I had an abnormal pap and was diagnosed with HPV approximately 7 years ago. Ever since then, I have had normal paps and 2 clean HPV DNA test in the last 24 months. Do I still have HPV? Do I have to tell future partners about this? Am I still at high risk of developing cervical cancer?
(Dr. Handsfield is Professor of Medicine at the University of Washington and Visiting Scientist at the Division of STD Prevention, Centers for Disease Control and Prevention (CDC), he is an internationally acclaimed expert in clinical aspects and prevention of STDs. He is board-certified in internal medicine and infectious diseases, and during his 30-year career has been president of the American STD Association; authored or co-authored more than 200 STD-related research papers, review articles, textbook chapters and a book, Color Atlas and Synopsis of Sexually Transmitted Diseases, published by McGraw-Hill; and for 25 years directed the STD Control Program for Public Health - Seattle & King County).
Q1. After exposure to HPV, how long will it take to see symptoms?
A. Most HPV infections cause no symptoms at all, however when they do, warts usually appear a few weeks up to 3 months after catching HPV, but sometimes warts may first appear many months or even a few years after catching the virus. Therefore, the appearance of warts doesn't always mean recent sex with an infected partner.
Q2. Shall I treat my warts or let them go away on their own?
A. Treatment will work less well if you delay; fresh, small warts generally respond more quickly than "mature", hardened warts. Further, some untreated warts will continue to grow, even to giant size--in rare cases up to an inch in diameter--this isn't common, but it's not pleasant when it happen. So as this implies, I don't think it is a wise decision to not treat and just wait for the warts to go away. If you try it, be prepared to start treatment promptly if your warts increase in size.
Q3. When can I expect to see my warts disappear?
A. My best estimate is that the average is 4-6 months, with some clearing in a few weeks and others taking a year or more.
Q4. Is HPV a lifelong virus or will it eventually go away?
A. What can be said with certainty is that the most sensitive tests available--tests that detect HPV DNA in genital tissues--become negative within 6-12 months in over 90% of infected persons. We also know that once the test becomes negative, the person is immune to catching the same HPV type again, which is further evidenced that the infection was truly eradicated by the immune system. However, it remains possible that HPV DNA (or maybe even intact virus particles) persists in small amounts, too small for detection by the available tests. Whether this happens at all, or in what proportion of infected persons, cannot be known with certainty with available technology. But if infection persists, it almost certainly is in amounts to small to be transmitted to another person and probably will never re-grow to cause warts or precancerous growth. But in most persons the most infections are controlled by the immune system and most experts believe they are truly cured. For "quick and dirty" responses by clinicians like me, the evidence is good enough to say "cure" and to reassure our patients accordingly.
Q5. What about the 10% who don't clear within 12 months?
A. Sometimes warts just persist or keep coming back. There are probably are differences in how particular persons' immune systems handle specific HPV types. The good news is that this sort of problem doesn't go on forever. It is the rare person who keeps having warts for, say, 5-10 years. But that may not be much reassurance: certainly 3-5 years can seem like forever in this sort of circumstance. Some people have a bigger problem with persistent or recurrent warts than other people. It doesn't mean they are abnormal, just different. The best advice is to just keep treating the warts as they appear.
Q6. Do I need to tell future partners about my HPV outbreak? A. My practical take-home message is that after several months with no wart recurrence normal pap, the person can consider him/herself cured; this is practically true if not always biologically true. Such persons probably transmit HPV to future partners rarely, if ever. Accordingly, I do not consider it ethically mandatory, or even recommended, that every person who ever has had HPV must henceforth and forever tell future partners they once were infected. My personal judgment is that you should inform partners in the next 3-4 months after your warts have disappeared, but if after then you have had no recurrences, you can safely assume your immune system has cleared the HPV infection and no longer need inform partners.
Q7. Can condoms protect me from HPV?
A. Condoms reduce the risk of HPV transmission, but they are not perfect, because they allow a lot of skin-to-skin contact beyond the coverage area.
Q8. What can I do to help boost my immune system to fight the HPV?
A. Nothing I know of will "boost the immune system" to speed resolution of warts or eradication of HPV. A balanced diet, getting a good night's sleep (most nights) and exercising are always good for a healthy immune system, but none of these has ever been shown to speed the response to HPV.
Q9. Do I have to stop having sex if I have genital warts? Can my partner and I keep "re-infecting" each other? A. No, you cannot transmit the infection back and forth. If you have a regular partner before the warts appeared, you don't need to stop having sex at all, except to avoid irritation if the wart areas are sore from treatment; s/he is already exposed and likely infected, too late to make any difference. (Some experts would say stop having sex until the warts clear up, then resume.) For a new partner, you probably can start having sex as soon as the warts clear up. That soon, you SHOULD tell your partner, because there is still some chance of transmission. If s/he is aware of the low risk of an adverse outcome and feels OK with proceeding, don't let HPV stand in your way. If it has been longer than 6 months, I don't think you need say anything. Some people would endorse 3 months, 4 months, or a year; the science doesn't allow any more precision than this. I say 6 months.
Q10. I just found out I have HPV and I feel ashamed and dirty, should I?
A. No. Your body is full of viruses. And bacteria. And fungi. And larger (but still microscopic) parasites. Being alive invariably involves being colonized with billions of other living things of hundreds of different species. Further, it is believed that most of the microbes that colonize us haven't even been identified yet. Normal life not only involves colonization by microbes; it requires it. It begins as a baby emerges from the uterus (and sometimes starts while in the uterus) by exposure to the bacteria that normally reside in the mother's genital tract; and it continues with every skin contact with another person, with breathing the air (in which the spores of various organisms always are floating), and so on. Same for viruses.
Going even further, from an evolutionary perspective some parts of our very cells are derived from parasitic bacteria. Do you remember mitochondria (singular mitochondrion) from your high school or college biology? They are the "energy factories" where much intracellular chemistry and metabolism takes place. Mitochondria are present in the cells of all animals you are familiar with. They originated billions of years ago, when some sort of bacteria entered the cell(s) of the primitive beings from which we evolved. Both species benefited and the relationship continued. Our mitochondria still have their own DNA and reproduce independently in our cells. Chloroplasts--the chlorophyll-containing energy factors that make plants green--are similar and probably developed the same way as mitochondria.
The take-home message is that nobody should feel "contaminated" just because a particular virus (or bacteria or other germ) happens to be detected because it causes something we notice and consider "wrong". Over 99% of our interactions with microbes are either neutral they benefit us in some way; harm is rare. Also, there is nothing particularly special about the fact that a virus or other microbe is acquired sexually. Sex is simply one of the many ways in which humans interact with one another. All those interactions involve sharing bacteria, viruses, etc. The ones transmitted primarily by sex are that way because they are too fragile to be transmitted by dry skin contact or through the soil, air, water, etc. Transmission requires very direct exposure of intimate body parts or fluids with other intimate body parts or fluids. That's all. In that sense, you can view many STD germs as "weaker" than such things as staph, influenza, or E. coli.
Q11. What about all the people you hear about on the web forums and chat rooms who insist on new research challenging the clearance studies, they say that HPV has no "cure", is this true?
A. There is no "new" research indicating that HPV persists for life or that it doesn't. The suspicion that it sometimes (often? usually? always?) persists has been present for 20+ years and to my knowledge there is no knew knowledge that provides clear answers.
And about "cure", one problem is terminology. What does it mean for an HPV infection to persist? If a snippet of DNA has been integrated into the host cells, but not enough DNA to result in viral replication, does that count as persistence or cure? If the virus's full DNA genome persists but the immune system successfully prevents it from replicating and causing warts or pre-cancerous changes, is that persistence or cure? What if there are whole virus particles, not just DNA, but something (immune system, DNA regulatory mechanisms) keeps it from ever causing a problem?
So the biology is uncertain. But some of the epidemiologic facts are clear. Once HPV clears up, it is rare for that particlar infection to either cause problems in the future (warts, pap smear changes) or to be transmitted to a sex partner. And once a person has cleared a particular strain of HPV, the immune system makes it rare to catch that HPV type again. But "rare" doesn't mean these things never happen; they do.
From a practical standpoint, my view is that most people can consider themselves cured when all signs of their HPV infection are gone, there is no recurrence within a few months (and certainly within a couple of years), and the available tests do not detect the virus. Undoubtedly some people with those outcomes still carry viral DNA. I consider them cured, and I encourage affected persons to act accordingly. It is precisely because of the emotional impact that I lean toward using the word "cure".
Q12. I’m a male with HPV, my girlfriend is afraid that she will get HPV if she gives me oral sex, is this possible?
A. Oral warts are rare, despite the frequency of oral exposure to HPV and undoubtedly to warts themselves. The biological reasons aren't known, but whatever the explanation, the various HPV types take hold on certain parts of the body but not others. The situation is different in people with immune deficiencies. Newborn babies (whose immune systems are still in development) sometimes get warts of the mouth and throat from exposure to mom's genital HPV during deliver; and oral and facial warts sometimes are seen in people with AIDS. But most sexually active persons have nothing to worry about in regard to oral sex and HPV or warts.
Q13. I had a lapse in judgment and had unprotected oral sex with a prostitute in a massage parlor. What are my chances of catching HPV.
A. Virtually zero.
Q14. I’ve noticed warts in and around my anus, what should I do?
A. Warts around the anus can be treated like genital warts, with liquid nitrogen, podophyllin, cautery, Aldara, etc. As for internal warts, it usually isn't that big a deal; and just like external warts, internal ones usually clear up on their own after a few weeks or
months. For all these reasons, in my STD clinic, we generally don't even look for internal anal warts - we just treat the external ones. However, if the external ones keep recurring, sometimes a referral to a proctologist is the best bet. Or if they become large--large enough to feel--they generally should be treated; it might help your external warts resolve. Call your local medical society for a referral to a proctologist (rectum specialist).
Q15. Do home remedies like tea tree oil and freeze kits help fight genital warts?
A. If there were valid research showing tea tree oil to be effective, it would be in the medical literature. But taking nothing for granted and having never heard of tea tree oil, I searched the scientific medical literature on it. I learned that it has promise as an antibacterial agent, such as a possible future ingredient in first aid creams (sort of like Neosporin). But there is no mention of research on treatment of warts.
Q16. How can I find out where I acquired my HPV?
A. It is almost impossible to know with certainty when HPV was acquired or from which sex partner (unless, of course, someone has only had one lifetime partner).
Q17. Will these new vaccines help clear my warts?
A. No, these vaccines will not treat existing infection. For those without HPV, one vaccine will protect only against the common "high-risk" types that often cause cancer and pre-cancerous changes in the cervix; the other company's product will also protect against the most common wart-causing types. Q18. What test can I take to determine whether or not I have HPV, and does the home vinegar test work?
A. There is no test which will determine the presence of HPV if there is nothing visible. The vinegar (acteic acid) test is not reliable, because it "lights up" many things which aren't HPV. It is especially unreliable, with both false negative (missing HPV infections) and false positive results (abnormal in the absence of HPV) on dry skin. The main use is in evaluating the cervix of women with HPV infection--not to diagnose HPV, but to determine where to take a biopsy. Its use may be appropriate by the occasional highly experienced observer, such as a well-trained dermatologist or perhaps your urologist, but even there the results often are questionable.
Q19. Is getting HPV normal?
A. Most people acquire a genital infection with HPV sometime or another; at least 70% of people who have had 3 or more different lifetime sex partners has been infected; it likely rises to 80-90% in most people who have more partners than that. "Normal" doesn't mean getting HPV is desirable, just that it happens to most of us. But most infections remain asymptomatic. That is, of those who get infected, only a small proportion go on to develop HPV disease, warts or an abnormal pap smear.
Q20. What are the statistics on HPV?
Centers For Disease Control:
1. Sexually active persons between the ages of 15 and 49 get at least one HPV infection (about 80 percent of Americans) at some point in their lives.
2. At any given time, somewhere around 20 - 40 million Americans are infected with sexually transmitted types of HPV.
3. By age 50, at least 80 percent of women will have acquired genital HPV infection.
4. About 6.2 million Americans get a new genital HPV infection each year. 5. Over a typical college career approximately 60% of sexually active women will become infected.
Q21. Do you have links from any respected medical institutions or government agencies that confirm your findings?
A. "Most people (up to 90%) who test positive for HPV with very sensitive tests for HPV (polymerase chain reaction [PCR] and Hybrid Capture® II) will become HPV negative on the same tests within 6-24 months from first testing positive. This is due to an effective immune response to HPV."
http://www.arhp.org/healthcareprov... ... cfm?ID=95#
"Most HPV infections appear to be temporary and are probably cleared up by the body's immune system, and in 91 percent of women with new HPV infections, HPV became undetectable within two years. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own. However, reactivation or reinfection is possible."
"The large majority of people cure themselves (usually without ever knowing that they had been infected). Average length of time from infection to cure is about 8 months"
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