HPV conventional wisdom and new research

[Spencer23]

Doctor Handsfield,

First of all, let me thank you for taking the time to run a forum like this.  The opportunity to have STD-related questions answered by an expert in the field such as yourself is really a great public service, for which I’m sure many (not just myself) are quite grateful.

I was recently diagnosed with genital warts, and since then I’ve done a lot of research.  Most recent studies indicate that HPV is transitory, most infected persons “clearing” the virus in a year or two, and most probably not contagious after a few months of no warts.  But both the doctors I was examined by (my usual doctor, and a dermatologist) were unaware of these new studies, and said that to the best of their knowledge the condition was life-long.  It seems that this is still the prevailing “conventional wisdom” regarding HPV, and what's all over most web sites.  Both of these doctors were in their 60’s, so if they hadn’t studied anything regarding HPV/GW's since medical school then it’s not surprising that their knowledge is out of date.  Also, since genital warts are a common benign condition, they are probably low on their list on concerns.

However, as you are no doubt aware, the emotional impact of an HPV diagnosis can be far greater than the impact of the disease itself.  On most HPV-related websites and discussion boards I visited, unrestrained panic seems to be the order of the day (that was my reaction at first, too!).  Being told that the condition is permanent (still quite common with most doctors) probably doesn’t help matters much.

Well, one thing that confuses me, is that you state that you rarely see a patient have active GW’s for more than a year or two.  As this seems to be the case with most doctors, I would think the anecdotal evidence (no patients in most doctor’s experience with life-long warts) would contradict the conventional wisdom (that HPV is a life-long condition). Since so little was known about HPV, did doctors prefer to err on the side of caution or what?  Since life-long abstinance, as you are aware, isn't a realistic solution for most, this attitude may have done more to help spread HPV then if doctors had told patients to abstain/tell new partners for 6 months after visible signs are gone, as you do.

So I have a few questions about the formerly accepted medical knowledge of HPV.  What earlier studies led researchers to believe that HPV was permanent?  How old are these studies?  In light of today’s methods, were these studies scientifically flawed, or was the research sound?  Obviously, I would like to believe that HPV is transitory, but since I've seen two different doctors who've told me otherwise, I'd like a little more detail.  Is the transitory nature of HPV now widely accepted my most (knowledgable) doctors?

I think answering these questions would help ease the minds of many HPV patients who are getting conflicting information.

[H. Hunter Handsfield, M.D.]

There are detailed discussions of exactly the issues you raise earlier in the STD Forum.  Search for HPV, especially in the early part of this year (as I recall).

There is no "new" research indicating that HPV persists for life or that it doesn't.  The suspicion that it sometimes (often? usually? always?) persists has been present for 20+ years and to my knowledge there is no knew knowledge that provides clear answers.

One problem is terminology.  What does it mean for an HPV infection to persist?  If a snippet of DNA has been integrated into the host cells, but not enough DNA to result in viral replication, does that count as persistence or cure?  If the virus's full DNA genome persists but the immune system successfully prevents it from replicating and causing warts or pre-cancerous changes, is that persistence or cure?  What if there are whole virus particles, not just DNA, but something (immune system, DNA regulatory mechanisms) keeps it from ever causing a problem?

So the biology is uncertain.  But some of the epidemiologic facts are clear.  Once HPV clears up, it is rare for that particlar infection to either cause problems in the future (warts, pap smear changes) or to be transmitted to a sex partner.  And once a person has cleared a particular strain of HPV, the immune system makes it rare to catch that HPV type again.  But "rare" doesn't mean these things never happen; they do.

From a practical standpoint, my view is that most people can consider themselves cured when all signs of their HPV infection are gone, there is no recurrence within a few months (and certainly within a couple of years), and the available tests do not detect the virus.  Undoubtedly some people with those outcomes still carry viral DNA.  I consider them cured, and I encourage affected persons to act accordingly.  It is precisely because of the emotional impact that I lean toward using the word "cure".  But at a biological level, depending on the definitions I imply above, some (a few? many? most? all? we just don't know) are not cured.

When the STD/HPV experts can't completely, it isn't surprising that a clinicians' counseling advice is all over the map.  Perhaps the best advice, to health professionals and concerned patients alike (and all sexually active people) is for everyone to keep their antennas up for new information.  There is no doubt that these concepts will change as time passes and new data emerge.  In what direction, no one can tell.

Best wishes--  HHH, MD

[Spencer23]

Thanks for the response.  Personally, I don't care if there's remnants of HPV viral DNA hiding in my cells - or if they have a summer home by the lake - so long as I can't spread it to anybody else and I no longer have wart outbreaks.  

However, I was just curious what "old" scientific evidence formed the basis of the "suspicion that it sometimes (often? usually? always?) persists" that "has been present for 20+ years" as you state.  Is this purely an academic argument?  I understand that a virus isn't technically "curable" like a bacterial infection, but as long as symptoms and transmission aren't generally possible, that's good enough for me.  

So are you saying that there is no scientific evidence for extended, life-long GW infections?  If so, I wish doctors would stop telling everybody "you're going to have this forever" because most people are going to assume that they are talking about WARTS and not just some cellular DNA components...

[H. Hunter Handsfield, M.D.]

I'm not an HPV biologist, but some such persons have long believed that HPV persists indefinitely in all or most people who acqure the virus, at least in latent (DNA only) form.  There is no doubt that some people have permanent latent infections; the debate isn't whether it happens, but whether it is the exception, the rule, or something in between.

In any case, I don't agree that most people assume the discussion means warts, not HPV.  In my experience, many more people (mostly women) have questions about their non-wart-causing HPV infections than genital warts.  Most people with warts correctly understand that in general they are an inconvenience, not a serious health threat.

HHH, MD

[SunnyTriangle]

hey Doc you ever gonna put up that HPV FAQ?  This answer would be great for that!!!!!!!

-Sunny

[Spencer23]

Sorry, I shouldn't presume to speak for "everyone".  Of course I can see why women with high-risk HPV would be concerned about latency.  But since I have the low-risk, wart-related variety, I'm mostly concerned about the risks of recurrance and contagiousness.  If there's pieces of DNA left, big deal, as long as they don't do anything...

[Bobo_]

HI Guys
I have have noticed a wart on my penis about 2-3 years ago
at that time I didn't know what that was I actually thought that I always had it , like a birth mark or something ...
about a year ago I went to URO and he asks " hey do you want this wart removed ?"  
I was shoked , I was like wart ??? Then he explained to me that it was HPV . He actually found 5 of them underneith my shaft need testis. I got them removed and here I am , Just like new...
I don't even know where and when I got the damn thing ohh well..
But scince then I never had any new ones pop up.

And If anyone out there is woried , Don't be it does not hurt at all like I said above.  It is not life threatning ..
And removal of those things is not bad either :)

[mc19]

I'm glad I found this forum - I have been going through a hard time the last few months.  I was diagnosed with HPV in early June, when I noticed I had some genital warts.  I was prescribed Aldara, which I have responded wonderfully to and two months later, all of my warts are gone except for one which has reduced in size about 75%.

However, the emotional and psychological impact this has had on me and my relationship is not as great.  My live-in partner has not taken this well and this has destroyed our relationship.  Chances are I got HPV from the person I was with before him since he and I have only been together since April.  My GYN has told me that if this has destroyed the relationship then maybe I need to re-evaluate the relationship and I think she is right.  I have a friend who found out his partner is HIV-positive and he has stood by his partner and their relationship has florished.  But in my case, it is not so and with HPV not being as serious as HIV, this makes me wonder about the depth of my partner's feelings for me.

As it stands, he doesn't want to ever have sex with me again.  And he keeps asking me these questions which I can't answer.  He has a hard time accepting that HPV is an STD that is somewhat of a mystery...the percentage of infected persons is high plus there is no cure and I think he has a hard time accepting that.  He feels like there has to be some concrete answers.  I even took him to my GYN appointment last week and had him sit in and talk with her about it.  I thought that would do the trick but after we left, he still said he could not believe that 85% of patients have HPV and don't know it.  He wonders if he has it and is incensed that there is no test for men.  As of now, he has shown no symptoms.

It has been hard for me, living with him.  I feel like a leper.  And reading this thread in particular has lifted my spirits.  Is there really a chance that the virus will go away on its own?  I guess it's daunting to hear that this is a virus that you would have for the rest of your life.

I do know in terms of my current relationship, it is done.  I guess I just needed to vent in a place where people can understand my situation.  

Thanks for giving me a venue to do that.  :)

[H. Hunter Handsfield, M.D.]

I'm not sure whether you were looking for a response, but I was moved by your comments.  As you clearly understand, your (former?) boyfriend is seriously immature, regardless of his age.  I am not a relationship counselor, but perhaps it is good you are rid of someone who would make you "feel like a leper" over HPV/warts--especially after hearing the doctor's explanation, and even more especiall since you might well have caught HPV from him; 2 months (April to June) is pretty good timing, and it is at least as likely you caught it from him as from a previous partner.

And yes, your immune system will clear the virus over the next few months.  Once your warts resolve and do not recur for several months, you can consider yourself cured.

Best wishes-- HHH, MD

[krissy1121]

I was wondering... I was diagnosed with HPV about 2 years ago, and after treating the warts I haven't had an outbreak since then, so for about a year and a half.  Just a couple months ago I had an abnormal pap and then a colposcopy that showed moderate cell changes, and I am wondering if I would be considered 'cured' or if I could still transmit the HPV to others, since the virus isn't completely gone if it showed up in my pap?

[meemee21]

A related discussion, HPV latency period was started.

[pansy78]

A related discussion, red spot- HPV? was started.