[Question #9793] HPV Questions
29 months ago
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Hi,
I'm a 30 y/o male. In 2019 I discovered some very small, light brown genital warts - which I was able to clear via cryotherapy. I also received the Gardasil vaccine at that time. I haven't had any more trouble until two weeks ago, when I discovered what I thought might be a recurrence. This time they were just a couple of semi-translucent bumps, which I could barely see, but which looked like tiny warts to me, so I removed them with salicylic acid. I'm pretty upset about this recurrence, as I had hoped that my body had cleared the infection years ago. I'm now starting a new relationship, and I feel like I may need to disclose this, but I've heard so much mixed advice. So, my questions are: does this sound like a recurrence? And, what is my obligation to disclose, given the time frame, vaccination status, nuances of HPV, etc.?
Thanks very much in advance, and please continue this amazing work you do!
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H. Hunter Handsfield, MD
29 months ago
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Welcome to the forum. Thanks for your confidence in our services. You raise a difficult conundrum, not one I can solve conclusively. There is no clear right or wrong answer about disclosure of current or recent HPV infection.
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In would have been wise to be examined professionally when the recent bumps appeared. "Semi-translucent" and so small you could "barely see" them isn't typical for warts and could well have been something else entirely. That makes it more difficult to judge the disclosure issue. On one hand, even if they were warts, with them now gone after your self treatment, you likely are minimally infectious for HPV. However, nobody can say the risk is zero but there are no clear guidelines and, as you have found, advice online and elsewhere is all over the map. Many couples discuss past sexual lifestyle and STD history before having sex, in the sprit of communication and mutual respect, even when transmission risk is nil -- so even without this possible recent recurrence, you might decide to tell her about your past warts and vaccination.
In direct response to your questions, I would say you have no "obligation" to disclose any of this. But it might be wise anyway. Even though there is no obligation to discuss past HPV, partners often expect it. On the other hand, assuming she has a typical sexual lifestyle, undoubtedly your partner has been infected with HPV (just as you can assume you have other HPV infections beside the one that caused your past warts). And at any point in time, research studies have found that up to 50% of all people in the typical dating ages (20-35 or thereabouts) test positive for HPV DNA, so sex with you will not necessarily elevate the chance she has or will become infected -- so what's the point? OTOH, of course some partners would expect you to disclose all this, and you should ask yourself what her reaction is likely to be now versus how she would react if it comes out say a few months or years down the road.
Thanks for the advance thanks. I hope these thoughts are helpful. Let me know if anything isn't clear.
HHH, MD
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29 months ago
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Very clear answer, thank you Dr. Handsfield! I do have a couple follow-up questions/thoughts:
First, do recurrences of genital warts typically present in the same way (i.e., if they were darker colored, textured, and clustered when they first appeared, would it be typically for a recurrence to follow the same pattern?).
Second, is appearance tied to the particular strain of HPV, or is that more related to how your body processes it (for lack of a better term).
To close the loop on my original post, I find the idea of disclosure incredibly difficult, mostly because I also have GHSV1 (thank you for your incredible youtube video on the topic if HSV). Though I've always disclosed it (with success), I worry that HPV could be the proverbial 'nail in the coffin'. It sounds like HPV is so ubiquitous that I really don't pose any more risk than someone who has no idea of their status and/or is unvaccinated. In that sense it feels unnecessary. However, as it may be an issue of trust I have to consider the longevity and strength of my relationship.
Anyway, perhaps I, like many people here, are just looking for whatever reassurances and silver linings you may be able to offer!
Take care!
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H. Hunter Handsfield, MD
28 months ago
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I am unaware of systematic data -- i.e. published reports -- on the appearance of warts initially or at the time of delayed recurrence. Thinking back on my clinical experience, I suspect there usually is no difference. I also am unaware of any data on whether the different HPV types result in different wart appearance, but I strongly doubt it.
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I agree exactly with your statement that "...HPV is so ubiquitous that [you] really don't pose any more risk than someone who has no idea of their status and/or is unvaccinated"; and with the implied conclusion that, from a scientific perspective, disclosure is unlikely to reduce most partners' risks of infection or, more important, consequences like warts or future cancers. But of course that scientific truth doesn't necessarily eliminate human considerations, like potential partners' understandings and expectations. Undoubtedly one size does not fit all! However, I believe it remains true that most sexually active persons in the dating game are not as concerned about HPV as herpes, so your positive experience with HSV disclosure might help guide your decision. Also, many potential partners these days have been immunized against HPV, in which case their chance of infection with your wart virus (assuming you in fact still are infected yourself) will be very low.
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28 months ago
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Thank you very much for taking the time to give me such complete answers! They have helped ease my mind and provided much needed clarity. Take care!
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H. Hunter Handsfield, MD
28 months ago
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I'm glad it was helpful. Thanks for the thanks. Take care and stay safe.---