HPV - ongoing anxiety

[worried_need_advice]

I am sorry to be coming back to you for advice yet again.

Basically, background (as before) is that I had 5x protected intercourse with escorts in 2009, between March and August. I had full STD screen after this episode and came back negative for all. As you know, I am concerned about HPV and whether I could have infected my wife, who is unaware of all this. I am married in late 40s. I had two sexual partners before marriage and think my wife may have had 3-4.

In June 2011, she had a negative pap screen and is not due for routine screening for another 3 years.

Although initially reassured by your advice, I have been suffering from increasing and continuous anxiety about this situation, to the point now where I think about it pretty much all of the time.

Questions that continue to swim around my mind are:
- What is the realistic likelihood of my wife having a serious health outcome given the negative pap screen around 2 years after the exposures? Does the negative pap test at least mean that it is unlikely that I have passed on multiple high risk HPV types to my wife?
- How could it be that use of condoms make infection unlikely when such a large proportion of people catch HPV ?
- With all the different types of HPV out there, how is it that having a moderate number of sexual partners means that risk of further infection is reduced?
- Am I being selfish in not informing my wife - because she could then have a test for HPV and catch any problems earlier (especially if there is a high likelihood of high risk infection)?... or...
- Would I be selfish to inform my wife as it would just pass on the anxiety to her (as well as all the sadness it would create about me having betrayed her)?

I know you probably can't help much with the last two questions... but I would appreciate any final views or advice you could give to help me get all this into perspective, make the right decisions and handle my anxiety.

[Edward W Hook, MD]

With all due respect, these questions have been addressed, at least in part, already.  My sense is that your concerns about your wife and the ever decreasing possibility that she will suffer any sort of adverse effect from your extra-marital liaisons are more a manifestation of guilt than any scientifically plausible risk.  It has been several years since your last contact outside of your marriage and since then your wife has had a normal PAP smear.  This makes the risk that she has HPV or will have any sort of consequence from infection is she does statistically implausible.  I will not repeat all that Dr. Handsfield and I have said before however I will suggest that it is time to confront your lingering concerns/guilt.  There are two approaches- discussing this with a counselor who can help you to explore the options and approaches or discussing it with your wife. Should you choose the latter course, I would not get into the HPV issues but simply acknowledge your extra-marital contacts and say that you have changed your behavior.  EWH

[worried_need_advice]

Thank you for your kind words... and patience!

[Edward W Hook, MD]

I agree with your assessment- time for you to sort your own guilt and shame over this out and move forward.  Take care.  EWH

[worried_need_advice]

Dr Hook,

Many thanks again for your advice. You are right that I am feeling a lot of guilt about this. However, I think I can work through that as long as I know that I am not making the situation any worse.

By biggest worries have been:
- That I am putting my wife at further health risk through not disclosing to her
- That she will find out about my infidelity through an 'out of the blue' positive smear result next time around

It sounds from what you are saying that I am not putting her at further risk and that an abnormal smear in two and a half years' time as a result of my infidelity is now very unlikely?

If that's the case, I need to sort my head out and move on.