[Question #944] HPV risk in new relationship

88 months ago
My new girlfriend and I have several questions about our STI risks for eachother... I have had a partner with known STIs and she has had probably more partners than you can count on two hands before she met me.  I think the first question that is weighing on me is HPV concerns.  
Over 7 years ago I had two partners that were treated for dysplasia prior to meeting me.  One had a LEEP procedure, the other I do not know how hers was resolved, but she said it was, and I no reason to doubt her.  The one with the LEEP procedure had normal paps for at least six months if not longer before we slept together, the other ex is unknown.
I think it reasonable to conclude I carry High Risk HPV, whether it is shedding or not I realize cannot be known.  I have encouraged my new gf to get the new multiple strain hpv vaccine, however it has put stress  on our relationship, largely due to my anxiety over the issue.  she also just turned 27 so it would take a little investigating to find a clinic that would offer it to her at her age.  Plus, we would like to be intimidate now, and not wait however many weeks it takes for the vaccine to offer protection.  I had hoped you could offer some perspective on our situation?
There are other concerns as well, but I think this is where we were hoping to start... we appreciate your time!
H. Hunter Handsfield, MD
88 months ago
Welcome to the forum. Thanks for your question.

These issues regarding HPV have been addressed many times on the forum. My replies will be succinct; you can find additional discussions in the many other threads that deal with HPV.

That you had past partners with dysplasia does not increase the chance you are currently infected, since the large majority of HPV infections are cleared by the immune system long before 7 years, typically within 1-2 years. Accordingly, I disagree that it is likely you are currently infected with the HPV strains related to those two partners. In my opinion, it was a mistake for you to even mention those past exposures to your new partner. As you have found, it is common to simply creat anxiety unnecessarily, without any benefit in reducing their risk of an HPV problem. I always recommend that people not tell their new partners about past HPV exposures or infections -- only about currently diagnosed and active infections. (Some couples routinely discuss their past sex lives including HPV or other STDs. But that's purely a relationship issue, not required for health reasons.)

And in any case, for every woman diagnosed with an HPV related problem, there are at least 10 others who are infected but not diagnosed. So your exposure risk is no higher because of the two you know about than it would be otherwise. Similarly, assuming your new gf has had other partners, she is just as likely to be infected with HPV, including high risk types, regardless of your past partnerships. The high risk HPV types are the most common; low risk are less frequent, and almost all sexually active people have been infected at one time or another with high risk HPV.

So I see no special need for your new partner to be immunized, especially since she is beyond the recommended age for vaccination. For sure she doesn't need it on account of your past exposures.

As for your "other concerns", assuming they are STD related:  if any doubt about recent symptoms or exposures, both you and your new gf could have standard STD testing, i.e. gonorrhea, chlamydia, HIV, and syphilis. If all negative, no further worries. Testing for other STDs is not normally recommended unless at special risk, e.g. if one of you has herpes and the other doesn't know his or her status.

I hope this has been helpful. Let me know if anything isn't clear.


88 months ago
Thank you, Dr. HHH.  I suspected that would be your answer, but I didnt know if maybe I was missing anything.  We have both had STD panels done, both negative.  
Herpes is indeed a concern for me, however...Perhaps this is a greater issue.  The partner with the LEEP procedure from years ago also had genital hsv2.  We were together for 6 months, had condom protected sex, she did NOT take medicine, and we had unprotected oral sex both ways often.  I have had both a herpeselect and WB done in the last year with negative hsv2 results (I have hsv1 probably since childhood).
I have had some strange symptoms.  I had a random itchy, hive-like rash appear this year in my boxer shorts region.  I have not been sexually active for a very long time.  I had the rash NAAT (Amplivue) swab tested right away and it was negative, and although the diagnosis was a mystery, soap related contact dermatitis is suspected.
Additionally, I also sometimes get oral sores that my doctor suspects to be canker sores.  I just had one recently swabbed and was negative for herpes.  They generally appear inside my lips, not outside.  Or just below my gums, not on them.  I understand that oral  herpes usually only shows on gums, hard palate, and external lips?  Any other way to differentiate canker sores from herpes?

Ive just had bad luck with random symptoms, Dr. HHH.  The negative testing is reassuring, but something Id like to stop having to think about... but then again those are suggestive symptoms, arent they?

The other concern/comment comes from my girlfriend.  She had a disgusting incident where a man danced on her, and actually ejaculated on her bare side/butt on the beach.  If he hadn't disappeared, we would have called the police.  That being said, she quickly showered, and from what I have read, that isnt really a concerning exposure from an STD stand point... correct? 
Thank you for your patience with the additional concerns.  I think this covers all of our bases, unless you require more details...
H. Hunter Handsfield, MD
88 months ago
The test results for HSV2 are much more reliable than symptoms in determining whether or not someone is infected. Your test results prove you are not. Which is of course typical: the average HSV2 transmission risk from unprotected vaginal sex, if one partner is infected, is roughly once for ever 1000 exposures. This is why many couples in which one person has HSV2 go 10 years and more, with regular unprotected sex, without the other catching it. In any case, "a random itchy, hive-like rash appear this year in my boxer doesn't sound at all like herpes. But most important, the test results settle the matter.

Oral herpes outbreaks rarely are inside the mouth, almost always on the outside of the lips, face, etc. Almost no recurrent canker sores are herpes.

In other words, no:  none of your symptoms are suggestive of herpes.

I agree your partner's experience at the beach was disconcerting and I understand it's upsetting due to the yuck factor. But nobody ever caught an STD from getting semen or other sexual fluids on the skin. No STD worries at all from this event.

88 months ago
Thanks Dr. HHH.  I just got mixed answers from my doctors which worried me.

That outbreak I had of raised red irritated itchy bumps all over my groin, inner thighs, some on my penis, and abdomen was pretty terrible. Of course I panicked.  I had recently worn and worked out in heavily bleached boxers that I definitely bleached more than usual, likely too much. I am hoping I simply had a bad allergic reaction.

I had discovered one red raised ‘hive’ on the the head of my penis and some general irritation on a Tuesday. That Wednesday morning had the doctor swab using Amplivue NAAT test (is this test good?) and the result was negative. The next day (a Thursday) the lesions/hives were wide spread in the boxers short area, particularly in places where the seams of my boxers rubbed. I was back into my Doctor on Friday for another swab of the new lesions, and again negative results.  A week or so later a new lesion appeared, swabbed that same day, still negative.  Could residual bleach or detergent on my skin caused false negatives?

Things not in favor of herpes:
Negative swabs, No noticeable ulceration or crusting, no sexual partners for years and negative blood tests…. Also one week before the rash, I did notice a sudden itchy red hive in my waist band area that cleared in less than a day.  It was similar to the outbreak.  Perhaps this was a precursor?

Things that make herpes possible:
Unknown diagnosis.  Randomly appeared.  No general redness or other irritation that is common with contact dermatitis.  No previous reactions similar to this before.  It was only on the front of my body, so it was a herpetic distribution and not general distribution that you would expect from underwear contact...

GP was unsure when I first came in, but said herpes unlikely with the negative results.  Dermatologist thought bed bugs at first (definitely not correct) and gave assurance he didnt think it was herpes.  However, I recently contacted him again about it, and he said he couldnt rule it out since bugs were off the table and it was so random.  Perhaps this was due to several weeks passing and him not fully recalling the lesions.

Was the Amplivue a good swab test? Do we know how accurate the WB or IGG is? Is a sudden allergic reaction to bleach a reasonable diagnosis?  How comfortable would you feel having sex with a new partner in my shoes?

H. Hunter Handsfield, MD
88 months ago
You're really obsessed about this, aren't you?  You are seriously overthinking everything. As I said above,  your test results overrule everything else.  (Amplivue is an excellent test, but all tests for the virus can't miss infection and often do. So that result doesn't mean anything. But the others are proof.) 

The factors that you think "make herpes possible" in fact do not, none of them.   I have pacience for a lot of things, but not for irrationality or unwillingness to concentrate on and accept  Scientific evidence and expert professional advice.You don't have genital herpes. Suck it up, believe it, and move on.