HPV Ethics

[99percentlightspeed]

good morning-

here is my experience with hpv. I was diagnosed many years ago with a wart on my penis. I was treated with liquid nitrogen and few time and had a couple recurrences and then aldara. After about a year, I thought that I was finally clear. I went to two separate dermatologists over the next 6 months and they both felt that there were no more warts. So, I started dating again and told my potential partners that I was diagnosed with HPV and was treated and told that I was clear via two different exams. Over the course of about 6 months, I dated 3 different women and told them the exact story and encouraged them to get the gardasil vaccine. one had gotten it and one got sick from the shot so stopped after the first injection. In both cases, I didn't allow oral and I was so extremely careful about avoiding skin-to-skin genital contact that it was bordering on embarrassing. I didn't allow my penis to be touched and I did my ultimate best to avoid any contact with my penis when i put on a condom. I also used a dental dam at the base and pubic area-- so there was complete and total coverage.

So, here I am, now with a new wart in the same location as before and I am totally devastated. I had it biopsied and it was positive as a wart. Now what? I feel as though I didn't do enough to protect my partners? I feel like I need to drive the girls to the ob/gyn to get a pap smear because i'm so worried about this. I guess what I'm wondering is--- did I do anything wrong?

[Edward W Hook, MD]

You need to stop beating yourself up!  You have one all you could conceivably o for your partners.  

HPV does not pass through latex.

Yes, I do think you can assume that not only does just about everyone have HPV but they have also likely given it to someone else.  

Try to move forward.  EWH

[99percentlightspeed]

doc, since 85-90% of sexually active people contract hpv and recent studies show 50% of men carrying active hpv--- is it pretty much safe to say that just about everyone has 'given' someone else hpv? I just don't want to feel alone if someone where to get infected because of me. thank you.

[99percentlightspeed]

i guess what I feel awful about is that even though i informed them of my infection, treatment and apparent clearance, I failed to tell them about the possibility of recurrence and/or invisible infection being present. I know on some level it's ridiculous--- it just occurred to me 'why didn't i have them sign an informed consent?' (that was a joke!). Anyway, doctor, I just don't quite understand where my obligation ends and my partner's begins. What is their responsibility after disclosure of a prior infection? By the way, I am very confused about whether HPV can work it's way through latex or not? I keep reading condoms aren't really effective. Can I propose a theoretical question--- if there was a condom that someone put on like underwear (basically everything is covered) would hpv be transmitted from genital-to-genital contact? thanks!

[Edward W Hook, MD]

Welcome to the Forum.  I hope I can help although ultimately the issue you are grappling with is less of a medical problem than a personal ethical issue.  I will start by offering you my sincere congratulations on all of the steps that you took to inform your partners and your (perhaps overly excessive) efforts to protect them from possible acquisition of HPV- you have done as much and possibly more than can be reasonably asked of someone.

While we are adamant about issues of barrier protection in the presence of infection and partner notification for sexual partners of persons with bacterial (treatable) STDs, our position in terms of HPV is more permissive.  There are several reasons for this.  First and importantly, virtually anyone who has been sexually active for any duration of time, irrespective of partner number probably already has HPV.  Current estimates are that over 85% of sexually active persons have or have had HPV.  Second, while remarkably widespread, the fact is that less than 1% of persons who acquire HPV as an STD get the serious result of infection, cancer – the remainder will clear the infection over time on their own.  Thus, as a practical matter, trying to prevent HPV exposure is a difficult, if not close to impossible task.  For this reason, our approach, based in large part on pragmatism, is that we encourage vaccination, disclosure, and routine PAP smears for women but feel less strongly about barriers or other efforts to prevent transmission.  You have gone over and above this.  From the sound of things, I think you have let your HPV diagnosis have a profound effect on you which may be having a negative impact on your relationships with others.  You have certainly done nothing wrong from my perspective.  

By the way, I have chosen to delete a post by a member who goes by the screen name  "veryworried420" as I do not agree with his/her perspective and do not wish for it to cloud the issue I am addressing here.  EWH