likely to happen for myself or my partner in the future? Assuming there’s no other unknown strains.

She didn’t get a proper diagnosis, but from what we saw, it looked exactly like a coldsore. She states shes never had one before in her life, so it may be new or old. During that time we avoided kissing and oral as well, until yesterday when we kissed but again we felt like it was safe to do so.

So moving forward I won’t think of this as anything more than just a cosmetic nuisance, is this a good way to think about it?

If after a few months of no warts, can I believe I’m pretty much over the infection? I know it may linger in your body for ever, but from what I read, it’s unlikely to resurface?

Thank you so much once again for all the help. I know this is my last response, but I wanted to add that you and this forum have helped me so much over the years and especially now that I come with something of my own. I hope it helps someone in a similar situation as mine.

H. Hunter Handsfield, MD

35 months ago

"since I have a wart causing strain, is it safe to believe that cancer is not likely to happen for myself or my partner?" Even with the highest risk strains, probably under one infected person in a thousand gets cancer. Your risk is even lower. You really shouldn't be worried about it.

Your partner should be on the alert for similar episodes. If one occurs, she should see a provider ASAP (within a couple of days) to test the sore for HSV. But this is no big deal: as I said above, half of all Americans (up to 90% in some countries) have HSV1, the cause of oral herpes. It truly is no big deal and should not have any effect on her life and yours. I would call it more than a "cosmetic nuisance", but not much more.

Yes, your HPV is not likely to resurface. It could happen, but shouldn't matter much if it does.

Thanks for the thanks. I also hope other users can benefit from this discussion, one of the forum's main goals. Best wishes and stay safe.

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