STDs Expert Forum
HPV and Garidisil
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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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HPV and Garidisil

About a year ago I found 2 small bumps on the head of my penis.  They were reddish about the size of pencil marks and sometimes fleshy in color.  Over time they joined into one larger bump and got a little hard and crusty.  They disappeared after about 6 weeks on their own and have not returned since.  She had a small bump as well on the inside of her vagina. Mine were gone by the time i saw a doctor but he thought it was hpv warts.  We broke up months ago and the last time we had sex, which was unprotected, was 3 months ago.I have a new girlfriend who is almost definitely clean.  My questions are as follows:
1)  What do you think percentage wise is the risk that she could contract warts from either oral sex or vaginal sex given that there is no visible bump (doctor checked, he wasn't worried)
2)  What's the risk of passing a high risk strain through unprotected oral and also through vaginal sex?  Is there any way I could know if I have a high risk strain?  Would there be any visible sign?  
3)  Is the new Garidisil vaccine considered safe?  Would you recommend it?  Even if there is a .0001 percent chance that she could get a high risk or low risk strain of HPV either orally or vaginally from me, I'd want her to get it if the vaccine is safe and would eliminate the risk or even lower it.
4)  Am I just freaking out about all this?  
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All things considered, it sounds likely that you and your former partner had genital warts.  However, since no health professional confirmed the diagnosis directly--only your doctor by your description, after the problem cleared up--it is possible you had something else.  But I'll respond to your questions as if you indeed had genital warts.

1,2) Warts rarely are transmitted by oral sex.  It isn't clear why, but we rarely see STD clinic patients with oral warts, even when they have obviously performed oral sex on partners with genital warts.  In any case, once a person's visible warts have cleared up on their own, it is probable that the infection itself is gone and cannot be transmitted.  There probably are exceptions, but the odds are that you aren't at great risk of transmitted that HPV infection to your new partner, either orally or vaginally.  But there are no data to put a percentage risk to it.

3) The HPV vaccines (Gardasil by Merck, Cervarix by GlaxoSmithKline--the latter isn't yet on the market in the US) are extremely effective and highly safe.  They have no known side effects except occasional mild pain or swelling at the injection site--pretty much like any vaccine.  However, if you are still carrying the HPV strain that caused your warts, the vaccine probably won't protect your new partner from it unless you delay having sex with her until at least a few weeks after her second dose of vaccine, i.e. 2-3 months.  And ideally you would have to avoid sex until after her third dose, 6 months after the first.  However, all women should be immunized against HPV, so I urge your new girlfriend to go ahead and do it.  Finally, warts are almost never caused by the high risk (cancer-causing) types of HPV.  However, there is no way to know whether you might also have a separate high-risk HPV infection.  But really no reason to worry much about it.

4) It doesn't seem to me you are 'freaking out'; your concerns don't seem unrealistic.  But you should understand that HPV is almost always just an inconvenience, not a serious health risk--i.e., the chance of a dangerous outcome like actual cancer is very low.  And remember that everybody gets genital HPV; it is more or less unavoidable, and since the majority of infections do no harm, it isn't something to lose sleep over.  The vaccines will protect against some but not all types of infection, so even immunized people are going to continue to catch HPV.  Getting HPV isn't desirable, but it is an expected, normal part of being a sexually active person.

Lots more information about HPV and its prevention is available at several reliable websites, such as www.ashastd.org, www.metrokc.gov/health/apu/std, and www.cdc.gov/std.

Good luck--  HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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