Questions about HPV

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Dear Dr. Myrtle,

Some common questions about HPV.


  1. I thought that two women couldn’t give each other STI’s, and now an old partner (from five years ago) is telling me she got HPV from me.
  2. I think I have genital warts on my penis, and although they were frozen off once, I don’t think they’ve ever gone away. Are they dangerous to me? Are they dangerous to someone else? How do I know if I have them? What can I do?
  3. Is it true that Human Papilloma Virus can be transmitted by oral-to-anal contact? I thought it was only a problem with penis- vagina contact.

 

Of all the sexually transmitted infections, I probably answer more questions about Human Papilloma Virus (HPV, or warts) than any other. I’m going to try to give you all the information I have about HPV, answering these and other frequently asked questions along the way.

What is HPV?

HPV is a common sexually transmitted infection, and approximately 15 percent of those with HPV are not aware that they are infected. In addition, HPV has a long "latency", meaning that it takes months after initial contact to develop the warts. This makes knowing which person was responsible for the infection very difficult.

HPV is an ancient virus, and evidence of HPV infection have been found in humans dating back as far as 200,000 years ago. There are over 80 different subtypes of HPV now identified, yet all HPV types selectively infect skin or mucous membranes (for the scientists out there, any type of squamous tissue).

HPV causes warts. Different subtypes of HPV like different parts of the body. For instance, if you have "genital warts" you likely have come in contact with types 6, 11, 16, or 18. If you have "plantars warts", you have most likely been infected by HPV type 1 or 4, which likes foot skin cells and causes inward growing warts (which is why they hurt). If you have "flat warts" on your arms, for example, you probably have been infected by types 3, 10, 27, or 41. While it is not impossible to have a different "type" of wart in different areas, a healthcare provider can usually narrow down the types by seeing where the infection occurred.

How could I have gotten an HPV infection?

HPV infections are caused by direct skin-to-skin contact, and by contact with objects that have infected skin cells on their surface. Genital HPV infections can be passed to many other sensitive tissues, such as from mouth to penis, mouth to vulva, vulva to hand to vulva, penis to vulva/vagina/cervix, mouth to anus, etc. It doesn’t matter what your gender is, or what the gender of your partner is. HPV-infected skin cells that have rubbed off on sex toys or other non-animate objects (called fomites in science lingo) still have the potential to infect someone else up to about a week after original contact [see J Infect Dis 1997 Oct;176(4):1076. "What does an infection look like?"]. It turns out that the virus is resistant to drying out, so the best strategy is to not share sex toys if you are infected, cover them with barriers (latex or polyurethane) when you’re using them, and clean them with soapy warm water promptly after use.

If infected, you might have single or multiple bumps on your skin with thick, white, rough surfaces, usually with many pointed projections of "fingers". The bump may look a bit like the head of a cauliflower. Usually the bump is a frosty white or your usual skin color, but can sometimes be pink or pale. Other things that mimic HPV warts: condolyma lata of secondary syphilis, molluscum contagiosium (a virus), or other benign skin bumps like "fibroepitheliomas". Most warts are diagnosed by observation of the bump and its location. Definitive diagnosis is made through laboratory tests of the bump, so it must be removed and sent to a lab for final testing.

What is the problem with having an HPV genital wart?

Complications of HPV infection for women include:

  • At the wart site: itching, bleeding, secondary infection from scratching the wart, vulvovestibulitis (a type of vulvodynia), spreading warts to other parts of your own body, and possibly obstruction of urine (if the wart is at the opening of the urethra).
  • At a cervical wart site: Cervical cancer has been shown to be caused by HPV types 16 and 18. Because of this, women who have HPV warts on their vulva, vagina or cervix need regular pelvic exams and treatment for warts. Careful watching and testing for the presence of HPV is important to avoid cancerous changes of the cervix. This is one of the reasons that lesbians need regular pelvic exams and pap smears. Transmission of HPV is not related to orientation, and sexually active lifelong lesbians are at risk for HPV and cervical cancer as much as heterosexual women are.
  • Infecting any subsequent sexually intimate partner (whether this includes oral/vaginal/anal penetration, or not).

Complications of HPV infection for men include:

  • At the wart site: itching, bleeding, secondary infection from scratching the wart, spreading warts to other parts of your own body, and possibly obstruction of urine (if the wart is at the opening of the urethra).
  • Infecting any subsequent sexually intimate partner (whether this includes oral/vaginal/anal penetration, or not).

Do HPV warts ever go away?

Many warts will not go away unless they are treated (ask your healthcare provider how this is done), although a good number of warts will go away by themselves within a year or two. If you have genital HPV warts, however, you may not be able to tell whether they have gone away completely, or whether they are just so small that you can’t see them. It is for this reason that most healthcare providers suggest that you be examined to determine whether you still have HPV. The safest route is to assume that you still have them, and to protect new sexual partners with barriers like gloves, oral sex dams and condoms.

Will I re-infect my partner if they are "cured" of genital warts and I still have them?

Great question, and I’m afraid medical science is going to leave us a bit in the dark here. The current CDC guidelines suggest that monogamous long-term partners do not need to use barriers between themselves, although they do need to protect themselves with any potential new partners. Most agree that the chances of re-infection with HPV is low because of immune system recognition of the virus.

The safest policy is to consider yourself infected if you’ve ever had HPV. Unfortunately, when someone no longer appears to have HPV warts, it is still possible that they could infect someone else. Studies show that about half of treated people still have HPV in their skin cells six to 12 months after all signs of the infection (the warts) are gone [see acta obstet gynecol scand 1997 Feb;76(2):140]. One of the best suggestions that I can make is to visit your healthcare professional and get an examination to determine whether you have HPV or not. Protect yourself and your partners.

Dr. Myrtle