HPV transmission

[bk21]

I am a woman in a relationship with a man who has HPV.  We have been together about 3 months and have not had intercourse and I have not performed oral sex on him. He originally had an outbreak of genital warts over 15 years ago and another a little over 2 years ago.  Both times, the outbreak was on the foreskin (he was not circumcised at the time).  He has not had any kind of outbreak in 2 years.  His doctor recommended circumcision because there is less of a chance of transmission.  The doctor said the virus could be dormant in his immune system, but because he has had multiple partners over the years, including one within the last five years who also had HPV, he may have been reinfected with another strain.  He recently got circumcised and I am getting the HPV vaccine (I have received two out of the three shots).  I am still concerned about contracting the virus, as I am a virgin and have no STDs. I have been to the gynecologist and been tested for everything, had a pap and HPV test, and I am all clear.  He does not have visible warts now and when the doctor examined him under the light, he did not see any warts at all.  Is it possible he no longer has the virus, is not contagious, or is at no risk of transmitting it to me since he has now gotten circumcised and will use condoms with me if we do have sex?   If I perform oral sex without a condom do you think I will be safe or should I only engage in that with a condom?  If we wait another 4 months to have sex (after my third vaccination), and he has had no outbreaks in the meantime, should his body be cleared of any infection he might have acquired within the last year or so?   Should I still be worried if we have safe sex after I have received all three shots of the vaccine?  I guess I just want to be 100% sure I will not contract the virus before I have sex with him.  Is that a possibility?  Sorry for so many questions but I'm just very nervous about this!

[Edward W Hook, MD]

Your questions tell me that you did not go to the web site.  Please do so.  to briefly answer your questions (further questions will not be).

1.  Yes the immune system clears both high and low risk infcitons.
2.  Yes it is likely he has been infected in the past with multiple strains.
3.  Yes, circumcision is likely to help.   EWH

[bk21]

Thank you so much for the information.  I do have a couple additional questions.  If he happens to be carrying a high-risk strain for cervical cancer as well, will his immune system clear it the same as a low risk strain or will he always be a carrier of it?  I think that he only has the low risk since he had genital warts and also because his former girlfriend who also had HPV had the genital warts strain as well and never had any abnormal paps that I know of.  He has had multiple partners over the years, so it is possible he has been infected with more than one strain.  I know there is no way to tell if he has a high risk strain, but would the circumcision help with that as well?  Thanks again.  

[Edward W Hook, MD]

The topic of HPV and genital warts is a complex one.  I will try to provide some facts.  For addition 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)..

Now, on to HPV.  HPV is the most commonly acquired STD.  Over 85% of sexually active women will have HPV infection at some time in their lives and, in the year after beginning to have sex, nearly half of women have acquired the infection, even if they have had only one partner.  In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears (there are over 100 different HPV types).  In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-10 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.  With this as background, let's discuss the situation.

First, congratulations - you are doing everything right.  You and your partner have discussed his history and you are taking the vaccine which contains the 4 types of virus that cause nearly most genital warts and most cervical cancer.  

As far as his infectivity to you is concerned.  His circumcision likely removed the site of his prior infections. In addition, we teach that if a person has been without a recurrence of warts for six months following treatment, they are unlikely to be infectious to others.  For both of these reasons, while there are no absolutes, it is unlikely he will be infectious to you from his prior infections.  Condoms will further reduce your risk of infection.

Orals sex rarely results in HPV transmission.  I would not be concerned.  

Hope this helps.  Please check out the web site for additional information.  EWH