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HPV conventional wisdom and new research

Doctor Handsfield,

First of all, let me thank you for taking the time to run a forum like this.  The opportunity to have STD-related questions answered by an expert in the field such as yourself is really a great public service, for which I
11 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
There are detailed discussions of exactly the issues you raise earlier in the STD Forum.  Search for HPV, especially in the early part of this year (as I recall).

There is no "new" research indicating that HPV persists for life or that it doesn't.  The suspicion that it sometimes (often? usually? always?) persists has been present for 20+ years and to my knowledge there is no knew knowledge that provides clear answers.

One problem is terminology.  What does it mean for an HPV infection to persist?  If a snippet of DNA has been integrated into the host cells, but not enough DNA to result in viral replication, does that count as persistence or cure?  If the virus's full DNA genome persists but the immune system successfully prevents it from replicating and causing warts or pre-cancerous changes, is that persistence or cure?  What if there are whole virus particles, not just DNA, but something (immune system, DNA regulatory mechanisms) keeps it from ever causing a problem?

So the biology is uncertain.  But some of the epidemiologic facts are clear.  Once HPV clears up, it is rare for that particlar infection to either cause problems in the future (warts, pap smear changes) or to be transmitted to a sex partner.  And once a person has cleared a particular strain of HPV, the immune system makes it rare to catch that HPV type again.  But "rare" doesn't mean these things never happen; they do.

From a practical standpoint, my view is that most people can consider themselves cured when all signs of their HPV infection are gone, there is no recurrence within a few months (and certainly within a couple of years), and the available tests do not detect the virus.  Undoubtedly some people with those outcomes still carry viral DNA.  I consider them cured, and I encourage affected persons to act accordingly.  It is precisely because of the emotional impact that I lean toward using the word "cure".  But at a biological level, depending on the definitions I imply above, some (a few? many? most? all? we just don't know) are not cured.

When the STD/HPV experts can't completely, it isn't surprising that a clinicians' counseling advice is all over the map.  Perhaps the best advice, to health professionals and concerned patients alike (and all sexually active people) is for everyone to keep their antennas up for new information.  There is no doubt that these concepts will change as time passes and new data emerge.  In what direction, no one can tell.

Best wishes--  HHH, MD
Avatar universal
Thanks for the response.  Personally, I don't care if there's remnants of HPV viral DNA hiding in my cells - or if they have a summer home by the lake - so long as I can't spread it to anybody else and I no longer have wart outbreaks.  

However, I was just curious what "old" scientific evidence formed the basis of the "suspicion that it sometimes (often? usually? always?) persists" that "has been present for 20+ years" as you state.  Is this purely an academic argument?  I understand that a virus isn't technically "curable" like a bacterial infection, but as long as symptoms and transmission aren't generally possible, that's good enough for me.  

So are you saying that there is no scientific evidence for extended, life-long GW infections?  If so, I wish doctors would stop telling everybody "you're going to have this forever" because most people are going to assume that they are talking about WARTS and not just some cellular DNA components...
239123 tn?1267651214
MEDICAL PROFESSIONAL
I'm not an HPV biologist, but some such persons have long believed that HPV persists indefinitely in all or most people who acqure the virus, at least in latent (DNA only) form.  There is no doubt that some people have permanent latent infections; the debate isn't whether it happens, but whether it is the exception, the rule, or something in between.

In any case, I don't agree that most people assume the discussion means warts, not HPV.  In my experience, many more people (mostly women) have questions about their non-wart-causing HPV infections than genital warts.  Most people with warts correctly understand that in general they are an inconvenience, not a serious health threat.

HHH, MD
Avatar universal
hey Doc you ever gonna put up that HPV FAQ?  This answer would be great for that!!!!!!!

-Sunny
Avatar universal
Sorry, I shouldn't presume to speak for "everyone".  Of course I can see why women with high-risk HPV would be concerned about latency.  But since I have the low-risk, wart-related variety, I'm mostly concerned about the risks of recurrance and contagiousness.  If there's pieces of DNA left, big deal, as long as they don't do anything...
Avatar universal
HI Guys
I have have noticed a wart on my penis about 2-3 years ago
at that time I didn't know what that was I actually thought that I always had it , like a birth mark or something ...
about a year ago I went to URO and he asks " hey do you want this wart removed ?"  
I was shoked , I was like wart ??? Then he explained to me that it was HPV . He actually found 5 of them underneith my shaft need testis. I got them removed and here I am , Just like new...
I don't even know where and when I got the damn thing ohh well..
But scince then I never had any new ones pop up.

And If anyone out there is woried , Don't be it does not hurt at all like I said above.  It is not life threatning ..
And removal of those things is not bad either :)
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