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Avatar universal

Torn and tormented - Part 1

Thank you for administering this forum and providing some very thoughtful answers. I am really hoping you might be able to help me with some rational insight to a problem/dilemma that, I think I can fairly say, is almost consuming me.  It regards HPV and the fact that I have exposed someone to it. It is a complex story; I apologise for the length of this question - I have had to divide it into several parts - but I hope it will be understandable once I have explained things. I have tried to stick to only what is necessary.

I am, in fact, a young physician. During part of my medical school and early residency I went through some tumultuous years; years that I am not proud of but that have complex roots. During those years I was sexually very promiscuous, I abused alcohol, resumed smoking and generally, lost myself. Somehow, I made it through medical school and my early residency – I actually got some very good reviews but I knew I was living a double life and even while I was living it I knew that one day I would “reawaken” and would have to deal with complex feelings of remorse and shame for the ways in which I behaved during those years. I have a real conscience; I think about things, I aspire to be a just, responsible and good person and physician.
10 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
There is a reason for the character limit for new questions. It would take an hour just to read what you have written and I will not do th at.  Restate your entire queston within the 1500 character limit, i.e. about 300 words. Then I will read it and respond.  All else will be deleted.

HHH, MD
239123 tn?1267651214
MEDICAL PROFESSIONAL
And please limit your question to exposure history, risk assessment, and clinical questions.  All information about personal relationships and the guilts and regrets you might feel are irrelevant to this forum.
Avatar universal
I apologise. Here is the relevant information. I had unprotected sex with a 16 year-old female nearly 2.5 years ago. I am now positive I had HPV and an active genital wart at the time. I was, 3 months later diagnosed with GW. However, a couple of months before we ha inercourse I had noticed a penile lesion that I thought was a aslightly-larger-than-normal pearly papule like the ones I have always had. When it grew and others popped up I knew what I had and had it confirmed by a colleague. I am now tormented about this female. What if I had HPV16/18? What if I gave it to her? What if she doesn't go for pap smears? I have tried to contact her unsuccessfully through a mutual contact who has made it pretty clear she doesn't want to be involved. I called the public health unit who basically said they wouldn't do HPV tracing and to forget about it. I believe I recall her saying she had seen a colleague of mine - a nephrologist (she has some sort of renal history) - whom I had worked with as a resident and got along well with. I am now obsessing over whether I should call him and see if he might be able to locate her. I have only a first name but he generally sees patients older than 18 so perhaps he just might know. My counselors (2) and my girlfriend have argued firmly against this and have said this is brutal obsession. My girlfriend, in particular, has said it is overkill, that most women get paps and that, as I know, she (the 16 year old) is bound to be exposed to HPV if she hadn't been already at that time (I was certainly not her first sexual experience). I am really torn. I want to do the right thing.
Avatar universal
P.S. I eventiually had to have the warts surgically removed as they had grown quite ugly and weren' resolving with imiquimod. The pathology report came back "benign, probably condyloma accuminata"
Avatar universal
PPS: she is 18-19 now, not 16. She was 16 then
79258 tn?1190634010
"My counselors (2) and my girlfriend have argued firmly against this and have said this is brutal obsession."

Sounds like you're getting great advice already. I just wanted to suggest that the combination of meds and therapy is usually far more effective than either one alone. If you aren't already seeing a psychiatrist, you might want to start there.
Avatar universal
I know I have OCD. I am on medication and getting therapy. I just also have a real conscience and I feel terrible. I was very promiscuous at that time in my life and there is a real chance i am/was an hpv 16/18 carrier
239123 tn?1267651214
MEDICAL PROFESSIONAL
What if, what if, what if?  What if you got hit by a meteorite?  It could happen, but are you going to sit around worring about it? Your girlfriend's perspective is exactly right.

Everybody gets genital HPV.  Whether or not your then-16-yo partner got (or someday would get) HPV 16/18 has nothing to do with you. If not from you, she likely would be infected by someone else.  Sexually transmitted HPV is simply unavoidable, except by lifelong commitment to permanent and invariable mutual monogamy.  That sort of sexual lifestyle probably never existed as a common pattern in any society in human history.  (In Islamic countries, many women indeed have only one lifetime partner.  But not the men.)  And among those routinely acquired HPV infections, the most common types are those most prone to malignant transformation, e.g. HPV types 16, 18, 31, 45, etc.

Further, your partner is responsible for her own health.  Unless she is in an atypical social and financial situation, the chance she isn't going to get regular pap smears is low--and not your responsibility.  Every woman needs to get pap smears; whether or not a woman knows she has had HPV or not makes no difference.  (It's the same principle as for universal blood/secretion precautions that are so much a part of your life:  you don't consider whether a particular patient or specimen is infected, you protect yourself against exposure to any and all.  Same for women, HPV, and pap smears.)

The bottom line:  with uncommon exceptions--and this does not include the circumstances you describe--it is inappropriate and unjustified for any human being to go around feeling responsible for any other person's HPV infection.  You probably know that at at intellectual level; you're just having trouble integrating that objective understanding with your emotional reaction to it.  I can't help that part, but I am glad to see from your reply to monkeyflower that you are under treatment.

Keep your current girlfriend.  She sounds like a treasure and an important part of your support system.  And she sounds wise.

I hope this helps.  Best wishes--  HHH, MD  
Avatar universal
Thanks for your response. I really appreciate it and it was helpful.

I was a very different person at that time in my life. Even after I acquired GW I continued to sleep around and not always with protection. I have been able to contact most people to advise them and many have been very forgiving and actually not overly concerned. There was one person I have not been able to contact and really I don't think there is any way I could (again I ahve only a first name and have logn since lost any way to contact her). Anyway, I suspect I am guilty of the "uncommon exception" you mention above because of this. I am a far different person today and I have honestly made major efforts to contact anyone I put at risk and advise them/sincerely apologise. As for this one, there is not much I can do and I will have to live with that. But I really like who I am today in spite of all I have said and I know I am doing some really good work. I also know my girlfriend is a treasure and I have every intent of keeping her. Thanks kindly for your words.
Avatar universal
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