HPV and HSV-1

[gvb]

Doctor,
I have been informed by a past partner that they had a abnormal pap due to HPV. We had sex from approximately 1.5 years ago until about 4 months ago.  I have recently started dating a new girl, and am curious on how to continue forward, and would like some advice. Here are the factors i am considering:

a.) I am asymptomatic for any HPV (also recently examined for warts by a urologist) and, so there is a distinct possibility i do not have the virus. I have been "safe" in the past, and all episodes (except one brief encounter) with the HPV positive partner was with a condom.
b.) I could have contracted the virus and cleared it.
c.) based on statistics that you seem to be confident in, the majority of sexually active people will contract a form of this HPV virus, and that based on her past sexual history, i could be the one who should be worried about getting HPV from her.


1. How soon is the Gardasil effective? i have heard that just one shot, while not perfect, has an effective rate of 97%. This would seem to make sense, as immigrants to the U.S. are only required to have one shot of the three (of course U.S. Health Policy has been beyond asynine in the past).

2. Based on my sexual history (above) and 100% condom usage, what are your thoughts about possible transmission after only one shot/one month?  

Second topic, related but distinct. I believe i have oral HSV-1. I am not completly sure, blood tests hopefully be back to me later this week, but I am 90% sure. I recently gave oral sex to the new partner i was describing above.

3. The oral sex episode was around two weeks ago. Is there anything that can be done? From what i understand, i had no sores so the possiblity is low that there was a transmission from one episode. "Just wait and see"???



thanks in advance.

[H. Hunter Handsfield, M.D.]

It means that even if your partner has no history of oral herpes, there still is a 50% chance she has HSV-1.

Thanks for the thanks.  Take care.

[gvb]

Last two comments:

Could you clarify this statement:
"(Whether or not she has a history of oral herpes does not predict whether or not she has HSV-1.)"  

I thought oral herpes is HSV-1. Maybe you are saying that if she has a history of oral herpes, that does not predict whether or not she has genital HSV-1.


I will certainly recommend a blood test, and immediate vaccination. Based on other posts you have commented on, at least 80% of sexually active people have had the HPV virus sometime in their life, and at least 50% will test positive for HSV-1. To me, that means that if she is not in the 40% that have had both already (she grew up in central america and my limited research shows that she may even be higher risk for HSV-1), then around 40% of the men she would have sex with/date would put her in the same risk as me. I am still going to disclose this with her, but some logic and statistics goes along way.

Thank you for your response, this site is a genuine public service.

[H. Hunter Handsfield, M.D.]

Thanks for the clarification.  It was not clear from your original question that your former partner's HPV infection was diagnosed before the relationship began.

As for your new partner, it would make sense to use condoms if and when you start having intercourse, for at least a few months, to reduce her chance of getting HPV that you might be carrying.  But I definitely do not recommend avoiding vaginal sex entirely for such a trivial situation as the possibility of HPV.  Still, it makes sense for her to be immunized, as discussed above.

With respect to HSV-1, your more recent research is correct:  HSV-1 and 2 refer to the viruses, not the clinical conditions.  Either virus type can infect either the genital or oral area.  Your history of outbreaks triggered by UV exposure is typical for oral herpes.

Still, like HPV, your oral herpes should not be permitted to interfere with a rewarding sexual relationship.  There's a 50:50 chance she isn't susceptible, if she is in the half the population with oral HSV-1, she won't catch it again.  (Whether or not she has a history of oral herpes does not predict whether or not she has HSV-1.)  And when people get genital herpes due to HSV-1, typically they have few or no recurrent outbreaks and little asymptomatic viral shedding, so they don't have much risk of further transmission to other partners.  Therefore, genital HSV-1 really is not a very big deal.  All you really should do is avoid performing cunnilingus when you're having an outbreak.  Otherwise I wouldn't worry about it. (But of course discuss all this with your partner.  She obviously should have veto power over my advice if she wants to go beyond reasonable assurance to a 100% certainty she won't catch it.)  Another option is for her to have a blood test for HSV-1, so you and she will know whether she is susceptible or already infected and therefore immune to a new infection.

[gvb]

Just to clarify, and it probably wont change any of your answers.

The previous partner had the HPV diagnosis before we started having sex. It would not have been possible for me to give this to her.  She told me, and we decided to strictly use condoms. When we broke up, i did the research and saw that condom use is not 100%.  The concern is for the new partner, and therfore the recommendation of Gardasil was going to be for her.  

The second part was also for the new partner. I believe i have oral HSV-1, i never got any bad sores like i thought most people did, but did get slight "cold sores" (i think???).  I used to think that they might not be HSV because i only got them when i was out in the sun, but now i see that UV is a major activator of the virus.  My concern was giving her genital hsv-1 becuase of my condition, oral hsv-1. I had always heard that "oral herpes" is hsv-1 and "genital herpes" is hsv-2. Doing some research I find that it is simply not the case.  Learning that i could have given her genital herpes because of my possible cold sores hit me like a ton of bricks.  And to think the only reason I was giving her oral sex at the time instead of intercourse was to buy some time to learn about the HPV and possible remedies for that.

[H. Hunter Handsfield, M.D.]

It strikes me that maybe your questions about Gardasil were on behalf of your new partner.  She should consider it, but not necessarily because of your past exposure.  As a sexually active young woman (assuming she is under 26 years fold), she should have the vaccine on general principles.  But not necessarily because of your possible HPV infection.  If she does it, however, she should assume she isn't protected until after the third dose.  Any partial protection after dose 2 should not be counted on.

[H. Hunter Handsfield, M.D.]

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

Thanks for doing your homework and correctly interpreting most of what you found.  However, despite your urologist's reassurance and consistent condom use, you should assume you have been infected with the HPV strain that caused your partner's abnormal pap smear.  Consistent condom use reduces HPV risk by around 70%.  That leaves plenty of room for transmission over many sexual encounters during a long relationship. It is true that most sexually active people acquire HPV, usually more than once, but I don't agree that your partner necessarily was infected before your relationship.  It seems equally likely you could have been the source of her HPV infection.  You're never going to know.  Most HPV infections clear up within several months to 2 years; at this time, you may or may not be free of that particular HPV.  That you have not had warts doesn't mean very much; your partner's abnormal pap most likely was caused by a non-wart type of HPV. It also isn't possible to accurately judge whether or not your presumed infection persists at this time.

To the specific questions:

1,2) Gardasil won't have any benefit for you, at least not with respect to your partner's HPV infection.  Undoubtely it is too late to protect you from that particular infection.  The level of protection from partial immunization isn't clear, but most likely there is little or no protection until at least 3-4 weeks after the second dose, i.e. around 2 months after starting.  As in many areas of immigration law, the immigration requirement has little scientific basis, either in requiring immunization at all or in using a single dose as a measure of immunity.  Both of these ideas are wacko, in my view.  You may indeed decide to be immunized on common-sense grounds -- but you are only protecting yourself against future infection from sex with new partners.  (You probably know the vaccine is not yet approved in the US for use in men.  You probably can find a provider to administer the vaccine, but your health insurance probably won't cover it.)

3) This your first mention of "the oral sex episode".  From the title of your question and your comment about genital sores, I gather you are worried about the risk of genital herpes due to HSV-1.  In terms of preventing herpes, two weeks later, the answer to part of your question is no, nothing can be done.  But assuming that partner was not having an overt outbreak of oral herpes, that risk is probably zero or close to it.  I wouldn't worry about it.

Regards--  HHH, MD