HPV type 16 & 18

[yusufkamilgenc]

If you can please guide us through our HPV nightmare, we will appreciate it a lot.

I am writing this e-mail to you from Turkey. I am 33 yers old male. I have been in a relationship with my girl friend for a month. Recently, my girlfriend had pap smear and HPV tests. Pap Smear test was negatif; however, unfortunately, HPV types 16 and 18 were found.

We had a shocking moment and tryin to find out what to do. We have some questions, but unfortunately, could not find answers here from our doctors. Each doctor has different answers, which brought us nothing but confusion. Thus, I would like to kindly ask for your assistance. I have tried to list my questions below. If you could please answer those questions and besides guide me through this situation, I will appreciate a lot.

For my partner:

1.       What kind of tests shoul I have?

2.       What are the teratment options available?

3.       Should I observe for any genital warts, or not since those types are the ones generally causing cancer?

4.       I may have this virus from my ex boy friend, which I had 5 years long relationship. Since, I have recently had the test, is it right to say that my immune system could not kill the viruses, which is omitting this expectation fort he future as well?

5.       How long would those types be affective in my body?

6.       If I keep getting negative smear tests in routine controls, does that mean I am getting rid of HPV?

For me:

1.       Is there any test method for men? According to my research, there is no approved test methods for men, but in some studies, it is mentioned about the tests for women to be applied for men as well, such as HPV DNA testing, PCR  testing or micro chip array test. I am wondering if, even though it is not FDA approved yet, I can take any of these tests?  If so, which one(s) would you suggest?

2.       As far as I know, type 16 and 18 are the ones, which may cause cervical, anal, oral and some other types of cancers in women. Are those the types, which may cause penile, anal, oral, throat cancers in men as well?  If so, there must be way of testing men, at least a trial of test; and there must be a treatment as well. Would you please give me some information about this issue?

3.       What is the average window period for any HPV symptoms (such as genital warts) to occur or to wait before taking a test, if any?

4.       I have read some articles about test methods, such as acetic acid test. Is it something that can be applied, do you suggest it?

5.       Since my girl friend is diagnosed with type 16 and type 18, I assume to have those viruses most probably. In this case, should I expect to observe genital warts, some other symptoms in my mouth or somewhere else? OR, since those types are the ones generally causing cancer, would not they show any visual symptoms?

6.       In general, I am reading everywhere thet, both the men and women have to be treated; however, then almost evrybodys claims that there is no test and there is no treatment for men; then why experts are advising men to get treatment? What is the treatment? Besides, in order to get tretament, first, the diagnosis has to be made; then what is the way of testing?

7.       It is stated that, some STD’s comes together with HPV. What are the other STD’s that we should have tests for?

Again, we will appreciate if you can please answer our questions and give us some information about HPV and its symptoms and possible treatment ways.

Thank you very much,

Best regards,

[Wolfcub86]

Take care and let us know.

[yusufkamilgenc]

Hello Wolfcub86,

thank you very much for your precious share; it help me a lot to learn about the facts of HPV.

I will try not to bother so much, until any warts show up I believe.

Wish the best for you.

Regards,

Yusuf

[Wolfcub86]

Hello again,

First I want to clarify I am NOT a qualified doctor, but a NURSING STUDENT, and my answers are by NO means a substitute for a formal medical consulting in office. My sharing is based on my knowledge and general experience in the clinical field.

1) Your itching can be caused by many reasons. If it bothers you physically or mentally I advice you to see your doctor. Normally, there should be no constant/frequent itching around your genital area.

2) If you are concerned about cancer, you can have a routine rectal exam. I believe you can discuss with your doctor on that matter. However, please bear in mind that penile/anal cancer is very rare, and super rare in your age. When you to your 50s you might also want to have a rectoscopy.

3) The Gardasil Vaccine might help you only if you haven't been infected with HPV-6 and HPV-11 yet (which are highly related to genital warts, but not to cancer). It will NOT protect you against HPV-16 and HPV-18 (or any other strains).

[yusufkamilgenc]

Dear Doctor,

Thank you very very much for your time and answers. It meant a lot to us to get such a detailed response from you.

I have some itching around my genitals, but not observed any genital warts yet, I just have a sore throat with the white tonsils , which could be a regular flu, or maybe something related.. I believe, I am phychologically in a mood to interprete every symptom as HPV symptoms.

I have a few more questions if you could please clarify for me.

1) About this itching feeling, do you suggest anything?

2) For men, if there is no warts showing up at any time, still there might be type 16 and 18 laying down there somewhere (I assume I have it), which may be causing cancer in long run. Is there any suggestion that I can apply to prevent cancer or to find out potential cancer at early stages?

3) My girlfriend spoke with an infectious disease specialist today, who suggested both of us to take vaccination. Should we (both me and her) have Gardasil vaccination at this stage?


Thank you very much again for all you did,

Best wishes

Yusuf

[Wolfcub86]

Hello Yusuf,
these are a lot and good questions and I'll try to answer them initally in brief, and according to my academic and practical up-to-date knowledge:

For your girlfriend:
1. The current test - cervical PAP smear - is sufficient. In case there's an abnormality found - she might be reffered to have another tests. For now, that's ok, and important to have a routine PAP test as instructed by her doctor.

2. Current available treatments are for the lesions that might be caused by the HPV-16/18. There is no treatment for the virus itself.

3. HPV-16 and HPV-18 typically don't cause genital warts, but MAY cause pre-cancerous lesions. That's why having PAP smears are so important.
Yet it's important to remember that pre-cancerous lesions usually don't progress to cancer and many times get clear by themselves.

However there's no need to observe for your girlfriend, she can observe for herself, and that will be enough. Assuming she has got those two strains only - most likely she won't have genital warts.

4. In a minority of women the infection becomes persistent for many years, the reason for that is unclear but immunity is related.

If you are immunocompetent and not suffering from any serious/chronic disease - you have good chances your body will manage to control the virus. It's unclear if the immune system can eliminate the virus totally, but can supress it well enough for many years and even for lifetime.

5. There is no current way to predict its course, so in the meantime it's important to have the routine PAP smears.

6. No. The only way to rule this out is by having a test looking for its antigens such as a PCR test.

For you:
1. If you have no symptoms (such as suspicious lesions, warts, itching, etc.) you actually don't need to do any test.

A PCR test is unnecessary because there's no treatment for the virus itself. Most chances that you are already infected.

2. Yes, it might also cause cancer in men as well. However other types of cancer - compared to cervical (and oral) cancer caused by HPV are very very rate. For now there's no recommendation for tests for men. If you and/or your girlfriend are still concerned you can get a rectal exam and/or anoscopy. A penile cancer is very very rare.

3. The question is not clear to me. What tests?

4.  Acetic acid test is not specific enough, so it is not recommended. If you suspect you have warts or other kind of lesions you can have a colposcopy for your anogenital area.

5. Most likely they won't, not clinically at least.

6. What do you mean by "treatment"? It could be helpful to see any reference. In general there are some high-risk groups that having PAP test might be considered for them - especially people that are immunodeficient (such as HIV carriers).

7. There are many common STD/Is. It's best to consult with your doctor. Those tests might include: HIV, HSV, Hepatitis B/C, Chlamydia, Syphilis and Gonorrhea. All of these micro-organism might lead to much more serious complications than HPV.