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Warts // disclosure // for PARTNERS
Dear doctors,
Here is my situation:
I dated a girl for a bit over a month, during which time we had unprotected intercourse. About a week after we broke up she told me she had gone to the gynocolegist who had diagnosed her with genital warts.
I get regular STD check-ups and also go to a dermatologist every 3-4 months, who I ask to closely inspect me for genital warts. Here's my question--because of the fact that I had sex with someone who had actual genital warts, should I therefore feel compelled or obligated to inform MY future partners that *I* 'might' have genital warts or HPV, because I was with someone who had genital warts?
I'm thinking and hoping that the answer is a firm 'no' (and guessing that the reason is that, as someone with a very healthy amount of sexual partners in my past, I likely have already 'caught' whatever strain of wart-producing HPV my ex had or has, long before her...and that therefore I'm likely 'protected' from getting it again.)
So, provided I keep an eye on MYSELF for overt genital warts, should I be telling people I sleep with about this 'potential'?
Here is my situation:
I dated a girl for a bit over a month, during which time we had unprotected intercourse. About a week after we broke up she told me she had gone to the gynocolegist who had diagnosed her with genital warts.
I get regular STD check-ups and also go to a dermatologist every 3-4 months, who I ask to closely inspect me for genital warts. Here's my question--because of the fact that I had sex with someone who had actual genital warts, should I therefore feel compelled or obligated to inform MY future partners that *I* 'might' have genital warts or HPV, because I was with someone who had genital warts?
I'm thinking and hoping that the answer is a firm 'no' (and guessing that the reason is that, as someone with a very healthy amount of sexual partners in my past, I likely have already 'caught' whatever strain of wart-producing HPV my ex had or has, long before her...and that therefore I'm likely 'protected' from getting it again.)
So, provided I keep an eye on MYSELF for overt genital warts, should I be telling people I sleep with about this 'potential'?
MEDICAL PROFESSIONAL
Correct: this meaans that probably her abnorml pap was caused by a non-wart-causing type.
That really does wind this down. You can't exect to indefinitely ask about every additional nuanced issue that comes to mind.
That really does wind this down. You can't exect to indefinitely ask about every additional nuanced issue that comes to mind.
If you can abide one last clarification, I will really be done with this..
If she's telling me that the HPV she has 'is the kind that causes cervical cancer,' that DOES rule out the main types that cause genital warts, right? I don't want to keep bothering her with clarifications on this, obviously. I just got confused when you said that both low-risk and high-risk can cause abnormal paps.
If she's telling me that the HPV she has 'is the kind that causes cervical cancer,' that DOES rule out the main types that cause genital warts, right? I don't want to keep bothering her with clarifications on this, obviously. I just got confused when you said that both low-risk and high-risk can cause abnormal paps.
MEDICAL PROFESSIONAL
I've already said that if your partner only had an abnormal pap smear, not warts, I would advise there is no need to inform future partners.
The details of her pap smear -- the kinds of abnormal cells, medical procedures to remove them, etc -- make no difference. It is likely your partner indeed is infected with a high risk HPV type, i.e. one with the potential for cancer. But not necessarily; low risk HPV types alco can cause abnormal paps. In any case, the high risk types are actually the most common, and you can assume you have been infected with one or more such HPV strains, in addition to the potential exposure to your recent partner's infection.
I'm not keen on speculating about "what if" questions. If you and your partner had not had vaginal sex, of course your risk would have been lower. But what's the point?
I don't think it's appropriate to be "angry" with your doctor who recommended against HPV immunization, given your age. HPV vaccination usually isn't helpful beyond age 26, not because it doesn't work in older men, but because after age 26 most people have already been infected with some (if not all) the 4 strains covered by the vaccine; and also new HPV infections are a lot less common after age 26 than before. Of course there are always potential exceptions -- older people who would benefit from vaccination, and younger persons in whom it will make no difference. But I can't fault a doctor who follows the standard guidelines by all public health agencies.
That will have to end this thread. I won't have any further comments or advice. Best wishes.
The details of her pap smear -- the kinds of abnormal cells, medical procedures to remove them, etc -- make no difference. It is likely your partner indeed is infected with a high risk HPV type, i.e. one with the potential for cancer. But not necessarily; low risk HPV types alco can cause abnormal paps. In any case, the high risk types are actually the most common, and you can assume you have been infected with one or more such HPV strains, in addition to the potential exposure to your recent partner's infection.
I'm not keen on speculating about "what if" questions. If you and your partner had not had vaginal sex, of course your risk would have been lower. But what's the point?
I don't think it's appropriate to be "angry" with your doctor who recommended against HPV immunization, given your age. HPV vaccination usually isn't helpful beyond age 26, not because it doesn't work in older men, but because after age 26 most people have already been infected with some (if not all) the 4 strains covered by the vaccine; and also new HPV infections are a lot less common after age 26 than before. Of course there are always potential exceptions -- older people who would benefit from vaccination, and younger persons in whom it will make no difference. But I can't fault a doctor who follows the standard guidelines by all public health agencies.
That will have to end this thread. I won't have any further comments or advice. Best wishes.
--and does the fact that doctors are talking about 'removing pre-cancerous cells' mean that she has an especially "bad" type of HPV? Or that she's merely unlucky in how this particular, I'm assuming common, high-risk strain of HPV has affected her, personally? (In other words, that another man or woman with the same exact strain of HPV wouldn't necessarily have the same outcome that she does.)
Oh sheesh. Many apologies, but I have just clarified a few things with the ex, and it seems like the situation is actually slightly different. I hate to continue this thread overly long but if you could bear with me given the light of this info. She writes:
"I have the HPV that causes cervical cancer, not the kind that causes warts. There are hundreds of strains of HPV."
Which of course I know already. She said something about the doctors wanting to remove 'pre-cancerous cells form her cervix,' potentially. And I actually think she has known about this for a WHILE, but just told me now for some reason.
Given the fact that she does NOT have genital warts, but rather another strain of HPV, is your advice different--i.e., given the prevalence of those strains, can I indeed REFRAIN from mentioning this potential exposure to future partners?
And perhaps a weird (B) question--Had my ex and I NOT had intercourse, but only oral sex, would I have to be concerned about contracting HPV in my mouth (from going down on her), and therefore tell people about this risk before kissing them, engaging in any sexual activity, etc??
"I have the HPV that causes cervical cancer, not the kind that causes warts. There are hundreds of strains of HPV."
Which of course I know already. She said something about the doctors wanting to remove 'pre-cancerous cells form her cervix,' potentially. And I actually think she has known about this for a WHILE, but just told me now for some reason.
Given the fact that she does NOT have genital warts, but rather another strain of HPV, is your advice different--i.e., given the prevalence of those strains, can I indeed REFRAIN from mentioning this potential exposure to future partners?
And perhaps a weird (B) question--Had my ex and I NOT had intercourse, but only oral sex, would I have to be concerned about contracting HPV in my mouth (from going down on her), and therefore tell people about this risk before kissing them, engaging in any sexual activity, etc??
Thanks doctor. That makes me a bit angry then, because my doctor at the time (and another who I had consulted for back-up) said that there's 'no evidence' the vaccine is effective after the age of 26, which is why I did not get it. I assume your opinion is otherwise. (Again, I was considering getting it at the ag eof 29).
MEDICAL PROFESSIONAL
Yes, it would have made a huge difference. You put it very nicely: if you had been immunized, you could be assumed to be immune to your former partner's wart virus infection and wouldn't have to be worried about develping warts or about informing future partners. I'm sorry you didn't do it!
Thank you again, and this all makes sense.
Not to veer too much of course, but I was wondering--would this scenario have been different had I, as a male, gotten the HPV vaccine? I thought about doing so about 2 years ago, but at that point in time--around 29, with at least 50 sex partners in my past--it seemed not worth doing. Had I gotten the vaccine back then, and then found myself in this scenario, would I be able to consider myself reasonably protected from my ex's warts, and therefore without the need to warn future partners?
Not to dwell on the 'what ifs,' but just curious.
Not to veer too much of course, but I was wondering--would this scenario have been different had I, as a male, gotten the HPV vaccine? I thought about doing so about 2 years ago, but at that point in time--around 29, with at least 50 sex partners in my past--it seemed not worth doing. Had I gotten the vaccine back then, and then found myself in this scenario, would I be able to consider myself reasonably protected from my ex's warts, and therefore without the need to warn future partners?
Not to dwell on the 'what ifs,' but just curious.
MEDICAL PROFESSIONAL
As I discussed in my reply, warts are a special case; people at risk tend to be quite freaked out when they get genital warts or are at risk for them. If your former partner had only had an abnormal pap smear, for example, my advice would have been different.
I understnad you would "rather not" have to discuss this issue with future partners -- but the basis for our advice to patients is science and my clinical judgment, not what people would prefer to hear. I think you should continue to discuss the potential for risk of warts with new partners at least 6 months, and a case can be made to do so for a year or so. Look at it this way: how will you feel if a future partner comes to you saying she thinks she caught warts from you? And how would YOU feel about blind-siding her by not being up front at the start of the relationship? And what if a month or two into a new relationship, you develop warts -- not from your new partner, but your past one -- and then have to explain to your new partner that you had been worried something like this might happen?
I think you would do well to get the opinions of some women on this issue. Consider starting a discussion on the STD community forum, or the HPV community forum, and specifically asking for input from female forum users. I'll bet most will agree with my recommendations.
I understnad you would "rather not" have to discuss this issue with future partners -- but the basis for our advice to patients is science and my clinical judgment, not what people would prefer to hear. I think you should continue to discuss the potential for risk of warts with new partners at least 6 months, and a case can be made to do so for a year or so. Look at it this way: how will you feel if a future partner comes to you saying she thinks she caught warts from you? And how would YOU feel about blind-siding her by not being up front at the start of the relationship? And what if a month or two into a new relationship, you develop warts -- not from your new partner, but your past one -- and then have to explain to your new partner that you had been worried something like this might happen?
I think you would do well to get the opinions of some women on this issue. Consider starting a discussion on the STD community forum, or the HPV community forum, and specifically asking for input from female forum users. I'll bet most will agree with my recommendations.
And last addendum--by 'a few months' do you literally mean 2 months or so? Obviously if it can take anywhere between 2 months and 2 years to show up...well, I'd rather not have to spend the next 5,6,7, etc months telling potential partners that I 'might' have genital warts!
Thank you doctor, this great & clear information.
I guess the one thing I want to clarify,based on what I've read in other threads--the issue here is that my ex- had HPV that resulted in actual overt warts, right? It seems like the prevailing advice for partners of those with NON-wart causing HPV (like the sort detected in a pap smear) is that they DON'T have to go around disclosing the 'potential' of HPV to their own future partners..correct?
I guess the one thing I want to clarify,based on what I've read in other threads--the issue here is that my ex- had HPV that resulted in actual overt warts, right? It seems like the prevailing advice for partners of those with NON-wart causing HPV (like the sort detected in a pap smear) is that they DON'T have to go around disclosing the 'potential' of HPV to their own future partners..correct?
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
I'm afraid I can't give you the answer you're hoping for. While it's not a black and white situation and some experts would disagree with me, for the next few months I think it would be best if you inform future partners of this situation.
You are not likely the source of your ex-partner's genital warts. The average incubation period -- i.e. time from exposure until visible warts -- is 6 months, with a range of about 2 months to as long as 2 years. So probably she was infected a while before your relationship began.
Given your sexual history, you can be sure you have been infected with HPV; and since the types that cause most warts (HPV-6 and 11) are very common, you could well have been infected previously and now are immune (or at least highly resistant) to a new infection with those types. However, I cannot rule it out and neither can you. Given your sexual exposure several times to a person with newly diagnosed warts, you'll need to wait a few months to be sure warts won't appear.
My usual advice is that it isn't necessary to inform future partners. But that may not apply when there is a distinct possibility someone has a new infection that could result in overt warts. Although genital warts are rarely serious and should mostly be considered an inconvenience rather than an important health problem, for most people they have a big "yuck" factor, and many people would consider it unfair to knowingly expose someone to a significant possibility of future warts. As the discussion above suggests, there is at least some possibility that you are infected with and could transmit the strain of HPV that caused your former partner's warts. On the other hand, assuming most potential partners themselves have been sexually active, many will be immune.
The nature of the relationship also might enter into a decision. If you use condoms, then a one-time exposure would be low risk, even if you are incubating a wart virus infection. But a potentially ongoing relationship, especially before you make a mutual decision to not use condoms, might be a different story. Also, if a partner has a past history of warts herself, or if she has been vaccinated with the HPV vaccine Gardasil (which includes coverage for HPV 6 and 11), she would be at no risk.
Here is a link to another thread that has a more detailed discussion about informing partners about HPV:
http://www.medhelp.org/posts/STDs/HPV--Informing-past-partners/show/763292
I hope this has been helpful, even if it isn't the answer you were hoping for.
Regards-- HHH, MD
I'm afraid I can't give you the answer you're hoping for. While it's not a black and white situation and some experts would disagree with me, for the next few months I think it would be best if you inform future partners of this situation.
You are not likely the source of your ex-partner's genital warts. The average incubation period -- i.e. time from exposure until visible warts -- is 6 months, with a range of about 2 months to as long as 2 years. So probably she was infected a while before your relationship began.
Given your sexual history, you can be sure you have been infected with HPV; and since the types that cause most warts (HPV-6 and 11) are very common, you could well have been infected previously and now are immune (or at least highly resistant) to a new infection with those types. However, I cannot rule it out and neither can you. Given your sexual exposure several times to a person with newly diagnosed warts, you'll need to wait a few months to be sure warts won't appear.
My usual advice is that it isn't necessary to inform future partners. But that may not apply when there is a distinct possibility someone has a new infection that could result in overt warts. Although genital warts are rarely serious and should mostly be considered an inconvenience rather than an important health problem, for most people they have a big "yuck" factor, and many people would consider it unfair to knowingly expose someone to a significant possibility of future warts. As the discussion above suggests, there is at least some possibility that you are infected with and could transmit the strain of HPV that caused your former partner's warts. On the other hand, assuming most potential partners themselves have been sexually active, many will be immune.
The nature of the relationship also might enter into a decision. If you use condoms, then a one-time exposure would be low risk, even if you are incubating a wart virus infection. But a potentially ongoing relationship, especially before you make a mutual decision to not use condoms, might be a different story. Also, if a partner has a past history of warts herself, or if she has been vaccinated with the HPV vaccine Gardasil (which includes coverage for HPV 6 and 11), she would be at no risk.
Here is a link to another thread that has a more detailed discussion about informing partners about HPV:
http://www.medhelp.org/posts/STDs/HPV--Informing-past-partners/show/763292
I hope this has been helpful, even if it isn't the answer you were hoping for.
Regards-- HHH, MD
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