Suspicious genital wart

[uncertaintee]

I have been with my boyfriend for about a year and a half and just recently he had a wart appear on the shaft of his penis. His doctor confirmed that it's the HPV type and he had it frozen off. We're both 32, if that matters at all.

I have a few questions about this:

1) I got the HPV vaccine when I was 22 - will I definitely get genital warts? I've had two pap smear and HPV tests since we started dating and they haven't shown anything.
2) If we've been together for all of this time, does it mean he cheated on me? He says he hasn't. I want to believe him, but I thought I'd see what you think.
3) If he hasn't noticed an outbreak before, does this seem like a long time for a first time infection to appear?

A bit more background: my last boyfriend before him was for 6 years and I haven't had any other partners in that time. I'm really confused and any help you could provide would be appreciated.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

Assuming the diagnosis is correct, it isn't possible to know when and where your partner was infected. (FYI, all warts are caused by HPV; there's no such thing as a non-HPV wart.) Warts typically appear 2-12 months after catching HPV, but it can be 2 years or more.  Also, previously acquired HPV infections -- sometimes years earlier -- once in a while are the cause of apparently new warts.  I'll go directly to your questions:

1) There are two HPV vaccines.  Gardasil protects against 4 HPV types, including the 2 types that cause ~90% of genital warts (HPV 6 and 11), as well as the 2 that cause 60-70% of cervical cancer (HPV 16 and 18).  Cervarix covers only HPV 16 and 18.  Do you know which type you had?  I'm guessing Gardasil, which became available in the US before Cervarix and might have been the only vaccine available 10 years ago.

Vaccine protection probably lasts 10 years or more -- so the odds are you are not susceptible to your partner's HPV infection.  However, 10% of warts are caused by other types, in which case you could be susceptible.  It's also possible you had HPV 6 or 11 before you were immunized, in which case it is conceivable you have had a recurrence -- even if you haven't had  symptomatic warts.

2) This definitely does not mean either of you has had other partners recently.  Of course it's an STD, so that's always a reasonable issue to consider.  But if you have no other reason to trust your partner's fidelity, you should trust him on it.

3) As implied above, he could have been infected since before your relationship started; or you might have an undiagnosed (recurrent) HPV infection that was transmitted to your partner sometime in the past several months.

HPV is very sneaky, and it usually is not possible to ever know with certaintyt he source (when, where, or from whom) of a particular infection.  And for the most part it doesn't really matter.  You should be on the lookout for warts, and you should continue to follow standard guidelines for periodic pap smears.  But otherwise don't let this incident bother you.  It's genuinely an inconvenience, not a serious health risk.

FYI, here is the link to a thread with a detailed discussion of HPV issue; and as you will see, it contains in turn links to a couple of other threads.  Together these should give you a pretty good idea of the complexities and uncertainties about sexually transmitted HPV.

http://www.medhelp.org/posts/show/1269909

I hope these comments have been helpful.  Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

That's the right decision.  Probably nobody should ever end a relationship just because one partner turns up with an HPV infection.

[uncertaintee]

Thanks Dr. Handsfield. I decided I believe him. There there are too many possibilities to end a relationship for, I think.

[H. Hunter Handsfield, M.D.]

These questions already are partly answered above, and in detail in the other threads linked above.  Please read them if you have not yet done so.

1) Yes, this usually happens, but there are exceptions.

2) This is very common.  Most HPV infections are asymptomatic and remain that way, but can still be transmitted to partners.

3) Normal paps only mean that at the time you were tested, your cervix did not have abnormal cells due to HPV.  You could still have had a silent HPV infection of the genital area.

As I said above, "...it usually is not possible to ever know with certainty the source (when, where, or from whom) of a particular infection.  And for the most part it doesn't really matter."

Don't make yourself crazy worrying about where this came from.  When all is said and done, this will be a minor blip in your and your partner's health and shouldn't be any more than that in your relationship.  This kind of thing happnes to couples all the time.

[uncertaintee]

I thought of a couple more questions, if that's ok.

1) After a few months or years, doesn't hPV pass from our system? Like, our immune system fights it off?

2) I don't understand how it's possible that I've never shown symptoms but I could have given my bf the HPV?

3) I've had clean pap smears all this time -- wouldn't the HPV have shown up on them?

Thanks again.

[H. Hunter Handsfield, M.D.]

Thanks for the kind words.  I'm glad to have helped.

[uncertaintee]

Thanks for the information. I had read a lot of other threads prior to writing, but couldn't find exactly a similar situation, so that's why I wrote.

You do some good work here.

[H. Hunter Handsfield, M.D.]

Noted.  At least half of all persons acquire HPV within their first 3 lifetime sex partners -- so if your sexual lifestyle has been typical, you and your partner can both assume you have been infected with HPV before this.  

[uncertaintee]

Oh, I also wanted to add that my boyfriend was pretty sexually active before we started dating. He doesn't know if any of his previous partners had HPV.