The chance you have an HSV-2 infection if a) asymptomatic and b) a negative HerpeSelect test ~4 months after the last possible exposure is zero, for all practical purposes. You can put that fear to rest. I wish other labs would follow LabCorp's policy; there is no rational reason for you (or your doc) to know the numerical value if it was below the threshold. There is no difference in meaning of a test with an ELISA ratio of, say, 0.10 versus 0.40 versus 0.85. All are absolutely, unequivocally negative. This forum is loaded with questions from people who didn't understand that, leading to a waste of their $15.00, not to mention my time!
As to the warts, you don't need to know virus type; most likely, such a test isn't even available in this circumstance. The vast majority of external genital warts are due to HPV type 6 or 11. And even if you had a different type, it would mean nothing and would not change your treatment, your future sex life, or anything else. As to treatment, if the biopsy indeed removed all visually obvious wart tissue, there probably is no need for treatment with Aldara or anything else. However, follow your provider's advice. There are no data on applying Aldara as broadly as you suggest. I definitely recommend against it; you'll get pretty sore, with no benefit.
The HPV vaccine isn't officially recommended for women over age 26. It certainly would work; it's just that the manufacturer has not yet reported data to the FDA on older women, therefore it cannot be officially recommended. And for that reason, her insurance won't cover it. But if she wants to pay (probably around $500 for vaccine plus the office visits), it's fine for her to be immunized.
I hope this helps. Best wishes-- HHH, MD
Thanks for your reply. I have read the other threads about HPV as well as information from the CDC and ASHA. I am familiar with the estimated clearance time of 6-12 months post last visible wart, eradication vs low detectable amounts of DNA for possible transmission, and of course no guarantees. However, I am confused about the norm for HPV causing warts. Does it now become a visibility/guessing game from here on out as to whether or not I have a wart and whether or not I am still contagious? It seems like the only way for people to know is to continue to examine themselves for the next couple of years, and that seems like a difficult task, even for a genitally focused person like myself. What do you tell your patients? I am sure my provider will only tell me to return if symptoms recur or persist.
Happily, I am aware that HPV is mostly harmless and I can accept that, however, I am only concerned about infecting my potential future spouse. I was under the impression that HPV can be typed. In a way it does matter to me, that I know she can be vaccinated and immune to something I have. There is no dollar amount I wouldn't pay for that kind of assurance.
My final comment: It is unfortunate that there aren't enough data for something as common as HPV. We know where HSV, HIV, and HCV can reside in the body and replicate but we are still unsure about HPV.
In case you are counting, this is my second (and final) post for the next few months. I know there are others in need of advice. Thanks again for your help.
I tell my patients exactly what I told you, and have said many times on this forum: For people who have had genital warts or a postive HPV test on pap smear, most likely they are not infectious once visible warts have been gone for 6 months, or 6 months after a negative pap suggestive of HPV. I also warn them that these are only very rough guidelines--not the result of data, but my own best guess.
In response to your first question, yes, it's largely a clinical judgement and guessing game. Happily, as you say, "HPV is mostly harmless". A future spouse is likely to have been infected with HPV already anyway .
Sorry, but the science doesn't allow any more precision than this. It's just the way it is.