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.
Thank you fro your post and welcome to our forum. I am afraid that Dr Handsfield does not answer questions on this forum as this is the International STD one.
The transmission of HPV is easy as only skin to skin contact is required, and can happen even when using condoms. HPV is very common, found in about 20% of those between the ages of 15 and 49. Once infected the immune system would normally erradicate the virus. In those with a competent immune system can happen after 18 months of the initial infection, and in up to 95% of infected people, this would happen after 2 years (studies have shown that in 95% of cases, HPV is no longer detected after 2 years). Only in cases of immunosupressed patients, such as following renal transplant, HIV positive individuals, patients on certain medication, this will not happen, with risk of relapse or dysplasia more likely.
I believe that in your case, even if you have been infected, you are not carrying the virus anymore, and therefore you are not infectious, unless you or your girlfriend had been infected by a third party.
By the way, chickenpox does manifest itself as shingles in cases of reduced immunity.
Dear Dr. Jose,
Thanks for taking the time to respond. My reading of your answer is that it is only in people with severely suppressed immune systems (HIV, maybe chemo therapy? etc.) that relapse of HPV happens. Is that correct? I have heard stories that people can relapse even if they just get really stressed, or get pregnant. Can you tell me if this is incorrect? My primary concern is that if I have never had HPV that I cannot suddenly become infectious again at random because I've gotten stressed or something. This is actually a really big fear of mine and keeps me up at night. I imagine that someday this might happen, infect my wife, maybe she clears it, and then she gets pregnant and has a complicated pregnancy. Is this just a total fabrication of my imagination? It's seriously worrying me.
Thanks again for your input. I look forward to your input! Best regards, -Josh
You need to relax a bit. From what you are telling me, I do not beleive that you have HPV anymore, even if you got infected in the first place. And regarding your wife, she should have regular PAP smears anyway like all sexually active women.
What you say about pregnancay and stress is certainly possible, but only if the infection has happen recently, within the last couple of years or so. Once the virus has been erradicated, this is not likely to happen.
Thanks again for your response. Maybe you could answer just one more question. I really appreciate your insight.
I have had one relationship since this girlfriend I mentioned, which has now ended. The girl had Gardasil, which innoculates against the two longest lived strains of high risk HPV.
At this point, I am not dating and will not have sex again until I am married, which likely won't happen for a couple of years at the least. I read a few papers showing that HPV has faster clearance rates in men who are circumcized, which I am. From the look of things, it is faster on average because circumcision seems to significantly reduce the fraction of cases which linger for longer than ~6-12 months.
I just don't want to feel like a threat to my wife someday. So you tell me that if I'm married in 2-4 years, it is highly unlikely that I'll still have HPV in a state that can "flare up"?
Thanks so much for all your help, -Josh
Dear Dr. Jose,
Any further information would be greatly appreciated! At this point, I will not have sex again until I'm married, and I anticipate this is at least two years away. But I would be willing to get a Gardasil vaccination (I have not) if this could reduce the likelihood of reemergence (if I've ever had HPV) down the road. Can you comment if an ex post facto vaccine might at least reduce the likelihood of reemergence? Thanks again, I really appreciate it! -Josh
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