infection risk, future obligations

[mje57]

I was in a heterosexual relationship with a girlfriend for several months late last fall and had protected and unprotected sex with her multiple times.  

After we had decided that we probably were not compatible with one another relationship-wise she told me that she had been treated for cervical precancer ten years earlier with a procedure and had also received chemo.  Naturally, I was a little surprised that this had not come up earlier in conversation.

Now after reading about HPV as the cause of cervical cancer and dysplasia I am worried that I might have contracted HPV from her.  I am concerned that I  have the potential to spread the virus to another partner (through unprotected sex with my current girlfriend) and since I am male I cannot even be tested.  

I have read about HPV, etc. but I guess that I have lost some of my objectivity.  Could I have contracted HPV from her?  Also could you clarify for me what my responsibility to my current and any possible future female partners should be with regards to this?  Thanks.

[H. Hunter Handsfield, M.D.]

Don't worry about it.  We all get genital HPV; it is inevitable in almost all sexually active persons.  If you have had unprotected sex with 3 or more women in your life, you already have been infected with HPV, regardless of this particular partnership.  In any case, since her precancerous disease (and the HPV strain that was responsible for it) were 10 years earlier, it is unlikely she still was carrying the virus.  You have no ethical responsibility to even mention this issue to future sex partners.

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

[mje57]

Thank you so much!!

I was wondering though--how useful do you really feel that condoms/ "protection" are in preventing the spread of HPV in a couple that is having a sexual relationship and not taking extraordinary precautions to prevent any genital contact (like most people).  

In the same light, how useful are condoms in preventing the spread of HSV-2 in such a relationship?

[monkeyflower]

While you wait for Dr. Handsfield's reply, I can tell you that he's mentioned a study (yet to be published) showing that condoms are very effective in preventing transmission of HPV. I also recently read they were around 80% effective - not sure if that statistic is from that study or others, though.

As for HSV, you might appreciate the results of the Valtrex study: in HSV discordant couples, the risk of transmission from female to male, only avoiding sex during outbreaks, was around 4%/year (pretty darn low already, if you ask me - that's over an entire year of having sex like 2-3 times/week). Condoms cut that in half, and suppressive therapy cut that in half again.

[H. Hunter Handsfield, M.D.]

That's a great question and makes a valid point; and mf's comments also are correct.  The University of Washington study she refers to is in revision for ultimate publication is a prestigious journal.  It shows ~90% protection against HPV in women who used condoms correctly and consistently for all sexual exposures, and who also had no genital-genital contact before the condom was applied; it's around 80% in those whose condom slip-ups were for non-penetrating sex.  (Which demonstrates that some HPV transmissions indeed occur by genital apposition without penetration.)  Those figures are better than for any other STD, and approaching condom effectiveness in preventing conception.

But the rub in condom effectiveness (pun sort of intended) is the correct/consistent part:  truly correct and consistent condom use simply isn't realistic over the long run in most committed relationships.  The importance of the study is 1) political, since the religious/political right has used HPV to promote the supposed lack of condom effectiveness against STDs; and 2) in prevention messages for sex outside committed relationships.  A person is substantially protected against HPV (and other STDs) by using condoms for new, casual, or other non-committed partnerships.

But I believe it is completely impractical to advise HPV-discordant couples to use condoms indefinitely.  For many couples, such advice would have a significantly negative impact on sexual fulfillment and, in the long run, wouldn't work anyway.  This may change in the not too distant future, when the HPV vaccine is on the market.  Telling a couple they need to use condoms consistently for 6 months, until the 3rd dose of vaccine (or maybe only 2 months, until after the 2nd dose) often would be acceptable.  But even this would challenging.  In many HPV discordant couples, the apparently uninfected partner already has the virus; the horse is of the barn and galloping across distant hills.

HHH, MD

[mje57]

I am curious about what the exact definitions of unprotected sex and correct, consistent condom use are in relation to HPV transmission in this new study.

Are there any numbers available regarding HPV transmission with either very brief episodes of vaginal intercourse or single episodes of vaginal intercourse?  Or is it the general belief that transmission (if prsent) is considered to be guaranteed in such an encounter unless a condom is used?

Finally, we hear so much about what the risk factors are for HPV, but what are the characteristics of the 25% of the population that that has never had it?  Are they simply the individuals in the population who have never had sex with anyone other than their partner and a lucky few others?

[H. Hunter Handsfield, M.D.]

Proper condom use just means the condom is in place before any genital contact, doesn't break, and is withdrawn with the penis while still erect.

There are no data on single-episode HPV transmission risk, regardless of the duration of insertion.  Transmission definitely is not "guaranteed" for a single episode of sex; no STD is transmitted with 100% efficiency.  The risk undboutedly varies with the viral load in the HPV infected partner, which is impossible to know.

About 75% of American female college students became infected within their first 3-4 lifetime partners.  Beyond that, it's guesswork, but 75% probably is a minimum figure among most sexually active people, most of whom have more partners than that in their first few years of sexual activity.  But the risk undboutedly is lower for people with fewer partners (depending, or course, on their partners' past sexual history).  To my knowledge, there is no research to answer your question in any more detail than this.

HHH, MD