Latent hpv

[aloha37]

I have had sex with only two men in the past 15 years.  One was my husband and we last had sex 1 1/2 years ago.  He had genital warts in the early 90's and I know of no outbreaks in the past 5-10 years.  I never had external warts but I had abnormal paps about the same time he had warts and I had the cells removed and paps have been normal since then.  I had multiple partners before we married so that may have been the source of the abnormal paps.  We divorced.  I had sex with one person about a year ago and the same person again about 3 months ago.  I now have external warts.  From what I have read in this forum, it seems unlikely the warts are from my husband.  What is your opinion about where these current warts were likely aquired, partner A (husband) or partner B (boyfriend)?  I am very worried about future boyfriends if the virus could stay latent for such a long time if it turns out I aquired it from my husband so long ago.  Also, once a person has warts from a specific type of hpv, are they immune to that same type in the future?  Thank you so much for this forum. It has helped me quite a bit up to now.

[H. Hunter Handsfield, M.D.]

I deleted the contentious exchange about whether or not a reply/comment was or was not appropriate.  I don't mind debates on this forum about health/STD issues, but we're not going to get into internet etiquette.  Take it somewhere else.

Even when an HPV infection clears up by all available tests, the infection may persist in a latent state.  In fact, many HPV biologists believe that every HPV infection is lifelong; and that when a test becomes negative, it only means the infection has been suppressed by the immune system--but may persist.  Thus, the new appearance of warts could be either from reappearance of your old infection, or new infection from your new partner.  The latter--recent infection from your new partner--sounds like the best bet.  But there is no way to know, and I doubt you will ever know for sure.

To answer your last question:  yes, once a person has been infected with a particular HPV type, s/he is believed to be immune from catching it again.  But your warts might be reactivation of an old infection, as discussed above, not necessarily a new infection. It it is newly acquired, it probably is due to an HPV type other than that you had in the early 1990s.

I hope this helps.  Best wishes--  HHH, MD

[ChicShane]

Medicine for the affluent.  Healthcare by tax bracket.  Advice only for credit cards.  Sadness.  Some of us are not so fortunate.  Wow I wish I had health insurance :(

[aloha37]

I am still a bit confused and troubled by the possibility that this infection is an "old" infection. I understand that, in general, certain types of hpv cause abnormal paps and other types (usually 6 and 11) cause external warts.  How likely is it that my husband's external warts caused me to have abnormal paps at one point and 10 years later manifested as external warts?  As far as I know I never had them before externally.  So if I was infected by him I must have suppressed the virus all these years.

Also, I have read in this forum that you see no ethical reason to report a prior hpv infection to a current partner if one has been clear for at least 6 months.  Does this mean transmission to a new partner is highly unlikely during latent infection?

I would not be concerned about hpv in general, considering how common it is, but external warts are a different story.  If I carried external warts in latent state all these years then that is troublesome.

Because up until this week, I considered my husband's warts to be an "exposure" that never turned into external warts.  I knew I'd been infected with his hpv but assumed I was one of those people that would never develop external warts from it.  Is it possible I was infected 10 years ago and now the infection is "full blown" and will be out of my system once I fight it off? Do biologists know how it works?  What is your opinion as an STD expert?

If an exposure to external warts can show up all these years later then that has far reaching implications for anyone that has ever been exposed but never developed warts, don't you think?

[H. Hunter Handsfield, M.D.]

Unfortunately, there are no clear answers to any of your questions.  To be honest, genital warts generally aren't important enough an STD problem to have garnered much research support (unlike cervical HPV, cervical cancer, etc), so that much of what is known is the "soft" evidence of experts' opinions and clinical experience.  But yes, I believe it is possible to have genital infection with HPV 6 or 11 (the types that normally cause warts) that causes only cervical/pap abnormalities, then remains latent, then pops up later as genital warts.  It's probably rare, but my guess is that it happens from time to time.  If this occurred, it is very unlikely you were infectious for your sex partner(s) all that time; latent infection probably is not transmissible.

That something CAN happen doesn't mean it happens frequently; and in my mind, ethical judgements may vary based not just on the possibility of a particular outcome, but how likely that outcome is and how dangerous the condition is.  It is not permissible, in my mind, for an HIV-infected person to ever have sex with another person, even with condoms, without informing the partner--because AIDS is deadly.  But HPV and warts are mostly benign, if upsetting, and I do not believe they require identical ethical standards in communicating with partners.  In any case, I have always carefully described my judgement about the ethical obligations in informing partners as personal and in a gray zone, and that reasonable people--both expert and lay--may disagree.

HHH, MD

[aloha37]

Thank you.  I suppose I will never know for sure and that it really is not that important anyway, as you said.  I tend to agree with you that there is no moral obligation to inform someone of prior hpv once asymptomatic for several months, even if I did carry the virus all this time.  There is no way to sort out each new encounter and who had what first, and it is far too confusing to try to explain, even for those with a medical background.  And you are right, no one is going to die from it.  I'm just going to get over it and move on.  Thanks again.

[aloha37]

If you are still with me on this thread, I do have a follow up question regarding treatment/prevention of hpv.  I started low dose birth control pills about the same time I remember having symptoms of warts for the first time(in hindsight)which was about 5-6 months ago.  I have read that women with hpv have a higher risk of developing dyplasia if they take birth control pills.  Does it seem reasonable to think that birth control pills have the same effect on all strains (ie. external warts as well as internal strains) of hpv?  Perhaps they increase the risk that an exposure will develop into warts or a latent infection will develop into warts?  Is there a higher risk of recurrence in women taking birth control pills?  

Can you direct me to any research on birth control pills and hpv?  Probably I will choose another form of birth control now that I realize there may be a link between the two.