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1306047 tn?1333243591

High Risk HPV Questions

Hi Auntiejessi et al.  I have questions regarding high risk HPV strains.  From I understand, it seems like the science could be more robust about high risk so it's difficult to pigeonhole it into a neat package with define behavior.  Or, maybe much more is known about it these days and I missed it.  

My questions:
1) It seems like low-risk HPV is much more readily spread when lesions are present, or even before you see them but the virus is activated and preparing to break out.  It seems as if the risk of transmitting low-risk HPV isn't terribly high once you've gone a year or more without lesions developing.  Is the transmission risk/rate of high-risk known?  If a man has it, or anyone really, what facilitates infection transmission?  

2) I certainly have high risk strain 16 and one of the other high risk strains other than 18.  I'm currently not dating nor sexually active, but probably will be next year at some point.  What factors do I need to consider when I'm ready to have sex again?  

3) Am I doomed to have to have sex with a condom now for the rest of my life?  What is the percent(ish) chance I'll infect a future partner with one of my high risk stains.  

4)  What about non-penetrative foreplay?  I also have one or two strains of low-risk hpv so in the past have avoided skin to skin, non-pentrative foreplay, but it's been years since I've seen a wart and I feel the risk of transmission is very low.  Can genitals rub on each other without penetration and still pass high risk strains?  

5) Let's say we both have the same strains in our genitals.  Can we lodge the virus anew in our throats or anus during future sexual activity?  

6) You probably don't want to answer this one, but is there a rule of thumb for disclosing your HPV status with future partners?  I'm not talking about during the first year or two after diagnosis, but rather am talking about the long term responsibility after it's been years and years.  

7) I'll ask this separately... are you just as contagious five or ten years after getting infected with high risk HPV as during the first two or three years?  

8)  We have HPV for life, right?  So if a woman tests positive for high risk, has a colposcopy and then tests negative for that strain, is it gone?  Or is it still there but the cells the virus activated in now gone and it's not detected because the cells that still have it haven't activated so can't be detected?  Then, at a later date via stress or whatever factor, it becomes active and abnormal cells are detected again?  

I know that HPV is the single most common STD out there and that there are really no long-term serious consequences from it.  Still, it's taboo enough a subject so I only know one person whose ever been even remotely open about it.  What's prompting this inquiry is the news that a long-term partner of mine has now tested positive for high-risk in her last three paps.  The first was pos for 16 resulting in a colposcopy.  The second was negative for 16, but pos for one of the others (not being 18).  The third was the same as the second.  I'm the only one she's had unprotected sex with.  

Looking for answers and advice because she feels down in the dumps and I do too.  I feel super shiddy about it and I don't really know how to proceed.  Any and all facts regarding what is known about high-risk would be much appreciated.  I loath the thought of never being able to have sex naturally (no condom, no restrictive behaviors) again without a care in back of my head.  Thanks in advance for any time you spend on this.  
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207091 tn?1337709493
COMMUNITY LEADER
Okay, so I'm really confused by some of your questions. It sounds as if you were diagnosed a long time ago with genital warts, but haven't seen any warts in a very long time. And recently, a long-term partner had some abnormal paps?

First, let me address the most important parts.

HPV clears your body within 2 years for 90% of those infected. This is for high and low risk strains. Since you haven't seen a wart in years, you can assume you are no longer infected with the low risk strain, for sure, and I wouldn't worry about disclosing that.

HPV can be transmitted while using condoms. Your long-term partner may have gotten it from you, or may not have. How long ago was your relationship?

About 90% of us will get HPV at least once in our lifetimes. Most experts consider it an inevitability.


1) It seems like low-risk HPV is much more readily spread when lesions are present, or even before you see them but the virus is activated and preparing to break out.  It seems as if the risk of transmitting low-risk HPV isn't terribly high once you've gone a year or more without lesions developing.  Is the transmission risk/rate of high-risk known?  If a man has it, or anyone really, what facilitates infection transmission?  

High risk most often has no symptoms, but is transmitted when the virus is present on the skin. This is invisible to the naked eye. HPV of all types is extremely contagious.

Both low and high risk clear the body within 2 years for most of us. The longer you've gone without symptoms of low risk, the lower the chance you have of transmitting it, until it clears the body and you are no longer infectious.

2) I certainly have high risk strain 16 and one of the other high risk strains other than 18.  I'm currently not dating nor sexually active, but probably will be next year at some point.  What factors do I need to consider when I'm ready to have sex again?  

This depends on how long it's been since your exposure. The best thing you can do is just use condoms. If you and your partner decide on monogamy, and are free of other STDs, you can decide to ditch the condoms after 2 years past your high risk exposure.

3) Am I doomed to have to have sex with a condom now for the rest of my life?  What is the percent(ish) chance I'll infect a future partner with one of my high risk stains.  

No, not at all. If it's been less than 2 years since you may have had high risk, use condoms, as the chances of you transmitting it are high. If your partner has been vaccinated for HPV, you can avoid the condoms (assuming you've both been tested for other STDs and discussed birth control).

4)  What about non-penetrative foreplay?  I also have one or two strains of low-risk hpv so in the past have avoided skin to skin, non-pentrative foreplay, but it's been years since I've seen a wart and I feel the risk of transmission is very low.  Can genitals rub on each other without penetration and still pass high risk strains?  

You probably don't have the low risk strains anymore. I don't know the time line for the high risk, but for the low risk, you're fine now.

Genital rubbing can, in theory, transmit HPV. It depends on how hard the rubbing is, but in practicality, intercourse is more likely to transmit than just rubbing.



5) Let's say we both have the same strains in our genitals.  Can we lodge the virus anew in our throats or anus during future sexual activity?  

Yes, but it probably won't do much. You can get oral cancer from HPV, but oral cancers are rare, and are definitely helped along by smoking and heavy drinking.


6) You probably don't want to answer this one, but is there a rule of thumb for disclosing your HPV status with future partners?  I'm not talking about during the first year or two after diagnosis, but rather am talking about the long term responsibility after it's been years and years.  

Disclosing you had low risk in the past isn't necessary, unless you are directly asked, and you want to build trust and not lie. This would entirely depend on the type of relationship it is. If it's a casual, one-night hook up thing, I wouldn't bother disclosing this. If you're going for a long-term relationship, I probably wouldn't disclose it unless asked directly. I wouldn't lie, but there's no reason to volunteer it, as it means nothing for you today.

If you are still within the 2 year time frame for the high risk, I would disclose that, and use condoms. Beyond that, there's no reason to disclose it, again, unless directly asked. I'm not a big fan of sitting down and doing the big confessional about the past, like how many people have you been with, what have you done with those people, etc. I think that way leads to nothing good, but your mileage may vary. I'm older, so what I did 20 years ago with someone has no bearing on a relationship today. If I'm directly asked, though, I might ask why they want to know, but I won't lie.


7) I'll ask this separately... are you just as contagious five or ten years after getting infected with high risk HPV as during the first two or three years?  

No, you aren't contagious at all past 2 years, unless you are still having symptoms. For women, if you are still having abnormal paps, you may still be contagious, but for the vast majority of people, after 2 years, you are not contagious.

8)  We have HPV for life, right?  So if a woman tests positive for high risk, has a colposcopy and then tests negative for that strain, is it gone?  Or is it still there but the cells the virus activated in now gone and it's not detected because the cells that still have it haven't activated so can't be detected?  Then, at a later date via stress or whatever factor, it becomes active and abnormal cells are detected again?  

No, we do not have it for life. If a woman tests negative, she is no longer infected. I might wait until a couple of negative consecutive tests for a woman to determine that for sure, but most likely, she is fine after.

If a woman has a positive test, a colpo, and tests negatively, then years later, tests positive again, most likely, she has a new infection.

Does this help?


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Thanks for you input.  It's very much appreciated.

I understand from the literature that  getting high-risk oral hpv that can lead to throat cancer later on is pretty low.  I'm not sure how low off the top of my head, though.  Because I have general anxiety disorder (medicated and doing well, but still susceptible to triggering behaviors like sex), I've very very nervous of performing oral sex on women.  Can you help me put it in a better perspective that might help me think less fearfully about it?  I met someone this past year and our interactions have steadily progressed to where my anxiety will most likely be triggered if we go any further.  The thing is, I want to, but responsibly honoring my nature as much as I can without letting it bully me around.  She claims she doesn't have any STDs and has only had sex a couple times in the last years.  If she's telling the truth, then I know i have nothing to worry about, but what if she's bending the truth and hasn't been entirely forthcoming about her activity in the last couple years.  How can you help me put my risk in perspective if I performed oral sex on her?  Hopefully, my post is a little clearer this time.  Thanks!
I mean, have you both done STD testing and shown each other results? When was her last pap smear? Did it include HPV testing? Can she get copies of that and show you? Not only anxious people should be doing that, but it could certainly help soothe your anxiety, right?

At some point, in any relationship, you just have to take a leap of faith, which is hard for a lot of us, anxiety or not.

And definitely talk to your doctor about the HPV vaccine if you are under 26. A lot of docs will give it to you if you are over 26, too.

This may help - https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm

About 90% of us will get a genital strain of HPV in our lifetimes, right? About 10% of men and 3.6% of women have oral HPV, and oral HPV infection is more common with older age.

https://www.webmd.com/oral-health/guide/oral-cancer#1 - About 50,000 people in the US were diagnosed with oral cancer in the US in 2019.

So those numbers are really low. Billions of people perform oral sex. A small handful get oral HPV. Even fewer of those get oral cancers from it.

Smoking and heavy drinking increase the risk of oral cancers, so if you do either of those, maybe stop.

A small note and you can talk to your counselor about this - anxiety isn't your "nature", any more than having diabetes is someone's "nature". It's an illness. Like someone with diabetes, you sometimes have to make accommodations, but it's not who you are.
Thanks for your wonderful reply. You're right. Anxiety isn't my nature. It's a condition I can pinpoint to the day it was triggered. It's good to be reminded of that.

I'm 46 so just outside the new age recommendations, unfortunately. I'm still going to visit my doctor to see if I can pay out of pocket for the vaccine even if just to assuage my anxiety.

I haven't been tested in a long time, but I haven't had sex in three years and had protected sex the year before that. My last unprotected sex was the summer of 2016. I have always tested negative for hsv antibodies, but have tested positive for low risk. I know I have high risk because I have it to my current long term partner who's never had unprotected sex in her life. Still according to the scientific literature, even at my age, my high risk strains probably aren't persisting.

You are right, though. I'm all her about her pap history then take a leap of faith. Thanks again.
Okay, I need to clarify something here.

HSV antibodies - that's herpes. That's not HPV, which is human papillomavirus. It's two very different infections. There is no antibody test for HPV, and unfortunately, no HPV test for men.

Using condoms greatly reduces the risk of transmitting HPV, but doesn't eliminate it. Just because your long term partner has HPV doesn't make you her source. What is "long term"? She's a current partner? If she's current, and you think you gave it to her, is this the one you are worried about having unprotected sex with?

I'm a little confused - was the last time you had unprotected sex with her in 2016? If that's the case, you both should have cleared it by now, and if your monogamous and not poly or in another form of open relationship, then you should be fine now.

I'm close to your age. Since we weren't of the generation that was vaccinated young for HPV, basically, we've all had it, at least once. You aren't alone.
OK. So, this is strange. I noticed today a fairly large, flat lesion on my shaft. It's bigger than any hpv wart I've had in the past at maybe an eighth to three eights inch diameter and is raised enough to be a bump of note. I don't expect you to remember what I wrote in the posts above, but I have not had sex in 3 years and I haven't had unprotected sex in 4 years almost. Just recently, as in the last 3 months, I've been receiving oral sex from a woman friend of mine about once a week. This was after I opened up about my anxiety centered around STDs and grilled her about her risk and history. Our genitals have never touched. Now I have what can only be a wart on my shaft. How is this possible if all the advice that is given on here always says that there's virtually no risk from oral sex and you don't have HPV anymore after 2 years? I really don't know what else it could be other than a brand-new HPV lesion, and considering that it's larger and different looking than the ones I've had in the past, what can I think other than this is a new strain? This blows. I haven't had a wart in almost 3 years and was getting really excited that maybe those days were behind me yet here I am again.
Sorry, it's not as big as I said. It is bigger than the ones I have had in the past, but at most it's an eighth inch in diameter.
It is possible to get HPV from oral sex, though not as likely. The level of risk is low, but isn't really understood. I found this post from Dr. Handsfield when he did a thing on reddit:

https://www.reddit.com/r/HPV/comments/a1q6d0/oral_hpv_questions_answered_by_h_hunter/

"And in STD clinics (in which genital warts and other HPV problems are the most common of all diagnoses), we almost never see people with genital HPV whose only possible exposure was a partner's oral cavity. That's not to say oral sex doesn't occasionally transmit the virus, but it's obviously uncommon compared with genital intercourse."

So it's theoretically possible, but not likely. I don't think I've said differently. Most of the questions we get about oral and HPV are about people getting oral HPV, not getting genital HPV from someone who has it orally.

There are a LOT of differential diagnoses for HPV - things that look and act similarly to it, so don't get too down yet. Go get it biopsied.

Molluscum contagiosum is one, lichen planus is another. Sebaceous Hyperplasia, cancerous conditions (sorry), a clogged oil gland, or a host of other things.

I understand the frustration. I have chronic conditions. Get it biopsied though. At least find out what strain it is if it's a wart. Let me know what happens.
Thanks auntijessi.  I'm going in right now to my derm and will insist on a biopsy.  The problem may arise, though, that I can't opt for DNA analysis as last time I had a biopsy it was microscope determination of HPV cells, I believe.  I'll see if I can push for the other method.

Personally, I don't believe this general advice that you get HPV for a year or two and then it's gone.  When I first got warts, I was all over this forum for several years even asking Dr. Handsfield or Hunter a couple/few questions.  One of his statements that sticks with me is, "nothing about HPV surprises me anymore." referencing how the virus has characteristics that fall into general categories, but that outlier experiences happen due to the vast arrangement of strains, immune systems, sex (male or female), life style and other things.  What I feel I learned on this sight years ago and via research is that you have the virus for life.  That in a year or two you suppress it's activity and therefore are most likely not contagious anymore.  That certain things like high stress/anxiety situations, pregnancy immune system changes, chemo or other things can trigger outbreaks years down the road.   The second time I had a year of outbreaks, I went more than 6 months without an outbreak a year after having my first one.  So when six months had gone by, I was pretty stoked I might be past the outbreak period.  Then, I had a triple whammy of super stressful things happen, and I immediately got another outbreak then another before they subsided.  I've never seen a wart again for three years now when I suddenly detected this one after finally deciding it was safe to be sexual again.  My theory is that, since my marriage is breaking up and I'm having these non-intercourse sexual experiences with another, that my stress is a little higher and probably triggered this outbreak.  I find that much more probable than getting a new wart strain from her mouth.  What is your opinion on that?  I am diagnosed with General Anxiety Disorder so that lends credence to my theory that my outbreaks at odd times are anxiety related, like herpes can be.  I'll find out for sure within two weeks, though, as I'm literally departing for  the derm after I hit submit. Thanks again for all you do here and the wealth of knowledge you have.  

SD
HPV clears within 2 years 90% of the time.

https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer

https://www.healthline.com/health/sexually-transmitted-diseases/does-hpv-go-away

Stress plays a role in the immune system, so that may be a factor. This is not a lifelong infection like herpes, though. I hope the biopsy gives you the strain, if this is HPV.

Is it possible you were infected with a different strain at some point? I think that's more likely that one strain causing this for so long, or you that you got a new strain from oral sex.

I'll be interested to see what happens. Good luck!
Hey thanks!  So, take this with a grain of salt but here's my take on the facts.  New years eve 2009/2010 is when I first got warts and that was a textbook outbreak lasting exactly one year.  I had very little sex, maybe none, actually, the summer of 2012.  I met my wife in 2013 and got warts again by the end of the year or early 2014.  This time it was at the base of the penis so I suspect I got a new strain from her because she told me she had warts when we met and even got one removed that first year we dated.  This was a textbook outbreak, too, lasting 14 months or so.  However, after that 14 months, six months after, a crazy stressful situation occurred and I had two more outbreaks.  So, in addition to any high risk strains I may have, I believe I probably have two wart strains.  They also presented a little differently in size clustered as opposed to solo, ect.  Our marriage isn't working out (we're still close friends) and haven't had sex in three years as stated earlier, only receiving oral from a new partner I vetted quite heavily to begin with.  So, either my stress at contemplating what's next in my life plus having a new partner (I have a fear of intimacy at first) is a more logical explanation than I got yet another strain of HPV warts from her mouth.  

Whatever, none of this really matters, I know.  And a counselor is my best option.  I'm just pissed that I can go years without an outbreak then get one right when I feel safe and responsible to dip my toe in the water!  

Anyway, I've seen about 24 different warts on my penis and I and the derm I just saw are very confident it's a wart.  I showed her the list of other options you gave me.  It is being biopsied, though.  I didn't really like her and it bothers me when derms or others in the field try and educate me on HPV.  She said that if it types as HPV, she'll request an analysis for the strain but they only test for types 16 and 18.  Aren't those high risk strains?  Is it possible for a wart to have 16 and 18?  Also, how come my wife can get a pap and the results can type low risk and high risk but my biopsy can't?  Is it lab specific?  Or are pap analysis' more rigorous?  

Well, thanks again for responding.  I'll def be back in a couple weeks with the results.  Cheers and gratitude expressed yet again.
Everything I'm finding is that 16 and 18 "don't usually" cause warts. I always understood it as the high risk strains don't present with warts, and the low risk strains do. I don't know if that's language designed to be vague, or if it's ever happened. Everything I was taught was that low risk causes the warts.

I also don't know how we know which strains of low risk HPV people have without biopsies? I understand why you didn't like her. I don't much like her either, and I didn't see her and it's not my body lol. It's possible she's wrong and the lab report will show something different than what she says it will.

It does seem as if you are one of the few that hasn't cleared it within 2 years, which sucks. I'm sure it's extremely frustrating. :(

Hello and merry Christmas

My biopsy result came in today and the analysis was a little strange. Maybe you can opine, AuntieJessi. I had only one wart, and the derm removed the entire thing for the lab. It came back typed as hpv 6 & 11. I asked for clarification to see if the test wasn't specific and merely detected 6 or 11,but she said that it specifically detected both. I believe it as my take on my hpv journey is that I've been infected twice. Still, any idea how a single lesion can test positive for two strains?

Luckily, Gardasil 9 vaccinates against both those types so at least there's that, but that leads me to a vaccine question. Will a partner whose been vaccinated against these two strains never get it from me (unprotected sex assumed)? What if I have unprotected sex the day a new wart is forming and I haven't discovered it yet?

Anyway, that's the update. Thanks for every reply you take the time to make.
So it's hard to say if it's a new infection, if that's what you're implying, because you've only had oral, and the low risk types, like 6 and 11, aren't usually found in the mouth. Given that HPV isn't usually transmitted orally, and low risk isn't usually found in the mouth, it seems really unlikely that you'd get it from oral.

To be honest, I don't know about the results reading 6 and 11 together, because every result I've ever seen, now that you mention it, says 6 and 11 or 16 and 18. It is possible to have more than one strain, but I don't know if that means you can have one lesion with both types, or if they just run those together and report the results that way. I can't find much on google to tell me, either.

No vaccine promises "never".

https://www.cdc.gov/vaccines/vpd/hpv/hcp/vaccines.html -

Assuming your partner received all the doses required, the quadrivalent (6, 11, 16, 18) vaccine was also found to have high efficacy (99%) for prevention of genital warts.

https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet#how-effective-are-hpv-vaccines -

"Gardasil 9 is as effective as Gardasil for the prevention of diseases caused by the four shared HPV types (6, 11, 16, and 18), based on similar antibody responses in participants in clinical studies."

Cervarix, which isn't available in the US, is about as effective.

You can transmit it without symptoms, or during the pre-symptomatic phase.

I know this weighs on you. I can't say it wouldn't weigh on me, but the vaccines are very effective. I wish I had clearer answers for you.

I hope you have a wonderful holiday. :)

I hope you had a wonderful holiday.  Thank you.  And thank you for the Gardasil statistics.  

No, I don't and never believed I have a new infection.  I believe that I had a stress induced outbreak of a previously contracted strain.  My take on things is that I was infected with one strain at the beginning of 2010 and another strain sometime in 2013 or 2014.  My last wart was three years ago until this recent one.  I wanted to type it because my recent oral interactions with someone new lead me to wish to know the type in order to know whether Gardasil would protect against the strains I have.  Going forward with dating, at least I'll be able to say that I'd be happy waiting while she got vaccinated or using this information to discuss risk if she's previously gotten vaccinated.  

Yeah, sex is super messy and a potential emotionally traumatic minefield thanks to pregnancy, STDs and complicated love emotions.  It really does suck not being able to participate in it without a care in the world, but part of life is being cool with what is and letting go our attachment to what we desired it to be.  I opened up about it to another woman I'd just met just to let her know from the get go about my situation, and she's still down to pursue things with me.  People are much more forgiving towards us than we are to ourselves.  We know this.  

Anyway, one final question about Gardasil.  If you pay for it out of pocket, can you be denied?  This woman I am talking to is 49 and divorced after 25 years so has only had that one partner this whole time.  She'd be a great candidate for the vaccine if she can get it.  Can anyone paying out of pocket get it?  I'd think just flashing the money in front of big pharm would be all one needed to do, but one never knows.  

Well, that seems to have done it for this thread.  Thanks so much for all of your involvement and sorry for the less than clear posts previously.  Those were made under the duress of the moment and I  couldn't formulate clear thought processes on the keyboard.  Have a happy new year!
"It really does suck not being able to participate in it without a care in the world"

I am in my early 50s, so in your age group, and totally get what you mean here, but sex was never actually carefree, right? Even if you didn't have HPV, you'd still have to worry about getting it, or herpes, or another STD, or getting your partner pregnant if pregnancy is not on your agenda. There's feelings, intentions, and insecurities.

I get it, though. I had my wild younger days, did the college party stuff, and then much later, got herpes in a long-term, serious relationship. It changes things.

Yes, people are more accepting than we think - but be careful about using the word "forgiving". You didn't do anything wrong, and it's not any different than if you caught a cold from someone you had sex with. Both are viruses, they just present differently.

Some doctors will give the vaccine to anyone who asks for it. The guidelines say to age 45, and she's just beyond that, so maybe her doctor will give it to her. If not, maybe she can call Planned Parenthood or the health department. She is the ideal candidate. Let me know what she finds out.

Happy New Year, and you're welcome. No apologies needed. :)
Avatar universal
Best thing actually is HPV vaccination for girls at age 14. But often conservative countries, communities people don't like to think about sexual activity of their young daughter. Sometimes even saying that "her daughter won't have much sex" or that "immunity will cause her having more sex".
So it's something that should be solved on a system level.

There is some risk of carying over warts to oral and anal surfaces.  And a very low risk of papilloma/carcinoma there.
So if you are bothered, don't have it that much.
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Avatar universal
Medical system is focused on the biggest damage - so ALL women should follow recomendations of ocasional PAP smear, at least once in every 5 years if I recall.

HPV is very prevalent and invisible, so the system focuses on cervical cancer.

For the same reasons I don't think people shoul disclose if they have HPV, aesthetic or cancerougenous strains. It's too complicated to follow who infected whom and it doesn't matter.

For Herpes it's a more unconfortable disease so status should be disclosed.

There are assumptions that person becomes a bit more immune to warts /HPV,  shedding and infecting others over the years. But it isn't really measurable in men, especally if asymptomatic.
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