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Definition of persistent HPV
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Definition of persistent HPV

I'm a bit confused as to what determines whether an HPV infection is persistent, and why it poses more of a threat.  I'm a male that had a flat, brown wart removed several years ago (Derm. confirmed it was HPV).  Over the next few years, I had several more brown spots removed that weren't tested, but a different doc said he thought they were HPV (they looked a lot lighter and were much smaller-married entire time).  I'm still finding tiny brown specks that I assume are HPV. The few spots I've watched and not had removed are still there a few years after first noticing them.  

1. Assuming this is HPV, does it constitute a persistent infection? If so, how does it actually increase cancer risk (ex. is it from the spots growing, turning to cancer, which means I should definitely have them removed)?

2. If it is persistent, how much more risk do I have for the following (even if initial risk is really small):

Penile? Oral? Anal (heterosexual)?

I know risk is tiny for these, but was wondering how much risk is increased because I've read rates are expected to rise, with oral HPV replacing tobacco as the number one oral cancer risk (I assume a persistent infection increases this risk).

3. I've read a persistent infection with wart causing (ie usaully not dangerous strain) may be caused by an underlying infection with a dangerous type, could you comment and does that affect the cancer risk for me (if I have the dangerous type) and how much?

4. Are flat brown warts more dangerous or considered cancer, etc?

5. Lastly, sorry for length, I have noticed a newish large irregular patchy area all around the base of my penis and along the bottom that is darker than the rest of my skin.  When flaccid, it covers 1/3 to 1/2 of the penis and is less noticeable when skin is stretched/erect.  Does this sound like some sort of large HPV infection, or something else (cancer, pigmentation changes, etc)?
239123_tn?1267651214
Welcome to the forum.

The definition of persistent infection, whether HPV or anything else, is pretty straightforward.  It means the infectious agent remains in the body.  For HPV, however, it's a bit complicated.  Some HPV infections persist in the forum of viral DNA, which can't be transmitted and never cause disease.  Whether you call this "persistence" or not is a matter of semantics, not biology.  If it never causes a problem and is kept in check by the immune system, who cares?

Whether or not you have persistent HPV, and whether it is causing recurrent warts, is not something I can answer based on the information provided.  That the recurrent lesions are similar in appearance to the original one is not, it itself, very reliable.  To your specific questions:

1) The HPV types that cause warts rarely cause cancer; and the cancer-causing ones rarely cause warts.  I can't say whether your lesions mark you as being at greater risk of genital cancer; this is a question for a dermatologist after personal evaluation. not online investigation.   However, I would reassure you that HPV related genital skin cancers are rarely dangerous; as long as you are on the alert for new lesions so that they can be excised (or otherwise treated), the chance of a serious outome is very , very low.  This is something to pay attention to, but not to be a cause of serious alarm.

2) I don't understand what you're asking.  If you have an active HPV infection, you can transmit it to partners by the activities mentioned.  But the risk to you for new HPV infections, or of cancer, is no higher than if you had no HPV at all.  Even though some oral cancers due to HPV-16 are rising in frequency, these remain rare cancers.  See the thread linked below:

http://www.medhelp.org/posts/STDs/HPV-and-oral-sex/show/1515473

3) As noted above, different HPV types cause warts and cancer.  This remains a question for a dermatologist, not an STD expert.

4) I don't know the answer to this. Again, a dermatologic question, not one an STD expert is likely to know.  (When we see unusual or recurrent penile lesions that may be recurrent warts or cancer in an STD clinic, we refer them to dermatologists.)

5) Once again, a dermatology question. This doesn't sound at all alarming, however, and I doubt it has anything to do with HPV.

I hope this has helped.  Best wishes--  HHH, MD
5 Comments
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Thank you for your time. Sorry for the unclear questions, I was typing while anxious.  Guess a very simple way to sum up my questions would be with a worst case scenario. If I did have persistent hpv and it was a cancer causing strain, do I have an increased risk for cancer?  And do you think I'd be more susceptible to oral cancer?

With that said, I realize my anxiety isn't letting me be rational, so could you tell me if I should be concerned at all if it was a worst case?

One quick note about family. Can I transmit this to my son in any way? Say , if I don't wash my hands after using bathroom and grab his hand, then he uses bathroom, touches lips, etc, or if he climbs into bed with us at night after my wife and I had sex and for some reason takes his clothes off in the night (he's three)? All very unlikely, but I'm just trying to get a feel for how easily it spreads do I can protect him.  
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239123_tn?1267651214
"If I did have persistent hpv and it was a cancer causing strain, do I have an increased risk for cancer?"  Yes, of course. But even in that worst case scenario, the chance you'll actually get cancer is probably no higher than one in several thousand.

"do you think I'd be more susceptible to oral cancer?"  Of all people with genital HPV, probably under 10% have the same infection in their oral cavities.  So there might be some risk --  but here again your chance of actual cancer is lower than your odds of winning a major lottery.  If you haven't done so, read the thread I linked above.

The genital HPV strains are not transmitted except by sex.  They are never transmitted in the houshold.  The exposures you describe are no risk to your child.

You are clearly abnormally obsessed with HPV. Having it is a normal, expected consequence of human sexuality.  That includes the cancer causing strains, which are among the most common of all HPV types.  Also read the following discussion:

http://www.medhelp.org/posts/STDs/HPV-Transmission/show/1522088

That will end this thread.  Try to mellow out about all this.
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Avatar_n_tn
Thank you. This really helps me relax. Especially for my son.

Any thoughts on the heart disease link?
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239123_tn?1267651214
The association between HPV and heart disease is statistical only, and reportedly only involves women.  My guess is it will turn out to be a minor issue, although I imagine it will be many years before we know more.

That definitely ends this thread.  Move on without worry.
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