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Itchy genital area, HPV type 6, and Gardasil
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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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Itchy genital area, HPV type 6, and Gardasil

Hi Doctor,
I had protected vaginal sex and unprotected oral sex with a sex worker 27 days ago. I went to a STDs clinic 15 days after the exposure (I'm in Hong Kong) and had a fully check for STDs. Two days later i got the report, all the STDs (Chlamydia, Gonorrhoea, Syphilis, HSV2, HIV 1/2) came out negative except HPV Type 6. After I found out that I got HPV 6, my doctor recommended me to get the Gardasil vaccine, I took it immediately. Later, I found out that the HIV test that I had may not be conclusive because of the window period, so 25 days later I went back to ask the doctor and he told me that all the tests I have done were very conclusive, because they used the 4th generation ELISA DUO test, its possible to detect the P24 antigen if I was infected. Anyways, on that day (the 25th day), I took the ELISA DUO test again and the result came out negative again.

My questions are
1) Should i consider all the STD tests that I had on the 15th and 25th day conclusive? today the 29th day, my pubic hair area is still itchy, is that possible that I got infected by other STDs related to skin?
2) I know that HPV type 6 cause genital warts, but my doctor said many people with good immune system will never have any symptoms and are able to get rid of them within 2 years, is that true?
3) I'm going to tell my girl friend to take Gardasil, when will Gardasil become effective and protect my girl friend from infection?
4) So now I'm a HPV type 6 carrier and I already had the first does of Gardasil, I know that Gardasil can only prevent infection but cannot treat cells that are already infected, but according to your experience and observation Doctor, do you agree that my first dose of Gardasil can minimize my chance of having genital warts outbreak in the future? Because I know that once genital warts outbreak appear, its very likely that they will reappear again in the future. so i will try not to let them come out even once...

Thank you very much




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Welcome to the forum and thanks for your question.

It's interesting that you had some sort of test for HPV.  No such tests are approved for use in most countries, and I cannot vouch for how accurate yours was.  I also don't know what sort of specimen was collected.  However, if we assume you do indeed have an infection with HPV-6, you may have had it before the sexual exposure 4 weeks earlier.  New HPV infections usually don't show up only a month after catching them; the average is 3-6 months.  As for HIV testing, however, your results are 100% reliable; they prove you don't have it. Also, STDs do not cause pubic area itching; and HPV doesn't cause itching at all.

To your specific questions:

1) You have been over-tested for STDs; one set of testing would have been sufficient after such a low risk exposure.  But the results are valid; you were not infected with anything.

2) That's true.  Most HPV infections never cause symptoms and clear up on their own.  However, you should still keep on the lookout for genital warts, which may not appear until 6 months (or more) after exposure.

3) Gardasil is given in 3 doses.  A month after the second dose (i.e. 2 months after starting) there may be partial protection.  Protection is not complete until after the third dose at 6 months.

4) Gardasil has no effect on existing HPV infections.  It will protect you from the three other types covered by the vaccine (HPV-11, 16, and 18), but it will not reduce the chance you will develop warts from your current HPV-6 infection.

It is not true that "once genital warts outbreak appear, its very likely that they will reappear again in the future".  That sometimes happens, but it is the exception.

I would encourage you to not worry too much about any of this.  HPV is rarely serious, and we all get one or more HPV infections during our sexually active lives.  This situation should not be upsetting.  And don't feel guilty about your commercial sex exposure a month ago.  As I said above, it probably has nothing to do with your positive test for HPV-6.

I hope this has helped.  Best wishes--  HHH, MD
5 Comments
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Thanks for your quick response Doctor Handsfield

The HPV test that I had is a DNA GenoArray Test. The specimen is the swab of the skin of my penile. Because its a DNA test, my doctor said it is unlikely that its a false positive result. One question for you Dr. Handsfield, what are the percentage that you guess I will have a genital warts outbreak? (I'm 23 and I have a not bad immune system and I consider myself healthy). I do worry that I will have genital warts outbreak, but the thing that I concern the most is I may infect my girl friend because HPV is contagious even there are no genital warts outbreak. I have never had unprotected vaginal sex with everyone and I still caught HPV type 6, so condom doesn't really prevent the transmission of HPV which also means that I cannot have sex with my girl friend until she finishes all 3 does of Gardasil and now I need to find a good excuse to make her to take Gardasil...
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Dr. Handsfield

I don't really get this "However, if we assume you do indeed have an infection with HPV-6, you may have had it before the sexual exposure 4 weeks earlier.  New HPV infections usually don't show up only a month after catching them; the average is 3-6 months."

Actually I had my HPV DNA test, and the urine tests 9 days after the exposure. The blood test for HIV, HSV, and Syphilis were done 15 days after the exposure because of the window period.

So for your sentence that I quote above, is that mean supposed I got the HPV-6 virus from the sex worker, the DNA test (9 days after exposure) should not be able to detect it? is that mean I got it earlier from my girl friend or other ways? but i only had sex with two women; my girl friend for probably more than 10 times and that sex worker.

Thanks
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By a quick google search, I see the HPV GenoArray test was developed in India.  It may or may not be reliable; it hasn't been studied extensively, especially in men.  Most likely it was designed primarily to test pap smear specimens in women.

With a positive result only 9 days after your most recent sexual exposure, if you really have HPV-6, I am even more confident you caught it before the commercial sex event you have described.  If so, you may have caught it from your girlfriend (assuming you have been sexually active with her).  If so, it is too late to prevent transmitting it to her.  There is no need to start using condoms for sex with her, if you have not been using them up til now.

I cannot judge how likely it is that either of you will develop visible genital warts.  But even if you do, it shouldn't be a big deal for you.  Genital warts are usually no more than a nuisance, certainly not a serious health risk.

It is well known that condoms are not 100% protection against HIV.  They reduce but do not eliminate the risk of HPV.  That's one reason that all sexually active peole catch HPV at least once -- in fact, most of us probably have several HPV infections during our sexually active lives.

Your situation is a good example why HPV tests like you had should not be used in evaluating patients for STDs.  The result is causing unnecessary anxiety, with no beneift to either you or your partner. I'm sorry this happened. But at this point, all I can do is encourage you (and your girlfriend, if you have been sexually active with her) to keep your eyes out for warts, and have them treated if they appear.  But don't lose a lot of sleep about it.  Even if that happens, I stress that warts are a minor inconvenience, not something to be consdiered serious.

That will have to end this thread.  Take care.
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Thank you for your professional reply Dr Handsfield. Now I feel much better and I'm going to make my body strong and get rid of the HPV.
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