STDs Expert Forum
Recent exposure - best practice for health care
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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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Recent exposure - best practice for health care

Hi Doctor,

These are the circumstances:

I am a 41 yo f, no history of diagnosed STDs.  I have been with 6 people for intercourse.  After the fourth I had the full battery of tests (HIV, Hep, chlym, syph) as he cheated on me.  All clean.  That was 2005.  Didn't have sex again until Jan 2008, once, with a man who had HPV/gential warts at age 17, w/ successful treatment.  I do not know his reoccurence status one way or another.   We used a condom with no breakage or slippage.  In October of 2008 I had my yearly PAP and added the HPV DNA test.  Both were negative for anything suspicious.  Didn't have sex again until a week ago (since January 2008). Yesterday, the man I was with last week, called to tell me lied when I asked about STD history. It turns out that he has HPV, having discovered a wart(s) about 3 years ago that he had trouble getting rid of until he was treated with some type of surgery 1.5 years ago.  Since the treatment, he is 1.5 years without any visible lesions.  He had none when we were together.  We used a condom and he claims that this is the only type of STD he has ever had (reminder though, he lied earlier).  He also states that the lesion(s) he had were near the base of the penis and the area was covered by the condom we used.  He apologized and began explaining about HPV when he told me.  I told him that I knew the risks and that our issue was the lie.  I've dealt with the lie issue as of this morning.  

I have lower pelvic dull ache and discomfort in the vaginal area which began a day or so after the last encounter.  My period was approaching so I decided to wait on gyno.  I tend to get yeast infections after a new partner.  I have my period currently.  I am left with some level of exposure both from the Jan 2008 episode and the situation a week ago.  What do you feel is reasonable for me to want my gyno to run for tests?  Also, any thoughts on me getting the vaccination?  Know it is not approved for 41 yo., but I could insist? Thanks, Lied2
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Welcome to the forum. The bottom line is that I see no signficant STD risks here and suggest you just not worry about HPV or other STDs.

Almost everybody gets a genital area HPV infection at ine time or another.  Over half of all women acquire HPV within their first 3-4 sex partners, so with 6 lifetime partners it is a good bet you have been infected.  Your risk of HPV is not changed by the fact that 2 of your partners had known HPV and told you about it, since it's a good bet one or more of the others also was infected.  The way to look at genital HPV is that catching it is a normal, expected, and, for most people, inevitable aspect of human sexuality.

I'm sorry your recent partner told you of his past HPV infection.  There really was no medical need to mention it, and most people would agree he had no ethical obligation to mention a past infection that had resolved more than a year earlier.  All notification has done is increase your anxieties, without anything special you can or need to do to protect your health.  You should have regular pap smears at the intervals recommended by your gyn health care provider -- but every woman should do that anyway and the news about your partner's past infection doesn't change that.

Most experts would agree that vaccination with Gardasil at this point is not necessary or recommended.  With only 6 lifetime partners I doubt you have been infected with all 4 of the types covered by the vaccine, so from a biological perspective, the vaccine probably would be protective.  So the need is related mostly to the expectation for continued exposures, i.e. on the numbers of new sex partners you expect to have going forward.  You could also factor in their age:  statistically, men at your most likely dating age (i.e. in their 40s and up) have much lower rates of HPV carriage than younger men.  Since you are out of the FDA-approved age range, probably immunization would not be covered by your health insurance and would cost you at least $500, including the cost of administration and clinic visits in addition to the vaccine itself ($360).

On balance, most likely immunization probably isn't a high priority.  It's more important you just continue standard recommendations for periodic pap smears.

As for your symptoms, no STD causes the dull aching you describe as the only or primary symptom, and no STD can cause symptoms the next day or two after sex.  Certainly HPV cannot cause such a symptom.  If the discomfort has anything to do with the recent sexual exposure, it is that sexual activity "stirred up" something inside, i.e. caused a preexisting condition to become painful.  You should discuss it with your gynecologist at your upcoming visit -- or it is severe, of course arrange to be seen right away.

I hope this helps.  Best wishes--  HHH, MD
6 Comments
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The man who had it at 17, is now 20 years past that episode (sorry I did not include that above).
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Thank you so much for your thorough and well-informed response.  I am amazed at the amount of erroneous information, mis-information and general confusion that exists not just about HPV specifically, but about STDs in general.  This website which gives the average person access to highly experienced, intelligent people like yourself who can provide such thorough responses is a really wonderful educational tool.  The power of social networking formats continues to amaze me.  I've looked at the ASHA site as well (after I saw that you sit on the board).  Another great resource.  Having grown up in a very religiously fundamentalist Christian household, I know first hand how terribly confusing it can be for some people to gain realistic, intelligent information, never mind having to fight back the mis-information, shame and social stigma.  Providing the kinds of resources that you and others are providing online is a great thing.  So, thank you, for myself and for the countless others you help through your work here.

If the pain in the pelvic area worsens, I will go in earlier, but for now, I just plan to check in with my gyno to update her on the recent situation after I've finished my period (in case she wants to check anything).  Thanks, again.  
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No doubt there's a lot of misinformation out there.  I'm glad to be able to help you get through the thicket.  Thanks for the thanks.
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As followup, I was checked by my doctor last week, treated for the yeast infection I suspected I had, and for a UTI (which is what the dull pelvic ache turned out to be).  I decided to have the STD screenings done to be proactive in taking care of myself.  Initials came back negative (chlymdia & gonn.) as you told me they would.  I will do the rest 6 months post encounter.

All in all, quite a learning experience for me.  In the past couple of weeks, I've learned how little people generally know and understand about STDs.  After spending time on this forum, I feel better prepared to be repsonsible for my own sexuality.  And I am prepared to have better conversations with future partners.  Thanks, Dr. Handsfield, for helping me through the thicket.  
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You're welcome.  Take care.
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H. Hunter Handsfield, M.D.Blank
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