Hi Dr. Handsfield. I apologize I wasn't able to respond to your most previous set of comments! You're right in that I was probably more worried than I needed to be, but after going through discussions on this website and getting your feedback I definitely feel somewhat better. Thank you once again for such an incredible resource here.

Question 340 seemed to be a similar case which was helpful to read.

I do have an appointment with another dermatologist regarding the bumps I mentioned so I'll let you know what they say.

In the meantime, here's the whole picture that I can really use some advice for assuming I do have GW that has 'reactivated' almost 9 years later. 

The timing of all of this was so unfortunate. I ended up getting the initial diagnosis from the dermatologist in March of this year (2021 was a typo in my original post in Question 9054) days before finding out that my wife and I had just conceived after trying for some time. I was in a pretty bad place mentally after getting the diagnosis and having the cryo done and given the whole goal is to make it 12 weeks, I rightly or wrongly made the decision to tell my wife later on as the guidance around pregnancy with HPV seemed to suggest it's low risk. I just figured that I didn't want to give her something to stress about when it seemed important that she stayed relaxed. My wife is anxious by nature and no doubt would have went down the same rabbit holes I did which I'm not sure how great it would have been for her. 

I spoke with my family doctor and asked what would be the best thing to do here. I asked if I tell my wife now and then our OB, would there be anything done about it (i.e. pap test, etc). He said no, any testing would be done after the baby has been delivered. Plus it seemed like there was a good chance that my wife has probably already cleared the HPV given the usual clearance rate. He seemed to agree that telling her early next year would be fine. So in my head I tried to lay this debate to rest and told myself I would do just that.

Fast forward to present and my silence on this is eating me alive. But as hard as it has been keeping this to myself, it is something I'd rather endure myself than potentially taint my wife's pregnancy experience with HPV concerns, if that's an acceptable move for now. This debate has been agony, however, as I am constantly thinking about the fact that my wife's last pap test may have been in 2018 or so. Based on endless reading online and discussions with my doctor, it appears that my wife and baby should be safe even with active HPV. Although what if my wife has warts right now and doesn't even know it? And then a nurse or a doctor points it out while she's in labour. That's a nightmare scenario that I visualize! I also agonize over how the OB may react when I/we tell her. Will she be alarmist about it or pragmatic? If she is alarmist, that will just put my wife in a whole world of distress. What if the OB dismisses the idea that it's possible for warts to appear this many years later? Again, my wife is a worrier and emotional by nature and with this pregnancy, that's only been amplified. All I keep hearing is that mom needs to be kept happy, especially during this third trimester and how extra stress can be harmful or can cause pre-term labour. So then I think that by telling her now, that could actually be compromising safety.

After reading through discussions on this website, I have learned a lot and my disposition towards HPV is largely positive. My anxiety at the moment is related to my wife and our baby on the way. So I am confident that I will be able to break the news about HPV to my wife in a calm and reassuring manner (I've assumed she doesn't know much about HPV, but I could be wrong here). The question is do I do it now and just have faith that my wife will absorb the key facts, stay off the internet and that her OB will also be calm and reassuring about it (I have also thought about scheduling an appointment with the OB without my wife and explaining the situation and getting her take, but wasn't sure if that meant she was automatically obligated to tell my wife) or just wait till early next year after our child is safely in this world under the presumption that a few more months won't change my wife's risk profile re: HPV.

I know this was a lot and I'm also aware that this might be outside of the scope of this service given it relates to pregnancy, but I just thought you might have an informed opinion on the matter.

I thank you tons in advance for your time.

It is nonsense for you to stop having sex with your wife on account of your apparent warts and HPV infection. You've presumably been having sex with her for years, during which time you had the HPV problem, and she likely may have already been infected as well. (I believe I recall you had no other risks, i.e. no other partners recently, and same for your wife.) Stopping sex now, after your wife has been exposed and likely infected, is closing the barn door long after the horse has been out and galloping over open fields. As for your worry that your wife "has warts right now and doesn't even know it," presumably she has been examined by her obstetrician. If warts were present, they would have been seen and she would have been told. If overt warts are present prior to labor, they can be treated. A newborn exposed to genital warts during vaginal delivery can be at risk for warts in the upper airways, called [recurrent] respiratory papillomatosis. But that's a rare condition, and any risk will be greatly reduced by treatment of visible warts. So if her Ob finds no warts, you needn't be worried at all. I'm also surprised to learn you apparently have not discussed your warts and all these issues with your wife. You obviously should do that -- there are no implications regarding sexual fidelity -- and certainly not go behind her back to speak independently to her obstetrician about it.

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

HHH, MD

1) I ended up seeing a dermatologist this week re: small bumps. He ruled out GWs. Said they were just little cysts that will probably clear up on its own which was a huge relief. . To your point, it makes me wonder about the small black spots/bumps I had earlier this year. But in any case, assuming I did have GWs which were removed in March via cryo, is there a certain amount of time I should let pass before concluding that I may have now cleared this virus?

2) I will be discussing everything with my wife this week ahead of an OB appointment. Would you be able to let me know what % of women with HPV go on to have cervical dysplasia and then what % of cases of dysplasia proceeds to develop into cancer? I understand it's a very low percentage, but was just curious to know if there's a precise stat as it might be good to relay this info as well.

Thanks very much for all the help and anxiety relief you've provided.

2)  The proportion of women with genital HPV who develop dysplasia depends on the particular HPV strain. For the "low risk" types (including those that cause warts), it's probably under one in a thousand. For high risk (cancer causing) types, it's higher -- maybe one in several hundred (?).

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