Am I too cautious?

[ArtVan]

My girlfriend, whom I havent had sex with yet, has high-risk HPV. She has never had warts, but she has had several consecutive abnormal paps and 2 colposcopys over a 2 year span. I have done extensive research on the web, but I havent found much information on how high-risk HPV affects men.

1. Is there any possible way her high-risk HPV can give me warts if I were to contract this from her? If so, how likely is it that her high risk HPV will result in me getting warts?

2. How effective are condoms? I read the New England Journal of Medicine's study on the effectiveness of condoms. However, it seemed to be more focused on the prevention of HPV in women. How effective are condoms in preventing high-risk HPV transmission from a woman who has it to a man who doesnt? (And I say "a man who doesnt" loosely. From your previous remarks, I see that there is no test for detecting high-risk HPV in males).

3. What risks are involved in performing oral sex on a women who has high-risk HPV?

I have been told by those close to me that I am being to cautious about this. I spoke to my doctors and they gave me the impression that this is not too much of a concern for men. Are they correct? I just want to be sure I address how having sex with a girl w/ high-risk HPV may impact my health.

Thank you very much for your help. I think this forum is fantastic by the way!

[H. Hunter Handsfield, M.D.]

First, you cannot assume your partner still is infected.  She may be, but if she has had treatment (e.g., cautery of the cervix), the infection might be resolved; and in any case most such infections clear up on their own within a couple of years.

1) But if indeed she still is infected, your risk of warts is low; high-risk HPV types rarely cause warts. (Of course, there is no way to know whether your GF has more than one HPV infection, and could happen to also be carrying a wart-causing type.  But most likely not.)

2) It is fair to assume the condom protection shown in women also applies to men.  The problem with condoms is not that they don't work, but they aren't perfect. The reduction in HPV infection in women in the NEJM report (the research was done my colleagues of mine) was 70% among those who used condoms 100% of the time, and 50% in those who used condoms 55% to 99% of the time.  In other words, even with perfect use, there still is some risk--and over multiple exposures with an infected partner, even with careful condom use, it is likely that most partners eventually will catch the infection.  (The importance of the NEJM study is not that condoms are a solution to HPV prevention, because 100% condom use is a difficult challenge for most people.  The study is important because it proves that certain political elements were wrong to use HPV as a poster child to claim that condoms don't work.)  Anyway, you will reduce your risk of catching your partner's HPV by using condoms consistently, but there still is a strong chance you will eventially be infected--if she still has a transmissible infection.

3) Overt oral warts are rare, but asymtomatic HPV infection is fairly common.  It is pretty likely you might catch it (again, assuming she is infected).  But if so, the chance of any kind of serious health outcome is zero or close to it.  If infected, almost certanly you will never know it.

Your friends and your doctors are entirely right, in my opinion.

Good luck--  HHH, MD

[ArtVan]

Thank you very much for answering my questions.

In addition to her never having warts,  her obgyn recently suggested that she receive the vaccination to prevent her from ever getting the HPV that results in warts. This made me assume that she does not have the wart producing strand of HPV. I assume this because, in my mind, it just didnt make rational sense for a doctor to recommend a vaccination for something she may already have. Is my assumption correct? Is it safe rule out the possibility of her having the wart producing HPV if her doctor suggests that she receive a vaccination for it?

[H. Hunter Handsfield, M.D.]

The new vaccine covers 4 different virus types.  It will protect her against any types she hasn't yet been infected with.

Almost certainly, her doc doesn't have a clue what HPV type she has, except that it's probably a high risk type.  You definitely cannot rule out her having an infection with a wart-causing strain.

But stop worrying about it.  Genital warts are a minor inconvenience, not a serious health threat.

HHH, MD

[earnest123]

Say ArtVan does have sex with his girlfriend protected or unprotected. . .

What does he tell any future female partner's (if that is the case)?

(1)Nothing.
(2)I am more likely to have HPV than the average guy.
(3)I definitely have HPV.  

Could be a deal breaker. . .

And what responsibility does any female with issues similar to his girlfriend's colpo probelms have while on the dating scene?

[monkeyflower]

What to tell partners in this case sounds like a personal decision to me. I can tell you what I would do, though: nothing. What's the point? For god's sake, he doesn't even know if he does have it or if he cleared it himself. And if you ask me, anyone who considers HPV a dealbreaker is destined for a long, lonely life ;-)

[H. Hunter Handsfield, M.D.]

As usual, monkeyflower speaks truth.  I agree with her.

HHH, MD

[Barbara 41]

You absolutely have a responsibility to tell her.  HPV for a man is an inconvience - for a women it can be life threatening.  I am 41, I've had 3 partners over the past 10 years.  I've recently had a series of irregular pap tests, and now have been tested for HPV and am awaiting the results.

HPV has been linked to Cervical Cancer in women.  I think you would agree, putting a woman at risk with her being informed, is not just irresponsible, it's immoral.  If this was HIV it would be criminal.

Sorry - but you need to tell her.

[H. Hunter Handsfield, M.D.]

Most experts disagree with Barbara 41 and agree with monkeyflower.  There are some circumstances when informing partners of HPV definitely is required, but this isn't one of them.  Almost every sexually active person gets genital HPV; it is inevitable.  (That will change with the vaccine, but not for many years.)  Warning about any particular potential exposure does not reduce a person's risk getting infected someday, especially when the infection probably has gone away.

B-41, this has been addressed repeatedly on this forum.  You might want to read those threads.  Try searching for "HPV prevention", "HPV transmission", or even just "HPV".

HHH, MD