HPV confusion

[ChristianZane]

I had unprotected genital and oral sex with a girl a couple of days ago, and recently found out I have genital and anal warts (not from that encounter). In a previous response to a post, you stated "but as you probably know, if she gets infected she'll probably never know it". http://www.medhelp.org/forums/STD/messages/2655.html
I was wondering if you could elaborate on that, I am going to definitely tell her about my new found diagnosis as I assume she has now been exposed, but could you please expound on that comment as it’s greatly confused me:

1. I was under the impression that someone will have a 33% of getting genital warts if they have sexual contact with someone who has visual warts.  So does that mean that if I am only shedding the HPV virus without visible warts, that person will still get the virus but most likely NOT warts?  How is that only 1% of people with HPV ever develop warts, but 33% of people who have sex with someone with visible warts do?  I am so confused about this, help!  Is there still a remote chance she WON’T get warts and never even know she has HPV?
2.  What are her chances percentage-wise A. of her getting an abnormal pap smear within the next couple of years and B) Getting genital or anal warts within the next couple of years?  My doc says the strain I have is most likely only a wart-causing type, if so, does that mean she won’t get abnormal paps?
3.  She told me she slept with a lot of men about 10-15 years ago.  Can I safely assume (I realize not 100%) that she *probably* has or had the most common HPV virus (which is probably what I have, 6 or 11) and even if I give it to her, her body will be immune to that strain and not develop warts or an abnormal pap smear and she will never ever know?
I was just confused about how she would never know she had HPV if I gave it to her, when a high percentage of people who have sexual contact with someone who has warts gets warts.  So I assume there is a difference between contracting the virus through asymptomatic microscopic shedding versus direct contact with the wart (high viral load)?  I would think that once the virus gets into the body, it doesn't know the difference how it got there?  This must fall under the “The dose of the pathogen” thing?  

[H. Hunter Handsfield, M.D.]

Well, my first response is to wonder why you were having unprotected sex if you had recently diagnosed genital warts (or any other STD)?  But more on that below.

My "she'll probably never know" statement about HPV transmission is accurate for the large majority of HPV infections.  It is less true about infection with HPV types 6 and 11, the main causes of genital warts.  You are wrong about these being the most common HPV types.  The large majority of HPV infections are due to the 40+ other HPV types that commonly infect the genitals and that don't cause warts.  

Few good data have existed on the frequency with which people with new HPV-6/11 infections develop overt, visible warts.  Therefore, the estimates have varied widely, which explains why some sources might say a third or more of exposed people will develop warts, whereas other sources might say it is uncommon or even rare.

A brand new study in fact suggests the risk is quite high (quite a bit higher than I would have predicted). It was in research with the new Merck vaccine against HPV, which protects against HPV types 6, 11, 16 and 18.  Among persons who received placebo and and who then acquired HPV 6 or 11, about half developed visible warts.  Some of these warts were small and/or internal, so not all of those persons would have known they were infected if they hadn't been in a research study (with frequent follow-up visits and careful examinations).  So maybe the one third estimate is about right.

But there is no way to directly apply these results to your situation.  The risk of HPV 6/11 transmission for any single episode of sex remains unknown.  (Most of the study participants who acquired warts probably had sex many times with the partners who infected them.)  Also, you have no way of knowing whether your partner might have been infected in the past with HPV-6/11.  If so, she is immune to catching that type again.  So to answer your specific questions:

1)  See above.  There is a good chance she will not get warts, but she certainly should be on the lookout for them.

2) There is no way to predict with certainty her exact risk of getting an abnormal pap smear from any single exposure to HPV of any type.  This is one reason that all sexually active women should get regular pap smears, even if they don't believe they are at risk for an STD.

3) Virtually 100% of people who have "slept with a lot of men [or women]" have been infected with at least one HPV type, but there is no way to know which types she has had.

As I suggested above, your question implies you had sex with this new partner after you were newly diagnosed with genital warts.  Presumably you told her about them before you  had sex with her, yes?  Or did I misunderstand something?

HHH, MD

[ChristianZane]

Sorry for the confusion, I didn't know I had warts when I slept with her, but shortly thereafter I found out after I noticed them.  

I've already spoke to her about and she is fine with it, in fact we are committed to each other for the long term, so she wants to know what we can do to minimize her getting warts, she doesn't care about getting the HPV virus which she is very educated about.  So other than a condom which doesn't cover where my warts are anyways, does having them cautered off and waiting for them to heal at least minimize the risk for her to get warts (but not catch the virus)?  I would assume removing the high viral load of visible warts would at least minimize her risk of not getting warts.  And in essence, even after being exposed to a visible wart in the genital area, she is more likely than not (33%) to NOT get warts and never ever have symptoms?  That's better than over 50% :) I'm still confused tho about your answer in regards to HPV transmission of direct contact with a wart as opposed to microscopic shedding, that's why she wants to know if removing my warts (but still having the HPV virus in skin) will at least minimize her chance of getting warts.

Happy Easter!!

[ChristianZane]

Oops one more question if possible: we sat in a lukewarm small bathtub together, we didn't rub against each other, I read somewhere that my anal warts could now someone infect her.  How would the HPV virus swim through luke warm bath water into her anus?  That sounds crazy to me, I would think if HPV could be transferred through hot tubs, almost anyone who used a spa would have anal warts.  And I don't have warts on my penis or the shaft, her chance of getting oral warts I would assume are ridiculously low?  I wish I lived back 2000 years ago when no one probably cared when they got warts, this social stigma of contagious pimples may doom a once in a lifetime relationship, ignorance would have been bliss I supposed, just like it is for the 30 million people walking around with this nonsense and not knowing it.

[H. Hunter Handsfield, M.D.]

Thanks for clarifying the timing.  Your question made it seem your diagnosis was made before your new partnership began.

Common sense suggests that removing warts reduces the risk of transmission by reducing the viral load, and most experts assume this is the case.  However, there are no data to prove the point, and undoubtedly some transmission risk persists, because infection also is present in normal-appearing skin.

Neither HPV nor any other STD has ever been known to be transmitted through hot tub water.

HHH, MD

[SweetKia]

I have a question about HPV. My last pap smear was abnormal and I tested positive for HPV. My gyno didn't say what "Strain" it was or anything, but I think she mentioned it was the high risk for cervical cancer...
anyway, my question is this: Virus's go away on their own right? Which means HPV will go away? Or will every pap smear I have from now on be abnormal because of HPV?

[DreamBro]

My girl have a genital HPV. Can i get HPV by touching
her genital skin with my hands? Or get it from her saliva.
Can i get HPV by touching something that an infected person touched with their hands?

[H. Hunter Handsfield, M.D.]

No thread jumping, which distracts attention from the original question and is unfari to the original questioner.  For a reply from me, re-post your questions in new threads.  Or just search this forum and other readily available online sources.  The answers to your questions are readily available.

HHH, MD