A related discussion, thanks was started.

I recently have been told that I have HPV genital warts. The doctor gave me some cream for the warts to go away. My question is, how easily can my warts be passed on to my girlfriend if they are not present at the time. She is very worried that she will get it. We want to continue having sexual intercourse but I do not want to harm her. Can you spread warts when they are not present or are the warts dormant to where we should not wory about it.

Maximum antibody levels that protect against HPV are universally present following the third dose of the Merck HPV vaccine (Gardasil).  They usually are quite high a month after the second dose.  Merck has not published data on actual protection after only 1 or 2 doses.  My personal judgment is that there is substantial protection after 2 doses.  But nobody knows for sure, because it isn't known whether antibody level per se is the only or main determinant of protection.

All HPV infections, and all individual HPV strains, have very wide phenotypic expression from completely asymptomatic to overt, giant warts.  To my knowledge there is no correlation between the manifestations in one person compared with his or her partner with the same HPV strain:  one may have flat warts, or no warts at all, while that person's first partner has classical condymomata and the next might have low-grade dysplasia and nothing else.

HHH, MD

I knew that single warts were uncommon, and that mine was oddly coloured and shaped to be a wart, but unfortunately there's no way for me to get an alternative diagnosis now so instead I am playing it safe.

I wasn't aware no studies were done on vaccine efficacy post dose 1, 2 & 3 at each point during the trial.  I assumed they had to test regularly to determine what dose would be required by the general public.  There's no way for me to know the standard level of protection after dose 2 then is there?

Thanks for the answers, at least I know i'm not being too reckless.

Thanks very much doctor, you've put my mind at rest.

At the end of the day we are just trying to be careful and to protect each other as much as we can.

I have a related question about transmission of HPV.  

I understand quite well that high risk HPV usually doesn't have much of a manifestation in males (maybe a flat wart that would go completely unnoticed), but it can present as cervical dysplasia in a female.

However, in the case of low risk HPV I'm a little uncertain about its manifestations.  Does each particular low risk strain of HPV cause the same type of wart for that strain in every non-immunocompromised individual?  Or maybe the research has not gotten that far?  

I'm just wondering because when you go online and google picture of warts there are examples of massive cauliflower-like lesions.  Is it possible that the phenotypic expression of a single wart strain varies so much?

There are no data to answer your questions.  First, it isn't certain you had a wart.  Single warts are less common than multiple ones.  Second, as you already know, if you did have HPV, you might no longer be infectious--or you might, there simply is no way to know.  Gardasil induces partial immunity pretty quickly:  probably not much after only the first shot, but probably very good a month after the second. That is, the odds are good your partner will be at least partially protected by early June.  But there are no guarantees.  You cannot expect 'straight answers' when there are no data, and the official advice from the vaccine manufacturer is that people should not expect to be protected until after the third dose.

On the other hand, you guys are going more out of your way than most experts would recommend.  Contrary to popular beliefs, recent research shows condoms to be highly protective against HPV transmission.  My guess is that you could safely have condom-protected vaginal sex without much risk of HPV transmission.  And remember that if she gets it, usually it's no big deal.  Warts are an inconvenience, not a serious health threat; and almost all other HPV infections remain entirely asymptomatic and never cause disease.

Don't get me wrong:  I think your partner's decision to get immunized with Gardasil was a good one.  But not so much because of your situation--just because it is smart for all sexually active young women, to reduce the later risk of abnormal pap smears and cervical cancer.

Good luck--  HHH, MD