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perceptions -- HSV/HPV
First off, Dr. Handsfield, I would like to thank you for a very engaging and informative web forum. I am hoping that you could shed some light on the prevailing views with regard to HSV and HPV of both the general public and medical professionals.
Multiple times I have read that approximately 80% of the population is infected with HPV at one time or another and that most of the time the infection is asymptomatic and usually goes away. However, I have also learned that HPV can cause cervical dyplasia, and, in rare instances in the US, cervical cancer which can lead to death.
On the other hand HSV-2 causes the majority of cases of genital herpes and is present in 25% of adult Americans. I have read that in most cases individuals are asymptomatic carriers of the virus, and those that do have symptoms usually do not have particularly adverse consequences
Multiple times I have read that approximately 80% of the population is infected with HPV at one time or another and that most of the time the infection is asymptomatic and usually goes away. However, I have also learned that HPV can cause cervical dyplasia, and, in rare instances in the US, cervical cancer which can lead to death.
On the other hand HSV-2 causes the majority of cases of genital herpes and is present in 25% of adult Americans. I have read that in most cases individuals are asymptomatic carriers of the virus, and those that do have symptoms usually do not have particularly adverse consequences
I read a recent study at a US college (can't remember the name) where around 600 sexually active female students were minitored for HPV. Most infections were transient and resolved in several months. I can't find the exact study, but see this link http://www.thebody.com/Forums/AIDS/Cancer/Archive/cervical/Q145923.html
HPV infections can be left to self-resolve - but this must be monitored by a proper doctor - it is called "watchful waiting". My GUM specialist said this was a perfectly fine option for genital warts but treatment can help with the pyschological element (i.e. seeing a wart you don't like the look of attached to your joy department). Had mine frozen, no more have popped up, nothing returned yet, going to wait a few more months.
HPV infections can be left to self-resolve - but this must be monitored by a proper doctor - it is called "watchful waiting". My GUM specialist said this was a perfectly fine option for genital warts but treatment can help with the pyschological element (i.e. seeing a wart you don't like the look of attached to your joy department). Had mine frozen, no more have popped up, nothing returned yet, going to wait a few more months.
Well my belief was that HPV could be a forever virus (like HSV) for some people although they might not even know it. . . although as stated earlier it is cleared by most people. . . but how can one really tell (expecially men)? Secondly, I totally agree that influenza kills many more people than HPV, but the vast majority of influenza's victims are the elderly and infirm. Cervical cancer strikes down many women in the prime of their lives.
Im guessing that HSV is proven to linger much longer in the body so is a "for life" virus to some extent. I assume that the worst HSV infection is far more painfull than the worst HPV infection. Interesting question though about ethical guidelines. Unfortunately in the world of ethics there is no definitive answer.
HPV is not a 'forever' virus, it usually clears up within 6-24 months and becomes undetectable by DNA tests. The flu kills 36,000 people a year, so you would need to inform anyone you stand next to at the mall or an airplane that you have a potentially "deadly" virus that could kill someone. It's the same thing with HPV, although cervical cancer kills about 3700 a year in the US, far less than influenza and the common cold. This is just my opinion of course.
I just wanted to add that this is why regular pap smears (and proper followup and treatment if necessary) are so important. Cervical cancer is preventable and curable if caught early enough. Most of the women who die of cervical cancer have never had a pap smear.
Also, there's a vaccine coming out sometime in the near future that will prevent two of the HPV types that cause about 70% of cervical cancers.
Also, there's a vaccine coming out sometime in the near future that will prevent two of the HPV types that cause about 70% of cervical cancers.
What do most doctors (gynecologists, etc.) tell their patients when it comes to HPV infections?
Do they really explain that it is an infection causing the abnormal Pap or do they feel that as far as there patients are concerned "ignorance is bliss." Or do they tell the patient they only have to wait six months and then in all likelihood the infection will clear and they won't have to stress about disclosure by then.
Is there any consensus about this or no? And if no, why not? It seems important enough.
Do they really explain that it is an infection causing the abnormal Pap or do they feel that as far as there patients are concerned "ignorance is bliss." Or do they tell the patient they only have to wait six months and then in all likelihood the infection will clear and they won't have to stress about disclosure by then.
Is there any consensus about this or no? And if no, why not? It seems important enough.
MEDICAL PROFESSIONAL
The facts are more or less correct as you state them. But your perception of the relative severities of HSV-2 and HPV, both clinically and psychologically, is backward.
1) HPV usually does not persist beyond several months to 2 years. Since almost everybody gets it anyway, there isn't much health benefit in telling a future partner about any particular infection. Since s/he is likely to have had HPV or to get it anyway, so what's the use? Further, for every person with a diagnosed HPV infection, there are 5-10 others who have it (or had it in the past). If 80% of a person's sex partners may be sources of infection, but only 10% of those partners know it and reveal it, how much prevention benefit can there be? Also, in couples where one person is infected and the other isn't, it's much harder to prevent HPV than HSV transmission. Add the stress and uncertainty of informing a partner after the infection probably is long gone, and you have yet another reason.
People with known, recently diagnosed infection (newly abnormal pap, genital warts) should inform prospective partners. But after a few months, without recurrence, in my opinion there is no need to keep doing so. Some experts disagree, but that's my perspective.
2) HPV is much more a nuisance disease--i.e., trivial outcome without serious consequences--than herpes, especially when caused by HSV-2. The usual absence of serious physical symptoms doesn't mean it's not a severe problem for many people; often the psychological impact is no less real or important than physical symptoms. The fear and anxiety herpes produces, both in people with the infection and at risk for getting it, often causes major problems in forming and maintaining relationships. Argue all you want that this shouldn't be the case--and in many ways I agree--we need to deal with the fact that it IS the case. And as I suggested above, it's easier to prevent transmission of HSV-2 than HPV--but maximal prevention requires the knowledge of both members of a partnership.
And there are very real physical risks for genital HSV-2 infection. The risk of getting HIV, if exposed, is at least double; and every year a couple thousand babies in the US get infected, typically dying or surviving with severe neurodevelopmental disabilities. These issues not only are important in their own right, but further magnify the psychological impact of the disease.
I hope that helps. Best wishes-- HHH, MD
1) HPV usually does not persist beyond several months to 2 years. Since almost everybody gets it anyway, there isn't much health benefit in telling a future partner about any particular infection. Since s/he is likely to have had HPV or to get it anyway, so what's the use? Further, for every person with a diagnosed HPV infection, there are 5-10 others who have it (or had it in the past). If 80% of a person's sex partners may be sources of infection, but only 10% of those partners know it and reveal it, how much prevention benefit can there be? Also, in couples where one person is infected and the other isn't, it's much harder to prevent HPV than HSV transmission. Add the stress and uncertainty of informing a partner after the infection probably is long gone, and you have yet another reason.
People with known, recently diagnosed infection (newly abnormal pap, genital warts) should inform prospective partners. But after a few months, without recurrence, in my opinion there is no need to keep doing so. Some experts disagree, but that's my perspective.
2) HPV is much more a nuisance disease--i.e., trivial outcome without serious consequences--than herpes, especially when caused by HSV-2. The usual absence of serious physical symptoms doesn't mean it's not a severe problem for many people; often the psychological impact is no less real or important than physical symptoms. The fear and anxiety herpes produces, both in people with the infection and at risk for getting it, often causes major problems in forming and maintaining relationships. Argue all you want that this shouldn't be the case--and in many ways I agree--we need to deal with the fact that it IS the case. And as I suggested above, it's easier to prevent transmission of HSV-2 than HPV--but maximal prevention requires the knowledge of both members of a partnership.
And there are very real physical risks for genital HSV-2 infection. The risk of getting HIV, if exposed, is at least double; and every year a couple thousand babies in the US get infected, typically dying or surviving with severe neurodevelopmental disabilities. These issues not only are important in their own right, but further magnify the psychological impact of the disease.
I hope that helps. Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
