Feeling Guilty - Had sex and didn't tell

[gay_male_hpv]

Hi,

I am a 24 year old gay male with anal warts. I used to have some casual sex. When I discovered I had HPV, it didn't cross my mind that I wouldn't be able to do that again as I was in a relationship. But I am now single and would like to start seeing other guys.

At first I was scared about telling future partners. But then I looked online and most websites suggest it is extremely hard to pass it on through touching (yourself and then your partner) and oral sex. I don't have anal sex anyway so I figured it would be ok for me to have oral sex with someone without telling them about my HPV.

I have since had sexual contact with two people. The first was oral sex both ways and touching. The other one wanked me. I don't think he touched himself after. Both times I made sure my genital area did not come into contact with his. I didn't feel guilty at the time because I thought the chances were minute that I was passing HPV on to them.

But since then a I saw a nurse who told me she would tell all partners about HPV as, while symptoms are present, there is a higher chance of passing it on. I went back to the net and found a load of articles saying that oral warts are on the increase and others suggesting it could be passed on through heavy petting.

Now I feel guilty about not telling the two guys I have HPV. I just want to know what the likelihood of passing it on through the kinds of contact I had really is. I have read so many different things. For instance, I have read it is impossible for people to get oral warts unless they have HIV. How true is this and are there any exceptions? With the heavy petting, how heavy does it have to be?

Should I be feeling guilty? Should I tell all future oral sex partners that I have warts? What about when my symptoms go away? I just want to have a normal sex life. If I found someone that I wanted to settle down with then I would want to be honest with them but what about casual partners?

Thank you in advance.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.

There are no hard and fast rules about informing partners about HPV infection, which is why you have found conflicing information.  Whether people with anal warts can transmit HPV to sex partners, when the partner does not come into direct contact with the anal area, is not known.  Probably the same HPV infection may also be present on the penis or elsewhere in some people, but the frequency is not known, nor is the transmission risk from such exposure.

Some experts suggest that all persons with known or suspected HPV should inform all potential sex partners -- which the nurse you saw apparently believes. However, others point out that genital (or in some persons, anal) HPV infection is unavoidable and everybody is going to get one or more infections anyway, so that no special precautions are needed; people are equally likely to catch HPV whether or not partners tell them of their infections or not.

There is a lot uncertainty about oral HPV.  Overt oral warts indeed are rare, although they are somewhat more common in people with advanced HIV infection (i.e., overt AIDS).  Asymptomatic oral HPV may be more common, but it's still rare compared to anal and genital infection, and in general oral sex is not considered high risk for HPV transmission.

Below are links to other threads that provide additional perspective about informing partners and about oral HPV, including its relationship to oral cancers.  In addition, I just tried entering "HPV informing partners" into this forum's search function and it came up with 371 threads.  Many of those also may be helpful.

http://www.medhelp.org/posts/show/552283
http://www.medhelp.org/posts/show/588157
http://www.medhelp.org/posts/show/1181303

Finally, you don't say anthing about current treatment of your anal warts.  Are they being treated?

In summary, my advice is that until your anal warts have been successfully treated or have cleared up on their own, you inform partners about them if there will be contact with your anus.  Otherwise, consider it optional -- but if in doubt, it's generally better to tell than not.  Also, any anal sex you have of course ought to be with condoms, and you should be asking all your partners about HIV status and discussing your own, before proceding with any sex.

Good luck--  HHH, MD

[H. Hunter Handsfield, M.D.]

Anal warts indeed can be frustratingly slow in their response to treatment or to clear spontaneously.  Sometimes surgery is the most efficient and quickest solution; the surgery isn't fun and the recovery period painful, but you could consider consulting with a proctologist or colon and rectal surgeon, if you haven't done so as yet.  In any case, eventually they will clear up.

Probably somewhere around 15-20% of the population experiences genital/anal warts by age 30, but the data are imprecise.  The frequency may be higher among men who have sex with men.  Asymptomatic or unrecognized warts probably are common, especially if they are internal, e.g. inside the vagina or rectum.

Hand-genital transmission of HPV probably is very infrequent, but it may account for some of the occasional cases of warts or other HPV infections diagnosed in virgins.  Transmission by oral sex, i.e. oral to genital, appears to be rare.  However, it is not possible to put a per-exposure percentage figure to transmission risk by any route.

[gay_male_hpv]

Oh, forgot to ask, for the asymptomatic oral infection? Would that person then be a carrier and able to pass it on to others through kissing or oral sex? When you say it's rare, are we talking a 5% chance of transmission or a 0.5% chance? Oral sex is the main thing I do and this would be useful to know.

[gay_male_hpv]

Thank you very much for your quick response.

Yes, I am being treated but it is taking forever. I am on my third different kind of treatment now. The buggers just don't want to go away!

Thanks. I have already looked at a load of other posts and some of them have been quite useful.

One thing I am still very confused about though is the amount of people who actually get genital warts. I know that 80% get some kind of HPV but what percentage is likely to get the wart causing varieties? And what percentage of those shows symptoms?

What are the chances that a sexually active gay man already has genital warts and just doesn't know it? What are the chances he will catch it at some point? I feel knowing this will make it easier to tell future partners. I would rather have the figures for the type that I have (the genital warts variety) than have it distorted by inclusion of all other types, many of which aren't even harmful to men.

Finally, what are your thoughts on hand to genital to hand transmission? Is it possible and how likely is it?

Thanks again!