Dr. Handsfield Input

[Djones13]

Hi,

I'm hoping Dr. Handsfield can answer this question. I just posted in this forum regarding my exposure to a partner with a case of genital warts. I know HPV isn't a big deal and that most people contract it, but I'd like my specific risk in this instance weighed out. I'd like to preface this question by saying I HAVE been fully vaccinated with Gardasil, and completed the series at least 2 month before any sort of contact occurred, though I realize that it doesn't protect me from all wart-causing strains of HPV.

My partner was diagnosed 2 years ago with a genital wart. He had it treated, but believes it has recurred, and is going to get it checked out next week. At this point in time we have not engaged in any form of penetrative sex (be it oral or otherwise), or genital-to-genital contact in any form. The only thing that has occurred was the he fingered me once after thoroughly washing his hands, and at one point in time I touched his bare penis, and may have touched myself shortly thereafter.

1) Dr. EWH has indicated that the handwashing probably wouldn't drastically reduce the risk of transmission, which now has me terrified of having potentially contracted the virus this way. You indicated in a thread back in 2006 that, regarding HPV, "the chance of transmission to your partner by hand-to-genital contact are very low.  They will be lowered to zero if you wash your hands." So can I assume in this instance I am safe? Who is correct?

2) Do I need to inform future partners that I had this type of contact with a man who had genital warts?

[Edward W Hook, MD]

This will need to be the final element of this thread but I hope my further comments will help you to move forward and not let your concerns worry you or interfere with your relationship..  Several comments:

1,  You are fully vaccinated with the HPV vaccine- this provides more than 99% protection from the viruses it covers, including the viruses which cause the majority of visible genital warts.
2.  Your BF has been treated. If he does not have a visible recurrence of infection n 3-4 months following treatment, he should be considered non-infectious for this infection.
3.  Condoms are highly protective against HPV.
4.  Your risk for HPV in the situation you have described above is far, far lower than your risk for contracting and contracting HPV from a new partner if they have ever had sex with someone else. Remember, most people have HPV and do not know it, nor do they ever suffer and health consequences from their infections.

This will conclude this thread. EWH

[Djones13]

Hi Dr. Hook,

As you can see from this thread, we had an ongoing discourse regarding genital warts and transmission, etc. If possible, I'd just like a little more information. I can see now that  my previous transmission worries were silly. However, I'm wondering if I can ever be fully intimate with my boyfriend (i.e penetrative sex with protection). He had his warts treated a few weeks ago by a dermatologist, and I am fully vaccinated with Gardasil. If we choose to have exclusively protected sex, how likely is it that I will develop genital warts from him? I'm just trying to be as safe and responsible as possible. I'm afraid I'm letting this silly virus interfere with my relationship.

[Edward W Hook, MD]

Correct, between your vaccination and the nature of the contact you describe, your risk is minimal (in a world where there is no such thing as no risk).  There is no need to inform future partners of this possible contact.  EWH

[Djones13]

He absolutely does have a wart. This was confirmed by a dermatologist just yesterday. My apologies for not making that a little more clear. But given your recent comment, I'm comfortable with knowing that you're aware of all the detail nows, and because your advice still has not changed, I feel better.

So to conclude, with the amount of contact we have had, and given my vaccination history, even though he DOES have an active infection, I am not at risk for contracting genital warts, and should not inform future partners of this matter? A simple yes or no will suffice and end this thread. Thank you!

[Edward W Hook, MD]

I apologize for the misunderstanding.   Your original note said “I just began a relationship with a man who was allegedly diagnosed with a genital wart 2 years prior. It was treated, and currently we believe he has no visible warts, though I am aware of alleged "micro infections”…”   I also note that he does not know for sure that he has a wart at this time.  That he now may have a wart however does not meaningfully change my advice or recommendations.  The risk that you may have acquired or been meaningfully exposed to HPV through masturbation however remains too low to be of consequence.  EWH

[Djones13]

I'm sorry but I feel like my questions are just being "skimmed over" and not thoroughly addressed despite the money I've paid. I'm trying to be polite, but this is something I've mentioned twice now, in the same thread, and your advice is issued on the basis of your perception that he does not have an active case of HPV. He does. It was confirmed yesterday by a dermatologist.

[Djones13]

But that's what I've been trying to convey this whole time. He DOES possess an active infection! He saw a doctor and has a genital wart. It resurfaced after the initial infection 2 years ago. Now I feel like I have to start all over. How much does this change everything regarding my previous questions.

[Edward W Hook, MD]

1.  I disagree with your assumption that you have been expoed by virtue of masturbation between you and your partner.  As I said above, there is no evidence that your partner has active, transmissible infection.  There is no need for disclosure or for future abstinence should the relationship end.  

2.  HPV infections are typically self-limited and asysmptomatic.  the majority of HPV infections likewise do not lead to objective signs of infection.  

Take Care   EWH

[Djones13]

Yes, your comments certainly have helped. I just have two more questions, and that will end this thread. My only worry is that my partner DOES have a confirmed case of genital warts. I understand masturbation in general doesn't warrant disclosure, but what about if the case is like mine, where you have had definite contact with an infected individual? If my relationship ends, do I have to wait 12 months to see if any warts show up on me before I begin any new relationships? I feel like the fact that I'm aware my current partner is infected warrants disclosure to future individuals, but perhaps I am wrong. Furthermore, I know that most people contract HPV at some point, and that most of these people never know because they don't show any symptoms. It it only because they don't contract wart-causing strains (like 6/11), or because they simply just never develop any signs? I worry that the fact that I have had contact with a "wart causing strain" somehow changes the game.

[Edward W Hook, MD]

No, there is no medical reason to inform potential partners about contacts which are masturbation.  The issue of how to discuss such matters is a hugely important topic for which I think there can be few generalizations.  The facts are that when STIs such as HPV, herpes and trichomoniasis are considered nearly all persons (both in the U.S. and globally) have had an STI yet we live in a world where, at least at present, there are widespread misconceptions that such problems are "bad" and represent "bad" or "irresponsible" behavior.  That is not the case but transition from these misperceptions will take time.  Until that time, I'm afraid I would suggest that the right thing to do is try to judge where potential partners are in terms of their willingness to talk about past sexual partners, past STIs, etc. and let that conversation guide your actions.

In your own case, you do not know that your potential partner has HPV or, for that matter any other STD, you have taken the HPV (and I presume, hepatitis B) vaccine to prevent vaccine preventable STIs, and have no evidence whatsoever that you have any STI.  Thus there is nothing to "disclose".  

I hope my comments have been helpful to you.  Your messages suggest that you are a mature, cautious, highly responsible person- these qualities will be helpful to you as yu move forward on this or future relationships.  EWH

[Djones13]

Okay, thanks Dr. Hook! Also, just one more quick question. Should I tell any future partners about this sort of contact? Is it really warranted?

[Edward W Hook, MD]

Sorry, we do not permit clients to ask the same question of each of us.  We have worked together for over 30 years and have never disagreed on the facts or our recommendations to clients..  Your inappropriate anxiety over HPV has lead you to over interpret the difference in wording in the two statements you have chosen to focus on.  I indicated to you that there is little if any meaningful risk of HPV and when you pushed with your "it might be possible questions" I told you that hand washing would further reduce the (already low) risk for infection still more.  You are asking for absolutes in an area where they do not exist.  EWH