HPV questions

[max_m]

I'm a male and while in college (about 6 years ago) I went through a really stupid phase where I got drunk and had unprotected sex with 4 different women in the span of about 6 months. For this behaviour, I was rewarded with a case of genital warts, which I had diagnosed at my college's health centre. At the time, I also got a general STD test and when it came back clean I quietly thanked god and began to smarten up.

About 9 months after that, I met a girl and began a relationship that continues to this day. We are sexually active and since it's quite likely we'll be together in the long term we do not use condoms. She was a virgin when we met, and is aware of my past confirmed HPV infection.

I've recently become quite concerned about the possibility that I acquired a high-risk strain of HPV (specifically 16 or 18) and my partner will eventually become ill as a result. In an attempt to assuage my concerns I contacted the STD clinic in my city to ask about getting an HPV blood test -- my logic being that I'm already thinking the worst, so a favourable result could offer some relief. The nurse I was talking to raised two points that surprised me, which I'd like to ask you about.

1. After describing the above to the nurse, she suggested that one way to help ensure the ongoing health of my girlfriend's cervix would be to get her the Gardasil vaccine. I told the nurse that I didn't think the vaccine worked like that. She asked me about my girlfriend's pap history and I told her that she's been getting them yearly for the duration of our relationship and they've all been normal. She then said that if that was the case, the vaccine would protect her from the strains it covers ever developing. In your opinion, is this accurate?

2. The nurse also said that it was "virtually unheard of" for a woman getting regular paps and doing the proper follow-through to develop cervical cancer. In your opinion, is this accurate?

Many thanks.

[Edward W Hook, MD]

Welcome to our Forum.  The topic of HPV and genital warts is a complex one.  I will try to provide some facts.  For additional information on this most common of STDs, I would suggest search for other HPV- and wart-related Q&A on this site, as well seeking addition information on sites such as the American Social health Association web-site (disclosure, Dr. Handsfield and I are both on the Board of ASHA)..

For better or worse, at present HPV is a "fact of life" and most people have it or will have it at some point in the future.  Despite this fact, only a tiny minority of persons with HPV get the consequences of infection (primarily women and primarily cancer and pre-cancerous lesions).  HPV is the most commonly acquired STD.  Over 85% of sexually active women will have HPV infection at some time in their lives.  The figure for men is less well studied but similar.   In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears.  In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-24 months.  In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated.  For men there is far less risk of any sort.  In your case the warts you had were almost certainly caused by a HPV strain that is not associated with cancer and while you may have HPV in the past at some point, it likely has also resolved by now.  

Also, although you did not ask, there are no clinically useful blood tests for HPV.  There are also no currently recommended tests to evaluate men for HPV.   With this as background, let's address your questions

1.  It sounds like the nurse you spoke with is quite knowledgeable.  I agree and in fact, recommend that all women receive the HPV vaccine. It is among the most effective vaccines developed and is quite safe. It is recommended for girls and women between the ages of 9 and 26 and appears highly effective for prevention of infection due to the types of HPV that cause the majority of cervical cancer, as well as the two types of HPV which cause most genital warts.

2. Yes I do.  Pap smears are highly effective at detecting the cellular changes which are precursors to cervical cancer in women. The web site I mentioned has good information on this.

I hope these comments are helpful to you.  Check out that website. EWH

[Edward W Hook, MD]

Your understnad and mine are different.

The scientific studies show that the risk of vaccine do outweigh the costs.  Brining up the vaccine shold not be a problem it is recommeded on TV ads, in magazines and by virtually every health promotion group.  EWH

[max_m]

Hi Dr Hook;

Thanks again for you help.

I did check out the website you referred me to, and I'm aware that any HPV infection I might have had years ago would no longer be present. However, I became sexually active with my current girlfriend about 9 months after my last potential exposure to high-risk HPV. So, in my understanding that if I did acquire any infections, it's likely I passed them to her.  

So, that being said, what I was trying to figure out with my question is if, given the overwhelmingly likely scenario that neither of us will have any additional sexual partners, the vaccine would provide any benefits. Although my partner is aware of everything I've told you, she isn't aware that I'm worrying like this and if possible I'd like for her to avoid sharing the same fate -- which I'm afraid will happen if I bring up the subject and we have to go through the vaccination process. Additionally, where I live, vaccination costs $500, which for us isn't an insignificant expense. I guess I'm just trying to figure out if, for us, the benefits of vaccination would outweigh the costs.

Thanks.

[Edward W Hook, MD]

1.  There are no recommended, or useful HPV blood tests that I am aware of..  The CDC makes no mention of them nor their use in any aspect of manging persons who have HPV.  No one would know how to use the information if such a test existed.  

2.  You missed thoe point and apparently did not visit the web site as I recommended.  If you had, you would appreciate that any HOV infection you might have had years ago would no longer be present. further as I said, virtually EVERY medical organization recommends HPV vaccination to prevent future infections.  EWH

[max_m]

Hi Dr Hook;

Thank you for your answers. I just have a couple of follow-up comments/questions.

1. The nurse (somewhat reluctantly) told me that the local testing lab offers HPV blood tests, which they usually use for expectant mothers that potentially have high-risk HPV infections (or something like that). Their website seems to confirm this; does this sound accurate to you?

2. To follow up on your response to my first question: my understanding of our situation is that, at this point, I've almost certainly passed any HPV infections I may have or have had to my partner, so Gardasil would offer her little protection from those infections potentially developing into cervical legions and then, possibly, cancer. Is this understanding correct? If so, would your recommendation for my girlfriend to be vaccinated be meant to protect her from acquiring any of the strains the virus protects from during potential future sexual encounters with people other than myself?

Many thanks!