[Question #9226] HPV Couple - Confusing/Uncertain Information from Healthcare Providers

35 months ago

Hi, I am a 22-year-old female who received my first pap this May. I have a family history of cervical cancer, and my mother passed away in 2020 due to cervical cancer caused by untreated HPV, so I am very cautious of the need to be regularly screened. My pap results indicated an LSIL, though the lab results took four weeks to return and when I was informed over the phone that this implied an HPV infection, I was not advised to have additional HPV testing. That specimen was collected four months ago, and then-since I have focused on maintaining my immune system through a combination of diet, exercise, and a daily vitamin intake of B complex, C, E & A. I also have a male partner with whom I have been in a monogamous relationship for 1.5 years, the majority of which has included unprotected sex as I take a daily oral contraceptive and we regularly get full STI/STD screenings. When I was informed about my LSIL, I was concerned how it would affect my partner, but the nurse echoed much of the research by stating that it was almost impossible to determine who the HPV originated from and, as we have long engaged in unprotected sex with one another, it was almost certain that we were both infected at this point. She continued that "it was nothing to worry about, and It was up to me whether I should inform him." Flash forward to two weeks ago, when my partner discovered what appears to be HPV-caused genital warts at the base and right below the head of his penis. These are painless and do not itch, and present exactly like images found online: those at the base of his shaft are raised and clearly wart-like, while those below his head present as flatter, almost collapsed. The information we received from healthcare professionals since then has only led to more confusion.1) Is it possible that we share the same strain if his is presenting as warts, mine as a LSIL? 2) Should be fully abstain from sex, or is it possible to continue a sex life? Any information would be helpful, we

35 months ago

(Cont.) We have both spoken independently to healthcare providers, but the information has led to more confusion.

We both received full suites of the Gardisil vaccine in our adolescence, so we have been met with confusion about how he is presenting genital warts at all. I know from research that Gardisil covers the strains that cause 90% of warts, not all, so having a NP tell me this was "impossible" lessened my confidence in their information.

Today he visited his primary care doctor to examine his warts, but the doctor's response amounted to little more than a shrug, "yeah, that seems like HPV," and the recommendation to see a dermatologist for better information.

I permanently moved to our area a few months ago, so this situation spurred me to find a new primary care provider and OBGYN in the area. The earliest I could get in was the end of October (I kept this appointment to share my complete medical records and schedule a follow-up pap), so I scheduled an appointment at the local Planned Parenthood for next week.

The main frustration is that we are actively exhausting our resources, and we are still without answers, really. I am still engaged in fruitless phone tag with the nursing staff from my old OBGYN and we have spent the better half of two weeks banking on his appointment with his doctor to provide us with some clarity.

35 months ago

The presentation of the areas on his penis seem to be HPV as they are flesh-colored, painless, and do not itch or burn. I suppose it is still possible that these are HSV2, which the STI/STD panel next week will hopefully determine.

H. Hunter Handsfield, MD

35 months ago

Welcome to the forum.

I'm sorry to hear of your personal and family experience with cervical cancer, and certainly I understand how this has heightened your personal concern, especially when you learned of your abnormal Pap smear result. But the bottom line is that you are at low risk for cervical cancer, and essentially zero risk for invasive (advanced, potentially life threatening) cervical cancer. As you likely have learned, your LSIL (low grade squamous intraepithelial lesion) is not truly a pre-cancerous finding. LSIL rarely progresses beyond that stage and typically clears up without treatment. In other words, the professional advice you have had is entirely standard, within virtually all authoritative guidelines. That remains the case whether it is caused by a low risk type of HPV (the usual case) or, less commonly, by a high risk HPV type.

You also have had accurate advice that it is rarely possible to know when and from whom any particular HPV infection was acquired. Your situation may or may not be related to your partner's apparent genital warts. It seems likely and certainly is plausible that you are sharing the same strain, but not necessarily. As for occurrence despite HPV immunization, either of you could have been infected before you were vaccinated -- depending, of course, on whether you were vaccinated before or after becoming sexually active. But you also could have been infected after immunization. The standard vaccine prevents infection with 9 HPV types, which together are responsible for ~90% of genital warts and ~90% of cervical and other cancers. There is little or no protection against 100+ other types transmitted primarily by sexual contact.

I agree it's a good idea for him to see a dermatologist for confirmation of the diagnosis and, if warts are confirmed, treatment. However, there is no possibility of HSV, which does not cause genital bumps that persist more than a few days without change in appearance. An STI test panel isn't necessary in evaluating these bumps.

The bottom lines, from the information you have provided: 1) Discuss with your new gyn when s/he recommends follow-up Pap smear. I'm betting s/he will advise doing it about 6 months after your previous Pap. Also discuss whether HPV testing also should be done along with the pap itself. 2) Your partner should follow through with the dermatology referral. 3) I would hold off on a general STI test panel for your husband. If he would like STI testing, I would recommend only urine for gonorrhea and chlamydia and blood tests for HIV and syphilis. I see no need for either of you to be tested for HSV. 4) For sure there is no need for you and your partner to stop having sex, or to start using condoms. Having been sexually active together, you have both already been repeatedly exposed to each other's HPV, and changing sexual exposure or practices at this time is pointless. If you are sharing the same strain, you both are immune to new infection with that strain.

Finally, as implied in my opening comments, do not be seriously worried about cervical cancer. Even if you happen to have a high risk HPV type (one not covered by the vaccine), the large majority of infections do not progress to cancer. If they do, it takes years for that to happen. Regular Pap smears are nearly 100% effective in detecting pre-cancerous changes (high grade SIL, i.e. HSIL) and early cancer, easily cured before it becomes invasive and life threatening.

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

HHH, MD

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35 months ago

Hi Dr. Handsfield,

Thank you so much for your detailed response, this information has been incredibly helpful. Please continue doing your important work - it is much appreciated!

H. Hunter Handsfield, MD

35 months ago

I'm glad to have helped. Thanks for the thanks!---