HPV contagious after unaided clearance?

[josh525]

Hi Dr. Handsfield,
    I have found out that a former girlfriend of mine had HPV before we dated.  This happened 2.5 years ago.  She had an abnormal Pap smear, and there was only very low grade squamous intraepithelial lesion present in the colposcopic exam.  They followed the colposcopy with an HPV DNA screening which gave a positive result for a high risk variant of HPV.  They waited to see if it would clear on its own.  The sixth month follow up show no changes.  After another six months, the Pap was normal.  An HPV DNA test (Cervista HPV HR) showed no evidence of any more HPV DNA.  We dated (briefly) after all this happened, but only about ~1 month later.   In the following two years, she has also had normal Pap smears.  
    What is the likelihood that sexual contact with her could have infected me with HPV?  I read that once HPV is cleared _unaided_, it is considered noncommunicable.  I understand the concern for my own health is minimal, as penile cancer is extremely rare.  But I want to get married someday (hopefully soon), and I want to be totally open and honest with my wife.  This girl and I used condoms on all but two lamentable occasions.  And I'll be honest, I'm scared.

    If I did get it, it's been a while.  I've read about instances when this virus seemingly flares up again due to stress, pregnancy, etc.  Is this correct?  I know that there is a lot of misinformation about HPV out there.  Why doesn't chicken pox come back when stress levels increase or in pregnant women?  I understand that herpes has a mechanism to avoid complete suppression, but I have not read that HPV does.  Are these stories mainly instances of a new infection?  If not, how common is the reemergence after clearance?  Even after years?  What "triggers" it?

    I'm a bit of an academic (but not in the medical field).  Technical documents are welcome if you have them.

Thanks for your time.  I really appreciate it.

[Edward W Hook, MD]

Welcome to our Forum. there are many questions here. I'll try to address them.

First, as relates to your former GF, you are correct, when HPV resolves on its own persons are typically considered non-infectious. This, plus the fact that you used condoms all make it unlikely that you acquired HPV from her.  On the other hand, it is likely that you, as well as any future partners, will already have HPV- just about everyone one does and most people actually typically have more than one type of HPV infection present.  As a result, for most people, HPV is a fact of life and the appropriate approach is to not worry about it, other than to get the HPV vaccine, if appropriate, for women to follow PAP smear guidelines, and for persons to have lesions which appear investigated by a trained medical professional.  To otherwise worry is simply not productive.  

As for HPV staying away when resolved as was the case with your former GF, this is the subject of debate.  Some scientists suggest that the virus is present but controlled but the host immune system, while others suggest that it completely resolves.  My suspicion is that the former situation is the case.  

I hope these comments are helpful.  EWH

[josh525]

Dear Dr. Hook,
    Thank you very much for your reply.  It is especially easy to worry about that one instance because it was known.  I understand the broader risk exists.
    Is the fact that her infection progressed to very low grade LSIL indication that it was some particularly "virulent" strain of HPV?
    My main concern is that if I've ever had HPV, that might spontaneously reemerge at some point.  I've heard some people say the immune system loses its handle on HPV even from things like getting stressed or becoming pregnant, while others say its only traumatic blows to the immune system like HIV, chemotherapy, etc which would do that.  Which is correct?  It seems to me that if getting stressed could lead to reemergence of HPV, then there would be enough statistics to _know_ whether it persists or is completely eradicated.  So it must not be very common, right?  This is a big worry for me.  I fear that it could reemerge, I infect my wife someday, and during pregnancy it emerges in her and causes complications.  I'm actually losing sleep about this fear.  Am I just letting my imagination get the better of me?

Thanks so much for your time.  I really appreciate your input.  Best regards, -Josh

[josh525]

Hi Dr. Hook,
   Any further clarification about the above issues would be great appreciated!  Thanks again, -Josh

[Edward W Hook, MD]

The term virulent is meaningless.  Even with the HPV types associated with gential cancers very few persons ever develop cancer.  Your use of the term suggests you are inappropriately concerned aobut something you have no control over.  

As to what constitutes a "stress" again there is person to person variation.  This is not somethign you have ANY cotnrol over and to worry ofr loose sleep over such concerns makes not sense.  EWH

[josh525]

Dear Dr. Hook,
   It seems like maybe I upset you and I'm sorry if so.  I know there's not a lot to do or worry about.  I only wondered if maybe an ex post facto Gardasil vaccination would increase antibodies for the most common strains and possible have the effect of reducing viral load and minimizing the chance of reoccurence if I've ever had these strains of the virus.  As a non-expert in medicine, it's not clear to me if this would work that way.  Again, I'm sorry if you were upset.  Best regards, -Josh

[Edward W Hook, MD]

I was not upset.  Your question however was unanswerable.  The follow-up is clearer.

The studies  of the HPV vaccine indicate that vaccination does not change the course of HPV infections that are already present.  The vaccine does protect however from future infection.  The protective effect is not marked after the first injection but is somewhat, although not maximally effective after the second vaccination.  EWH