 STDs Related Forums
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Welcome to the STD Forum! This forum does not cover AIDS/HIV issues. This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomonas, Warts, Yeast Infection
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum. 
Hunter Handsfield M.D. Senior Research Leader, Battelle Seattle Research Center University of Washington
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| Englishman 4/27/2006 | . | Hi doc. First of all let me say that you have saved me from some of the worse stress in my life - lack of sleep, unable to eat, etc. I have an experience that might help fellow readers, followed by a recurrence theory I would like you to respond to. I had growths on my penis, went to my local GUM (Genito-Urinary Medicine) clinic in England. The first thing I noticed was the posters and leaflets for genital warts – no where does it mention that there is no cure, it says only 2% of people with the virus develop symptoms, and that long-term problems are very unlikely. I had cryotherapy (which hurt a little, but not too bad) and spoke to the lady doing it (she had 5 years experience at this busy clinic) and she said it was nothing to worry about, that they will go away by themselves once my immune system responds, and that I don’t have to tell any future partners once my outbreak has cleared up. She said most people are probably immune or symptom free anyway (hence the 2 out of 100 who do develop symptoms and then go on to become immune and can not catch that particular strain of HPV again – as most proper recent studies show). The reason there is no cure is because technically there is no man-made cure (tablet, etc), but peoples immune system does the job (as it does with millions of pathogens all the time). This is why the vaccine that has been developed works, if the virus could not be eliminated (or totally suppressed if one is a molecular biologist!) by the immune system, scientists wouldn’t have bothered researching vaccination as a cure. The time difference among patients for the immune system to work is no different from any viral infection – some people get a cold for 1 day, some get it for several days, others longer, but no one gets a cold forever. My possibly theory on recurrence. 1. Warts treated, immune system kicks in, immunity from that strain likely within 2 years, usually much sooner – 6 months. 2. Exposure to a new strain, development of warts, patient thinks it is a recurrence, patient back to number 1 in this list. 3. A micro lesion remains, the patient is immune but the lesion is disturbed (scratched?, rubbed?) reinfects surrounding skin, the immune system does not initially respond because the nature of HPV is that it exists in essentially superficial upper layers of the epidermis (and is not a significant health problem from the immune systems point of view). Eventually the immune systems kicks in and clears the warts again. 4. If no micro-lesions are present and no new strain is contracted, and the immune system has cleared the virus, the patient is cured. 5. Some form of immuno-supression might explain cases not covered by the outcome of number 4 in this list – evidenced by certain people with HIV/AIDS, or very old people who develop warts – after all the priority for your immune system when you are 90 years old is not to deal with non-health threatening warts. What do you think doc, or any other readers? |
| Forum-M.D.-HHH 4/27/2006 | Englishman | It sounds like you found a knowledgeable provider, as I would expect in most UK GUM clinics, and have pretty good information about genital warts and HPV infection. Although I am not a virologist, nor do I keep up on research developments in the pathogenesis and immune response to HPV, your comments and theories about persistent and recurrent infection seem valid. I would just add that the very definition of HPV “cure” remains uncertain. Some experts believe that nobody is truly cured, i.e. that HPV DNA also remains (at undetectable levels, so that reappearance of active infection remains a possibility in for life. Other equally qualified experts disagree. Still others would agree, but still would call it a “cure” since the actual risk of delayed recurrence is low and such persons are immune from catching the same strain again. Best wishes-- HHH, MD |
| Englishman 4/27/2006 C1 | . | Thanks Doc, It seems to me that most American forums/sites I have investigated seem to promote irrational fear over this. I suspect that perhaps strong (Christian?) morality is influencing opinion rather than a rational scientific approach. From the news I read, many in the US seem both pro-life (anti-abortion), pro-death (support the death penalty, and indeed the War in Iraq, I am I the only one who spots the irony here?), pro-marriage, and pro-abstience until married. This forum represents a place where people can have rational intelligent discussion removed from religious morality and fear-mongering and I thank you for this. |
| Englishman 4/27/2006 C2 | . | One more thing. I accept the argument over "cured" and can see it from both perspectives. I have read your responses before about this. Arguments over definition are nearly always the dividing line between any two opposing views. I have been to university and now teach and have many a debate on a range of issues that almost always come down to a definition. Makes life both interesting and frustrating. |
| ChicShane 4/27/2006 C3 | . | Abstinence propogandists like to latch onto HPV as vehicle to promote their religious idealogy. |
| Englishman 4/27/2006 C4 | . | Agreed. Either way, it won't work! Not from my experience as a teacher of 12-18 yr olds. Generally the more religous the message, the less likely they are to listen! |
| Forum-M.D.-HHH 4/27/2006 C5 | Englishman | You surely are right about the political slant about HPV in the US. Happily, some of the outlandish voices have been somewhat stilled recently by the march of science. The still-to-be published research showing a high degree of efficacy of condoms in preventing HPV has taken wind from their sails.* And some of the more vocal rightist/populist organizations also have had to stand in support of the coming HPV vaccine, because they can't stand against cancer prevention. They made a few comments some months ago about the vaccine's supposed potential to promote promiscuity, got overwhelming negative feedback from their own constituents, and changed their tune. Sometimes common sense prevails, even in this bizarre, simplistic land. * From a scientific perspective, that research is the most sophisticated and probably most reliable study ever done on condom efficacy for any STD, and it shows that 100% condom use was assoicated with 90% efficacy in preventing new HPV infections. It has already influenced the US Food and Drug Administration, which was close to requiring a non-effectiveness warning statement on condom packages but now apparently will not do so. HHH, MD |
| Forum-M.D.-HHH 4/27/2006 C6 | Englishman | You surely are right about the political slant about HPV in the US. Happily, some of the outlandish voices have been somewhat stilled recently by the march of science. The still-to-be published research showing a high degree of efficacy of condoms in preventing HPV has taken wind from their sails.* And some of the more vocal rightist/populist organizations also have had to stand in support of the coming HPV vaccine, because they can't stand against cancer prevention. They made a few comments some months ago about the vaccine's supposed potential to promote promiscuity, got overwhelming negative feedback from their own constituents, and changed their tune. Sometimes common sense prevails, even in this bizarre, simplistic land. * From a scientific perspective, that research is the most sophisticated and probably most reliable study ever done on condom efficacy for any STD, and it shows that 100% condom use was assoicated with 90% efficacy in preventing new HPV infections. It has already influenced the US Food and Drug Administration, which was close to requiring a non-effectiveness warning statement on condom packages but now apparently will not do so. HHH, MD |
| Englishman 4/28/2006 C7 | . | Hi Doc / Any other readers, I would still like to know how this study was conducted. Did it assume that ALL HPV infected skin was covered by the condom. What about if HPV infected pubic areas were rubbing together during sex? Does this account for the 10% of transmissions that condoms did not protect? I would assume that on a microscopic scale, scientists would be able to see whether HPV could penetrate through the membrane of a condom. Or more simply if you "pushed" HPV into the membrane of a condom, does it pass through? What maximum force is required to push it through? Does the magnitude of this force translate to possible forces during sex? I assume the study was probably an epidomological one, but the above questions still need resolving to explain the observed results. |
| Forum-M.D.-HHH 4/28/2006 C8 | Englishman | The study is based on real-time diaries of sexually active persons (as opposed to retrospective recall of condom use in the past, the basis of most condom studies). But you (and everyone else) will have to await its publication for the details. The study was not designed to explain the exceptions, ie why 10% of 100% condom users still got HPV. Skin contact above the condom makes sense. Neither HPV, HIV, nor any other STD pathogen can be "pushed through" intact latex or polyurethane, certainly not at the pressures expected during sex. HHH, MD |
| Englishman 4/28/2006 C9 | . | This explains why CORRECT condom use is so effective against STDs. I saw a documentary on TV about a sex worker in a brothel in Nevada who was very confident about how to use condoms effectively and has never caught an STD despite having sex with hundreds of men over the years. Readers please note that I do not condone, nor condem this behaviour it is between her and her clients and has NOTHING to do with me - I am just interested in this from an educational point of view. In my past I have certainly not used condoms effectively - not enough lube so that they rip, not taking enough time learning how to put one on properly etc. This now translates to my teaching so that people can learn more about the practical ways of using condoms effectively. |
| Englishman 4/29/2006 C10 | . | Having said that, I'm sure she probably had asymptomatic HPV at some point in her "career". | [Thread closed to new comments] |
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