HPV questions from a male who has been exposed and may be a carrier

[hpvquestions123]

1)On a couple of places online I have read that that for dysplasia to occur, the HPV infection would have had to have been around for quite some time to grow.  I had an ex-girlfriend contact me and tell me that she had an abnormal pap, positive for high risk HPV, and had moderate dysplasia (she had not had a pap done in a few years).  We had sex 6 months prior to her finding out that she had the dysplasia.  We had a one time encounter and a condom was used.  Could moderate dysplaisa occur within approximately six months from the time of HPV infection, or would it have to take longer than that for it to develop that far?  

2)I have had 3 partners since I was with her the one time.  I have already discussed this with my current girlfriend. The other 2 women were both one time encounters using a condom.  Are the odds of transmitting high risk HPV with a condom during one encounter really high enough to present a substantial risk? I know my ex most likely had an active infection of HPV when we were together, whether I gave it to her or not will never be known, but at the very least I have been exposed to it.  Should I contact the other 2 women I was with after the woman with the positive HPV and tell them that I may have it?  

4)Would these other women be protected by receiving their yearly pap, or could dysplasia or cancer really come up quickly enough that I need to notify them to get checked out ASAP?

5)I was told by a phone counselor that for a woman to have dysplasia then the HPV would have had to have been in direct contact with the cervix, so the likelihood of infection to the cervix would be very low with condom use.  thoughts?

6)lots of dif theories re: hand to genital transmission. Is there a real risk of someone with high or low risk HPV touching their genitals then immediately touching there partner's genitals? man to woman, woman to woman, man to man?

6)What are the percentages of women who will get dysplasia with the high risk strains?

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.  The bottom line is that you have some misconceptions about HPV.  Even infection with the high-risk (potentially cancer-causing) HPV types should be viewed as a normal and expected consequence of human sexuality. Most sexually active people are infected at one time or another.  Therefore, little is to be gained by talking with partners about known or suspected past infections.  Having such information does not help protect anyone's health; the main effect is usually just unnecessary anxiett.

To your specific questions (using your own slightly atypical numbering system!):

1) Time from HPV infection to dysplasia:  You read wrong.  That's the common belief, held by most experts until 10 years ago.  However, it is now known that dysplasia can appear within a few weeks of acquring HPV.  But your partner could have been infected many years before, or long after the single sexual encounter you had with her.  The chance you either caught HPV or infected her during a single condom-protected exposure is very low.

2) There is almost never a valid reason to tell a sex partner about a previous partner's HPV infection.  It's not even always necessary when someone has had HPV himself or herself, e.g. if the known infection was more than a year previously.  It was a mistake for you to tell the one partner and I suggest you not compound the error by discussing it with the others.

4) Paps don't prevent anything from happening.  However, regular pap smears are highly effective in detecting pre-cancerous dysplasia long before it is likely to progress to cancer.  All women should have annual pap smears.

5) The phone counselor was right, but maybe for the wrong reason.  Whatever the mechanism, some research does indicate that condom use reduces the risk of dysplasia, separate from protecting against HPV infection itself.  But whether that is related to reduced penile contact with the cervix isn't known.

6) Hand-genital transmission probably occurs, but relatively infrequently and inefficiently.  But it's the likely explanation for most of the occasional abnormal pap smears found in virgin women.

6) This depends on the definition; there are mild, moderate and severe grades of dysplasia.  Mild dysplastic changes occur with most HPV infections of the cervix.

All these issues have been discussed many times on the forum.  Here are 4 threads that should answer any remaining questions about these issues.  The main take-home message is that you need to stop worrying about HPV; the chance you'll ever have a serious health outcome from HPV is very low.  And you can reduce that risk to still lower levels by getting immunized with Gardasil, the HPV vaccine that protects against some of the most important HPV types.  Regulatory approval for vaccination of men is expected in the US this fall.

http://www.medhelp.org/posts/STDs/HPV--Informing-past-partners/show/763292
http://www.medhelp.org/posts/STDs/Confused-about-hpv-interpretation/show/763984
http://www.medhelp.org/posts/STDs/HPV-Transmission/show/761416
http://www.medhelp.org/posts/STDs/concerned/show/980849

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

Answer (4) was supposed to have an additional comment:  All women should have regular (not necessarily annual) pap smears regardless of whether or not they have known exposure to HPV.

[hpvquestions123]

Thanks so much for the info Doctor.  I have spent many, many hours reading so much info on this site, and I am very grateful for you to kind of 'put it all together' for me.  One last question if it is answerable...  Can HPV be spread within 10 days of the infection?  Example: if I were with someone and exposed to HPV and got it, then had sex with a woman with a condom within ten days of the transmission, is it known if I would be contagious?

Regardless of whether or not I made the correct decision to discuss this with my current girlfriend, we are now addressing it and it's out in the open.  My current girlfriend was tested recently before we were together for HPV and was negative.  She is going in to get another HPV test done soon.  It does seem like extra anxiety, because I do realize that if she does test positive for HPV, it is likely as a result from exposure from me, but could potentially be from a previous infection that was lying dormant and was not detectable the last time she had a test.  So confusing, but again impossible to accurately point fingers and all.  

Much of my personal stress I believe comes from the regret and shame I feel for having made some poor decisions in sexual situations in my life, and realizing that even though I always thought I was 'doing the safe thing' by using a condom, I could still affect someone's health in a very negative way!  They really should teach everyone about this stuff in high school! I knew very little about HSV, and nothing about HPV before this came up...

thanks for the information!

[H. Hunter Handsfield, M.D.]

Nobody knows whether HPV could be transmitted as soon as 10 days after catching it.  I doubt it, but there are no data.

You're overthinking the situation by a long shot.  Please try to look at HPV just like staph, strep, E coli, varicella (chicken-pox virus), Epstein Barr virus (the cause of mono) and a hundred other bacteria and viruses that we all carry in or on our bodies.  All these occasionally cause serious health problems but usually do not.  When they do, it is never possible to nail down the source of infection; complications like cervical cancer, just as for a fatal staph infection, are unfortunate, but they are fault-free and should be blame-free.  The appropriate approach to HPV is to go forward with life with fingers crossed and with common-sense, uncomplicated prevention strategies like pap smears and vaccine, and otherwise to forget about it.