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For Dr. HHH re: HPV
Hello-- I've searched the archives but haven't found a situation quite like mine. I'm 54, female, with recurrent mild cervical dysplasia (2002, 2003, 2009). Apparently it's the reactivated kind as it has cropped up even when I have not had sex for a long time ( I was widowed in 2001 after a monogamous 20+ year marriage and was not sexually active in 2002 or 2009). I have now met a man, also 54, and although it's still new, I somehow know I've met the person with whom I want to spend the rest of my life, and he feels the same way about me. We have not had sex yet other than my performing oral sex on him. I’ve told him about my medical history and we’re starting to explore what to do next, along the lines of the vaccine, condoms, and our sex life in general. My questions (1) would it make sense for him to have the HPV vaccine, off label? I believe one of my paps came back positive for HPV 16. Cost is not an object. Of course we'd like to avoid the need for condoms for the rest of our lives. (2) and what about condoms - in the short and long term? Should we start off using them in any case? My pap was abnormal with mild dysplasia in July but the followup colposcopy was fine. Am waiting on the results of the 3 month followup currently. (3) he wants to eventually perform oral sex on me -- is it advisable to use those latex sheets? the HPV won't necessarily give me warning that' it's become reactivated and I feel the need to protect him, but is that over the top? (4) if we sex without condoms, and he picks up the HPV (assuming he doesn't already have it from prior relationships), and I later perform oral sex on him, could I infect my own mouth with the same HPV that causes the dysplasia? and even if so, is that a concern? Again, I thank you so much for providing your calming perspectives. It gave me the courage to date again and I've found the most extraordinary person, and the world is a brighter, more fulfilling place.
MEDICAL PROFESSIONAL
Dr. Handsfield and I share the forum. You got me. FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.
Your questions are good ones and well founded but you need not be concerned. Your recurrent dysplasia may or may not be due to HPV. While a large proportion of dysplastic changes noted on Pap smears are due to HPV, not all are. If they are HPV-related it is unlikely that your HPV is transmissible to sex partners and if it is, for better or worse, HPV is really of little consequence for men (or women either as long as they take the steps at follow-up, etc such as you have already been doing). As I suspect you know, for better or worse, at present HPV is a "fact of life" and most people have it or will have it at some point in the future. HPV is the most commonly acquired STD. Over 85% of sexually active women will have HPV infection at some time in their lives. The figure for men is less well studied but similar. In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears as appears to have been your experience. In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-24 months. In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated. For men there is far less risk of any sort. With this as background, let's address your questions:
1. If cost is not a concern, I see no reason for him not to get it. The vaccine is well tolerated and was recently approved for use in younger men so its male use is expanding. There is little downside other than the cost for him.
2. I see no reason for condoms in a long term committed relationship, either long term or short term, particularly if he receives the vaccine. I would not wait to complete the vaccine before stepping away from condoms either. AS I said, even if he were to acquire HPV, there is little risk to him or to you at this stage.
3. Similarly and using the same reasoning, I would not worry about unprotected oral sex in your situation.
4. Again, your major concern is an HPV that you may already have. I would not worry about giving it to him and then re-inoculating yourself in a different, oral location. Just not a meaningful concern.
I hope these comments are helpful. For additional information on this most common of STDs, I would suggest search for other HPV- and wart-related Q&A on this site, as well seeking addition information on sites such as the American Social health Association web-site (disclosure, Dr. Handsfield and I are both on the Board of ASHA). Take care. EWH
Your questions are good ones and well founded but you need not be concerned. Your recurrent dysplasia may or may not be due to HPV. While a large proportion of dysplastic changes noted on Pap smears are due to HPV, not all are. If they are HPV-related it is unlikely that your HPV is transmissible to sex partners and if it is, for better or worse, HPV is really of little consequence for men (or women either as long as they take the steps at follow-up, etc such as you have already been doing). As I suspect you know, for better or worse, at present HPV is a "fact of life" and most people have it or will have it at some point in the future. HPV is the most commonly acquired STD. Over 85% of sexually active women will have HPV infection at some time in their lives. The figure for men is less well studied but similar. In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears as appears to have been your experience. In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-24 months. In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated. For men there is far less risk of any sort. With this as background, let's address your questions:
1. If cost is not a concern, I see no reason for him not to get it. The vaccine is well tolerated and was recently approved for use in younger men so its male use is expanding. There is little downside other than the cost for him.
2. I see no reason for condoms in a long term committed relationship, either long term or short term, particularly if he receives the vaccine. I would not wait to complete the vaccine before stepping away from condoms either. AS I said, even if he were to acquire HPV, there is little risk to him or to you at this stage.
3. Similarly and using the same reasoning, I would not worry about unprotected oral sex in your situation.
4. Again, your major concern is an HPV that you may already have. I would not worry about giving it to him and then re-inoculating yourself in a different, oral location. Just not a meaningful concern.
I hope these comments are helpful. For additional information on this most common of STDs, I would suggest search for other HPV- and wart-related Q&A on this site, as well seeking addition information on sites such as the American Social health Association web-site (disclosure, Dr. Handsfield and I are both on the Board of ASHA). Take care. EWH
Dear Dr. Hook, I cannot thank you enough for your advice and perspectives -- and your rapid response. In reading this the first time, I was relieved to the point of tears. You and Dr. Handsfield are providing such a valuable public service. I'd like to donate a significant amount more than the small amount this site charges (the best $15 I've ever spent) to an organization that you recommend, to support your work. Please let me know who to contact, so that I can make a donation. Again, I am so very grateful.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
