HPV related question

[sleepless_in_michigan]

Hi Doctor

I had unprotected sex with a lady more than 2 years back. I have undergone tests for HIV, Herpes, Syphilis, Hepatitis A,B and C. All negative.

Recently, I have been worried about the HPV. I know it rarely affects men, but I am concerned about my would-be wife. I have following questions -

1. Can the antibodies to HPV be detected? It is said that the body clears off HPV infection within 2 years. If that is the case, there must be antibodies present in the blood (or are they localized only to the skin which is infected?). I am convinced that I was exposed to HPV, since the girl later said that she had had total 5 partners before me.

2. Is it possible to test for HPV in men somehow (blood test/penile swab). If there is no FDA approved testing, can I get tested by some test which is not yet approved (preferably in India, otherwise US is also okay) and if there is a test, then what is the accuracy and sensitivity.

3. Suppose I did contract a (or 2 or maybe 3) high risk strains of HPV. If I and my wife are monogamous throughout our life, will she still be at risk for cervical cancer? I have read somewhere that PERSISTENT infection of HPV leads to cervical cancer. What I am trying to ask is - even if she has developed immunity to a strain, can I still introduce the same strain to her again (maybe because I don't develop immunity and have the virus). And inspite of her immunity, the virus can cause damage?

4. What chances do you think I have of infecting my partner considering that I have not engaged in any sexual activity for last 2.5 years?

5. Suppose my wife gets infected with high risk strain(s). What is the probability of it developing into precancerous lesions? What is the probability of that eventually developing in cancer even if she undergoes routine pap smear smear test every year?

6. What is the probability of acquiring HPV in a single episode of unprotected sex for men?

[Dr Sean Cummings]

Hello again,

1) Really the swab needs to be taken from a moist area - this generally means in or around the urethra which is uncomrtable and around the head of the penis, which is not.

2) It is possible for them to disappear in a very short time but certainly not usual. They would normally be present for longer.

3) Your wife to be should undergo PAP smears every year irrespective of whether HPV is found on you or not.

best wishes, Sean

[sleepless_in_michigan]

Hi Doctor

Thanks for your responses.  have a few followup questions if you don't mind -

1. When the swab is taken for the commercially available PCR swab test, is it taken from the urethra  or only from the head of the penis. Basically, I am trying to find out if it is painful to take a swab.

2. I came to know about HPV only recently and have been trying to recollect if I exprienced any wart like things in last 2.5 years. There was at least one time when I had 2-3 itchy bumps on my penis shaft skin (separated, not cauliflower like) however they should have gone away in a week or two otherwise I would have gone to a doctor. Can warts go away within two weeks or do they take more time?

I am going through all this trouble because my would-be wife is most probably a virgin and I think I owe it to her to tell that I *may* be carrying this virus so that she can educate herself and decide for herself whether she is to marry me or not.
If she would not have been a virgin, I would not have cared much. But since she is a virgin, then because of me, she will have to undergo pap smear tests every year if she marries me!

[Dr Sean Cummings]

Hello,

Thanks for the post. I'll go through each of your questions in turn.

1) HPV is a superficial infection of the skin. The skin has squamous cells and HPV for the most part sits on these and does nothing terribly much. Occasionally, the HPV may cause an overgrowth of cells causing the appearance of warts. This can happen in any part of the body where there are squamous cells. These include the skin of the genitals, anal canal, mouth, vagina, vulva (outside part of the vagina) and cervix, shaft of the penis and head of the penis. The virus as I've said above will for the most part sit there doing very little. Over 90% of sexually active adults with a relatively small number of sexual partners in the past will have some evidence on the skin, using special PCR technology, of HPV contamination. There is a blood antibody response and this may become more important in terms of diagnostics in the future, but as yet it is not developed as a commerically available or necessary test.We don't know that you have HPV - you've just assumed that because of a judgement about the lady you had sex with a few years ago. In any event, 5 partners sounds modest.

2) You can be tested using a commercially available PCR swab. The specificity and sensitivity are indeterminate because HPV is usually invisible to the naked eye - so in some ways the test is relying on guesswork of the likely target areas. I'm not aware of this test being available in the USA or India but certainly is in Europe. I'll check for you and get back.

3) If you and your wife have been having regular penetrative sex then it is likely that you have swapped whatever HPV subtypes you have between you. The one thing that is certain is that your wife must continue to have regular PAP smears and act on whatever advice is given. There is much publicity currently regarding the benefits of Cervarix and Gardasil vaccines. These are useful but are best for HPV-naive individuals. Whatever their status, HPV vaccines curently will only protect against 70% of cervical cancers - which in itself is excellent but PAP smears must go on.

4) High if you still have HPV but zero if you don't. The time HPV is present on your skin will vary from person to person. The average is between 1 and 4 years.

5) It is thought that around 1% of women with high risk HPV subtypes will go on to develop precancerous (and detectable and curable) lesions. If she undergoes appropriate PAP smearing every year the chance of a missed cervical cancer is tiny.

6) No data on this.