HPV disclosure and my struggle with it.

[agualibre]

Back in 2001, my boyfriend had been diagnosed with genital wart and I didn't. In 2005 I developed a bump on my perineum. I didn't have it removed. About 6 months later I put garlic on it which did make it way smaller, though it came back. I used aldara just twice and garlic and it was gone- it took about a year.  Then it came back last year, in the same exact place, very tiny. I went to an NP and she put acetic acid on it, it did not turn white. She said it was not a wart, that sometimes you can get bumps. She offered to burn it off, I said no...
It stayed there the same size for a while and then it started to get bigger. I went to a different doctor who said it WAS a wart. She used liquid nitrogen to treat. That was back in May.  
I've started to date a new guy. I promised myself, I would tell him. He doesn't know that much about STD's, so I was worried.
Then we had sex. We weren't going to... we both said we'd wait. And part of the reason I wanted to wait was to build up the courage to tell him. We used a condom, but since then the condom broke and also he has rubbed up on me without a condom.
So I'm kind of freaking out. It's been a month, but he clearly is interested in a long-term relationship.  I've been really struggling with this. Because I'm afraid if I tell him he will break up with me because I didn't tell him before, or at the very least it will break down his trust in me and he will see me differently. =(
He has had psomewhere between 10 and 30 sexual partners, I don't really know. I figure he has probably been exposed and more than likely he has other strains he is exposing me to, but there is no way to prove it, plus there is no way to prove I am still able to transmit the virus.  
I am inclined not to tell him when I weigh the balance and the risk. I'm sort of afraid of a recurrence.  Since that wart was in the same exact place, does that mean it was a recurrence??  What do you think about my thought to not tell him??

[monkeyflower]

I think you actually can get the vaccine, but you'll have to pay out of pocket for it.

About telling your bf... if it were me I wouldn't bother, for the many very excellent reasons you and Dr. Handsfield listed. But since you seem to be on the fence on this one, think it all the way through. If your bf were to develop warts at some point in the future, there's no reason to blame yourself. He's had multiple partners, most if not all of whom likely had HPV as well. And you don't even know if you had HPV--and if you once did, you probably don't have a current active infection. And in the end, they're just warts. Kinda annoying, but the equivalent of a sniffle. Would you be as freaked if it were a wart on your hand?

[agualibre]

The reason why I say it gives no information-- is that I worked at two different clinics and the doctors and midwives were generally opposed to giving the test.  It tells you that you were exposed, but it doesn't tell you where the virus is, and it doesn't help you in terms of knowing if you can transmit it.  It left the doctors and NP's at a loss about what to say.

What I mean by "I know too much" about it... is that if I didn't know so much I would feel obliged to tell him... but by knowing more... it makes it more ethically difficult for me... like you keep pointing out that it is an ethically borderline issue.  If I didn't know so much about HPV, I would just tell him... but I know that more than likely he has been exposed to it...

Yes, his head is in the hand about STD's, of that I would agree... which is what makes it even harder-- I would then have to explain all of the nuances and unknowns about HPV... basically I end up telling him "I don't know if it was HPV, but it might have been, I don't know if I could pass it to you or ever have it again, but I might, I don't know if you've already had HPV, but you probably did, If I have it, I don't know if you'de ever have an outbreak..."

Knowing all of the unknowns.... that's what makes it hard.

Also in terms of the acetic acid-- yes, I looked up on the CDC website after I saw the NP because I was surprised by how sure she was that it was not a wart, and nervous she was wrong and it said that they did not recommend it because it causes false positives... but I did not see anything explicit about false negatives....??

[H. Hunter Handsfield, M.D.]

I don't think you "know too much" about HPV, but I do agree your prior knowledge is coloring your response to this situation.  For example, as a colposcopy assistant for an HPV researcher, you undoubtedly have seen acetic acid used on the cervix to highlight areas that might be HPV infected.  But that is the only legitimate use of acetic acid, to guide a colposcopist in knowing where to do a biopsy and/or to treat with LEEP.  But it doesn't work well for HPV diagnosis on genital skin.

As far as discussing with your partner, I agree with monkeyflower's advice, but also understand the dilemma of having raised the issue and being confronted by your partner's denial.  It does seem he has his head in the sand with respect to STDs.  This isn't a relationship advice service, but I imagine if you sent over to the HPV community forum you could get additional ideas about whether or how to pursue it from monkeyflower and others.

I disagree that the HSV blood test "gives absolutely no information".  The test isn't perfect and I don't necessarily believe you need to be tested, but many asymptomatic sexually active persons definitely benefit from knowing whether or not they have HSV-2.

[agualibre]

Hi Monkeyflower- thank you for your response... I know, but I was raised catholic!  I was raised to confess things!  Just knowing that I didn't tell him will always bother me!!  What you are saying is true though.... Someone on another forum suggested I talk about it with him...
Then again, I *did* try to start the conversation, by saying that everyone with more than 4 partners has had HPV... I said this when he told me he never had an STD... so he did not pursue the conversation further or ask me if I had it or anything... If he did, I would have told him... I did tell him I never had the blood test for HSV but never had an outbreak... I don't believe in taking the blood test if there is no outbreak.  There is no reason for that, it gives absolutely no information whatsoever.
I think i'm making myself a little bit sick with worry to be honest....

[agualibre]

>> another question related>> isn't the problem with acetic acid that it gives false positives?? does it also give false negatives?

[agualibre]

BTW, I did tell him that "people can have HPV or HSV and not know"... So I did say that and he did not ask any questions... I did try to bring up the conversation...

[agualibre]

Thank you for your response.  I am 29 years old, so I can not get the vaccine.

It's difficult to have a conversation.  I do know a lot about HPV, because I worked as a colposcopy assistant for a HPV researcher.

That's part of the problem... I know too much... I know that most people never have an outbreak, that most people are exposed at some time, that likely he may have already been exposed to HPV and is passing me new ones that are actually more dangerous to my own health than his.  I know that there is no way to test myself and there is no way for me to get tested.

So it seems like me bringing it up to him is just going to upset him.  So I struggle with what the benefit is?  The only benefit I can see is that if something is to happen down the road and I get another bump or something he won't freak out... BUT, the problem is... if he has the virus already from another partner and gets warts, then the blame will fall on me.

Also I just had that one single bump, which was not tested, and had conflicting opinions.  It never spread or anything... I don't know.  As much as I know about HPV, now that we've already had sex without me saying anything, I struggle with what is the benefit of telling him?

[H. Hunter Handsfield, M.D.]

First, congratulations for having pretty good knowledge about genital HPV infections and a level-headed, responsible attitude.  But I'm afraid I can't give you a hard and fast answer.  On balance, it's probably best to discuss the possibility you had genital warts with your new partner.  But I'm not sure you actually did.

Despite the most recent provider's diagnosis, the overall picture makes it seem unlikely, and I'm not sure that doc's diagnosis is any more accurate than the previous one.  Turning white with acetic acid doesn't say much; it is a terrible test, not intended for the diagnosis of warts on the skin, often giving false results.  We never, ever use in my STD clinic.    Also, 3-4 years is an awfully long time for genital warts to first show up, and a single bump appearing 4 years after exposure is unlikely to be a wart acquired from that person.  That the bump went away after liquid nitrogen also is meaningless.  Freezing destroys whatever it touches, so even a skin tag or other insignificant lesion also would respond to such treatment.

For those reasons, and since you have had no further recurrence for 6 months since freezing, it seems very unlikely you still have an ongoing infection with a wart-causing strain of HPV, if you ever did.  On the other hand, nobody can guarantee you are free of HPV at this time.  Also, consider the conversation if warts or other HPV infection do arise in your new relationship:  Would you rather have that conversation ("Yes, I might have had a genital warts but I thought the infection was gone") at that time or beforehand?  There is no clear answer, as you already seem to know.

You are exactly correct that your partner probably has had HPV, probably more than once.  I would also add that nobody should ever forego a potentially promising sexual relationship, especially a possibly romantic and long lasting one, because of concern about genital warts or other HPV.  It's an impersonal virus and rarely a serious health risk, especially for men.  I hope your partner understands this or that you can convince him of it.

You seem to know enough about HPV that you probably know about Gardasil, the HPV vaccine.  Talk to your health care provider about getting immunized, which will give 100% protection against 4 of the most common HPV types, including the 2 common wart-causing strains and the 2 most commonly associated with cervical cancer (not counting any of those types you already have been infected with).  HPV immunization is recommended for all sexually active women age 26 or less.

Finally, consider visiting the HPV community forum.  There are some knowledgeable people there and you can get lots of additional advice about the pros and cons of discussion the situation with your partner, as well as strategies to raise the issue with him.

Best wishes--  HHH, MD