Negative HPV test and new exposure

Hello Doctor,
I'll make this short as possible. My boyfriend and I live together and have been in a monogamous relationship for two years. When we first met, being responsible and safe, we both got tested for STDs before starting a sexual relationship-- we were both clear. After three months of having unprotected sex, I had my annual pap smear and my first ever HPV test -- both negative (which has now been a year and a half ago). Just recently, I noticed small skin colored bumps that look like moles on my boyfriend's penis. He has an appointment with a clinic next week to have them examined. Here are my questions:

1. Does the HPV test screen only for high risk cancer causing types of HPV or does it also test for low risk types? Also, does the HPV test screen for active HPV infection only or does it test for the presence of HPV in general (whether active or dormant)?

2. If we were having unprotected sex for three months before I had the HPV test, does that mean I was not infected at that time? (I guess question #1 will answer this question)

3. If my boyfriend does have genital warts (which I understand is usually caused by strains that DO NOT cause cervical cancer), should I get another HPV test if I was negative just one and a half years ago?

4. After reading the other posts and replies, I am assuming that if he does have genital warts I should consider myself exposed and also have HPV. If this is the case, should we start using a condom now (especially during visible warts) to decrease the chances of me getting them as well or does it even matter?    

Thank you for your time, I appreciate any information you can give me.

[Edward W Hook, MD]

The topic of HPV and genital warts is a complex one.  I will try to provide some facts.  For addition information on this most common of STDs, I would suggest search for other HPV- and wart-related Q&A on this site, as well seeking addition information on sites such as the American Social Health Association (ASHA) web-site (disclosure, Dr. Handsfield and I are both on the Board of ASHA)..

HPV is the most commonly acquired STD.  Over 85% of sexually active women will have HPV infection at some time in their lives.  In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears.  In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-10 months.  In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated.  At the present time, testing for HPV is not recommended for men or for women under the age of 30 (because it is so common and nearly always resolves itself over a relatively brief period of time (months).  

Also, please realize that you do not know as of yet that your BF has warts, thus you may be getting ahead of things.  With this as background, on to your specific questions.

1.  There are over 100 types of HPV.  The commercially available test tests for a limited number of the most common of them, both the ones that are associated with cancer in a tiny fraction of all women who become infected and the ones that do not.

2.  No, there are many reasons for the HPV test to be negative.

3.  As I said above, if you are under 30, you should not have repeat HPV tests.  On the other hand, if you are under 26, you should strongly consider getting the HPV vaccine.  It is highly effect for preventing the four most common HPVs.

4.  Correct.   To be honest, in my opinion, having (or not having) HPV is not a great reason for using condoms.  while condoms do reduce risk for HPV and no one wants HPV or warts, there is no way to really know if you or your partner has HPV, tested or not.  The critical thing is for women to get regular Pap smears to prevent the thing we are really trying to prevent, cervical cancer.

I hope this helps.  At the same time, I suspect my answers have generated new questions.  Knowledge about HPV is very rapidly evolving.  I would suggest that you read more about the topic on a reliable web site such as ASHA's or the CDC's or some other reliable source.  At the same time, beware as well.  There is also much inaccurate “information" on the net as well.  Take Care.  EWH

[Sierra818]

Thank you for your reply. I know that I may be asking these questions prematurely but I am the type that worries so the more I know, the less I worry.

I am over thirty so I guess my question still stands, should I get another HPV test if my boyfriend comes back positive for genital warts?

Also, I'm not sure if you answered my question about the test... does it test for active infection only or does it detect the presence of HPV including dormant strains?

Thank you again for your help, peace of mind is priceless.

[Edward W Hook, MD]

If he has warts, for all practical puroses, so do you, no matter hat the test shows.  I would only get an HPV test if your Pap smear is abnormal.

As far as the test, if it is positive, you have HPV infection. There really is no such thing as a detectable dormant HPV infection.  EWH

[Sierra818]

Thank you Dr., I feel that all my questions have been answered (by you and my research on the websites you recommended). YOU DO NOT HAVE TO REPLY TO THIS (Unless I am wrong about something listed below)

FOR ANYONE READING THIS... my worries are now at ease, I hope that what I have to share will help you as well. Basically here is what I have found:

1. HPV is VERY common and HPV has many different strains.  

2. Almost everyone will have it at some time or another (but most people dont know if and when they have it).

3. It usually resolves itself over time.

4. If you are in a long term monogamous relationship, you probably share the HPV strain/s.

5. The strain that causes genital warts is NOT the strain that causes cervical cancer.

6. HPV can lie dormant for an indefinate amount of time, so it is hard to know when and where you got it. (A negative HPV test does not mean you do not have HPV, it just means that you do not have an HPV INFECTION at that time). So, for example, if your husband of many years develops warts and you are HPV negative, it does not mean he cheated! You should assume that you have HPV too, it just hasn't manifested itself and may NEVER manifest itself.  

****Finally and most importantly****

7. The MAIN CONCERN about HPV is that some strains may lead to cervical cancer in women.

8. If a woman gets checked regularly (pap smears, HPV test, etc) and has an abnormal pap smear, there are treatments to effectively stop cervical cancer in its tracks. (Cervical cancer takes many years to develop and it is rare for women to die from cervical cancer in this day and age).


Thank you and take care.