HPV Likelihood and Detection

[jjsmith08]

Hi,

Recently, I had sex with a female who contracted HPV one year ago.  Her most recent pap smear was two weeks ago and was positive for abnormal cells on the cervix.  I had sexual intercourse with her once with correct condom use and a hot shower soon after.  I am otherwise a healthy individual with no medical problems.  I have found the primary lit articles and read about the modes of transmittance and potential lack of symptoms, but have also found that there is no FDA-approved, commercially available test for HPV for men.  I have been well coursed and well practiced in some of the common lab techniques used in other STD tests, such as PCR and ELISA, and this experience suggests to me that there have to be lab tests that can be run.  This was a fairly recent encounter, and a new partner understandably wants me to prove that I don't have HPV.  This being said, I have two questions:

1)  Is there any accurate way at all that a male can be tested for HPV (i.e., not acetowhitening)?
2)  What is the likelihood that I contracted HPV from this encounter?

I know that my peace of mind will be impossible to restore without knowing whether or not I have it, not to mention the problems this causes with a new partner.  Thank you so much for any assistance you can provide.

[H. Hunter Handsfield, M.D.]

I will try to help, but you're not likely to be thrilled with my answers.  First, focusing on a particular partner who you know had been diagnosed at one time with HPV says nothing significant about the risk you were (or have been infected).  I don't know how many different women you have had sex in your lifetime.  But let's say it is 10.  If so, probably 3 of them were infected with HPV at the time you had sex; and 8 of 10 had it at one time or another.  The fact that one of those women (and only one) had a definite diagnosis, and chose to tell you about it, makes no significant difference in the chance of you being infected.  Had your former partner been my patient, I would have told her to not mention her HPV to her future sex partners.  Had she followed that advice, you would be happier in your ignorance and it would have made no difference in your health or that of your future sex partners.

Second, for many of the same reasons, tests for HPV are not useful and may never be generally available.  There really is no point in such testing, since a positive result will not mean anything different (no treatment, no clear necessity to modify sexual practices); and a negative results would not prove someone isn't infected, since all current and conceivable future tests probably miss most infections.

To the specific specific questions are:

1) No, there is no way.  In the research studies, in order to detect most HPV infections, testing has to be done on specimens collected with abrasion (i.e., emery paper) from several sites of the penis, from the scrotum, and from the anal area.  And even those probably don't detect all infections, as I indicated above.  So even if the research tests were available, they are not practical for routine care.

2) Genital HPV is very efficiently transmitted.  If her infection was active when you were together, and if you had not previously been infected with the HPV type she had, then you can be sure you were infected.  If so, by now it likely has clear up.  If you had been previously infected with that type, you were immune to catching it again.  Either way, you remained asymptomatic and experienced little risk to your future health.

In summary, If you cannot get "peace of mind" without clearer understanding of whether or not you had that particular HPV infection, you'd better be prepared for a life of anxiety about it.  Instead of that, I suggest just mellowing out and not worrying about HPV.  Look at it this way:  getting genital HPV is inevitable and normal -- not desirbable, but it happens to just about all sexually active people.  Happily, important health outcomes are rare.  Women need to get pap smears; gay men and their health care providers need to be on the lookout for anal cancer; and all younger sexually active people can be protected against the most important HPV types by vaccination.  Other than those steps, nobody need worry much about genital HPV infection.

Best wishes---  HHH, MD

[canuck200775]

the propoganda out there about HPV and people's ideas about it I have discovered are ridiculous. Here is a very interesting comparison:

The Epstein Barr Virus is very common. Perhaps slightly more than HPV, but the rates are comparable. Perhaps 90% of sexually active people will get an HPV infection at some point in their lives. 95% or so of people will similarly be exposed to EBV. Rarely EBV is involved in causing lymphoma. Rarely, HPV can lead to cancer. Now, you do an internet search and everyone is freaking out about HPV, how terrible it is, how you have to forever tell everyone that you have been exposed if you know (i.e. GW or abnormal pap or slept with someone who had an abnormal pap in your case) and on and on and on. Does anyone though feel that you need to feel this way if you have had mono? No.

My suspicion is that it is all about HPV being sexually acquired and the stigma that goes with it.

whatever it is, lay people and the media alike should get informed.

[H. Hunter Handsfield, M.D.]

I misread the original question and thought the contact was a year ago.  I now see it is a year since her diagnosis.  Therefore, she probably is no longer infected; most HPV infection resolve before a year.  So there is no particular reason to believe you were infected during your exposure a week ago.

Thanks for the thanks.  Take care.

[jjsmith08]

Dear Dr. H,

Thanks again for your insightful comments - it is clear that the website has done a good job in recruiting helpful experts to field the questions in an unbelievably quick manner.  I did say I would only ask one follow-up, so answer this only if you want to, but the encounter was only a week ago, so if I contracted it, I doubt I would have fought it off already, which means I currently have it.  I'm guessing you would say that whether I "have" it now or "had" it in the past makes no difference and I should just proceed exactly as I would if she had never told me?

Thanks for the lesson in mellowing out.

P.S.  I promise that's the last follow-up.  You're the best.

[H. Hunter Handsfield, M.D.]

The high risk ("bad") HPV strains are the most common -- more frequent than the "low risk" types that cause warts, for example.  That makes no difference in my replies or in implications for your health, and neither do the details of her pap smear results.  Of course you have no obligation to talk to future partners about your former partner's infection.  You haven't even been diagnosed with HPV!  (If that were the policy, 95% of all dating people would be telling their potential partners "I might have had HPV in the past."  Well, duh.)

[jjsmith08]

Dear Dr. H,

Thank you for your comments - they've helped me to mellow out a little.

As a quick (and only) follow-up, I know that she was diagnosed as having one of the "bad" strains, and that at her most recent pap smear (shortly before my encounter with her), the findings were described as a "bad" strain that was causing "abnormal cells of no significance" and that she appeared to be fighting it off.  Does this change the situation?  Should I modify my sexual behavior or refrain from sexual intercourse with new partners?  Would you still say that it isn't necessary to disclose this knowledge to future partners?

Thanks again.