few questions about HPV

[perrier72]

1) how many different strains are capable of causing external visible warts?

2) I keep reading different numbers for hpv + people all over the internet. Is the
actually number really close to 85% as Dr. Hooke states?

3) I was in a relationship with a girl who was hpv + by pap smear and warts. I found small
warts along my penis shaft about 2 years later. In between that time I had protected
vaginal sex on a few occasions and unprotected oral sex with a few partners. how
likely is it for them to have oral warts and/or throat cancer? Do I need to tell them
to go get a dentist check up?

4) Recently, I was in a relationship for about 2 years girl who had over 25 partners. I was wart-free prior to meeting
her for about 4 years. I have warts again now. She called me and told me she had a +pap smear hpv test and
blamed me for the diagnosis even though she had a questionable + pap before meeting me. She told me it was
positive but the repeat was negative. Is it more likely that I have a new strain from her or a reoccurence of my original warts which I was free of for years? I read where most people clear the infection in 8-10months. can you comment on this? I know that's it's very hard to know for sure, but I was wondering what your medical 'hunch' is.

Thanks very much for your knowledge. You help so many people.

[H. Hunter Handsfield, M.D.]

Although condoms would improve sexual safety if used consistently for oral sex, the risks of STD and HIV are much lower than for genital/anal sex and condoms are generally considered optional -- and as you suggest, most sexually active people find condoms for oral sex distasteful (literally and figuratively).  Certainly oral HPV isn't enough of a risk to make condoms a high priority.  But it's a personal choice.

I already answered your second question.  See my reply yesterday (last part of answer no. 2); your closing comment about HPV clearance is correct.  Still, some infections persist and recurrent warts can be due either to a new infection or to reappearance of a previous one.  I cannot say which applies to you, except I also said above that it is important to get a professional diagnosis; perhaps the recurrent problem was something other than warts.

That will have to do it for this thread.  Take care.

[perrier72]

Thanks for explaining so thoroughly!
I checked out some sites, CDC and ASHA, since I wrote. they
are very helpful. I'll check out the gardasil when I'm done writing.
Thanks for allowing the follow-up questions.

1) So, after reading your response and the websites, I realize that
that condoms aren't a must for oral even if you've had
an HPV infection, correct? I know not to be cavalier about things, but when
I'm in a relationship for months, it's very tough to use a condom for oral.
It really takes a lot of will power to use it 100% of the time for vaginal!
And, I think I understand what you said, it really isn't a huge deal to have
oral sex with someone who has hpv. I'm certain that I've been exposed
numerous times from engaging in oral myself!

2) I'll try to reword  question #4 from above better. If someone has warts and clears
them then sleeps with a bunch of people (including someone with a history
of having 20 or so partners), is it more probable that a wart recurrence is a
result of a new strain or from the original strain? Do people have the same strain
forever and are they always contagious? I read where the vast majority of people
clear the virus or suppress it to non-detectable levels after some months. Is that correct?

thanks for sharing your knowledge once again!

[H. Hunter Handsfield, M.D.]

Happy to answer.  You ask your questions without preamble, so here come the answers the same way.

1) There are somewhere around 100 identified types of HPV, of which 30-40 types primarily infect the genitals.  Of those, 2 types, HPV-6 and 11, cause 90% of genital warts.  I don't think it is known exactly how many types explain the other 10%.  Probably several, but this has been studied carefully, as far as I know.

2) Eighty-five percent probably is about right for the proportion of persons who get at least one genital HPV infection in their lives.  We know for sure the proportion reaches 50-60% in people who have had at least 3-4 lifetime sex partners.  In the US, at any point in time around 25-30% of sexually active persons age 15-30 have genital infection with at least one HPV strain.  To answer one of your later questions, most HPV infections last 6-24 months, with most clearing up within a year.  The large majority of infections are asymptomatic in both men and women, not causing either warts or abnormal pap smears.

3,4) It sounds like these questions refer to the same partner and the same episode of apparent genital warts.  Warts usually show up within a few weeks of inection.  If your penile bumps were warts, they probably were acquired more recently than 2 years earlier.  If not professionally diagnosed, that needs to be done; self-diagnosis by medically untrained persons is very unreliable, since other things can cause bumps on the genital skin.

Neither your parnter nor you can know for certain whether one of you infected the other.  More likely than not, you both had multiple exposures to HPV infected people over the course of your sexually active lives, and you both likely have been infected with HPV more than once.  Except when someone gets HPV after having only one lifetime sex partner, it is pretty much impossible to know when and by whom s/he was infected.

As to oral HPV and cancer, the media have overblown that issue.  There is an association between some throat cancers and one of the high risk "genital" HPV types, namely HPV-16.  But those cancers come to a total of only around 6,000 cases per year in the entire US; most of those are in people age 50 and over; it isn't at all certain that they acquired their oral HPV-16 infections by oral sex or some other way; and there is no test or exam that can tell with certainty whether or not someone has an oral HPV-16 infection.  The bottom line is that it remains a very rare kind of cancer and not something that you should be worrying about.

I hope this helps.  Before asking follow-up questions, please do some research.  Read up further on genital HPV at websites offered by CDC (www.cdc.gov/std), my former health department (www.metrokc.gov/health/apu/std), and the American Social Health Association (www.ashastd.org).  Good information also is available from Merck, the company that produces Gardasil, the vaccine against the 4 most common HPV types (www.gardasil.com/hpv/index.html).  After that homework, please feel free to return with one or two brief follow-up questions.

Best wishes--  HHH, MD