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High-risk HPV: disclosure dilemma
Dear Doctor,
I've been monitored for cervical dysplasia for two years now, with a colposcopy/cervical smear every 6 months. This is after a history of HPV: genital warts over 10 years ago (all cleared) and CIN 1 that cleared by itself.
More recently I reached high-grade abnormality (CIN 3). I was treated with LLETZ and tested positive for high-risk HPV. It went down to low grade. Six months on and it's still CIN 1.
Now, to my immediate problem. I recently met a man and had sex with him once. He lives very far away and I'm planning to visit him for a few days soon. I've been weighing the pros and cons of disclosing my infection to him. I was fine not telling him at first but the guilt is creeping on me. My worry is that he's going to freak out! My questions:
1) With high-risk AND persistent HPV is the risk of transmission much higher?
2) If the lesions are on my cervix is it possible that condoms might offer a better protection than if it were genital warts? Basically are there differences in transmission between low and high-risk HPV? And between lesser and higher CIN grade?
3) Should I envisage female condoms?
4) How about oral sex (receiving)?
5) Given my situation would you say that disclosure is preferable? It's a tricky one because of the distance.
6) I have recently disclosed my status to my previous long-term/casual/on-off partner. He didn't know what HPV was but he seemed OK with it. What should I tell him to watch out for in the future...? I feel bad. Most likely I infected him as he's had a limited number of partners before being exclusive with me for years (unlike me).
7) Let's hypothesise I have sex with him (previous partner) again in the future, are added exposures to my HPV going to make much of a difference?
I believe my potential new man may be HPV-free because of the limited number of partners he's had. Any advice you could give me to help me take the best decision would be gratefully received!
I've been monitored for cervical dysplasia for two years now, with a colposcopy/cervical smear every 6 months. This is after a history of HPV: genital warts over 10 years ago (all cleared) and CIN 1 that cleared by itself.
More recently I reached high-grade abnormality (CIN 3). I was treated with LLETZ and tested positive for high-risk HPV. It went down to low grade. Six months on and it's still CIN 1.
Now, to my immediate problem. I recently met a man and had sex with him once. He lives very far away and I'm planning to visit him for a few days soon. I've been weighing the pros and cons of disclosing my infection to him. I was fine not telling him at first but the guilt is creeping on me. My worry is that he's going to freak out! My questions:
1) With high-risk AND persistent HPV is the risk of transmission much higher?
2) If the lesions are on my cervix is it possible that condoms might offer a better protection than if it were genital warts? Basically are there differences in transmission between low and high-risk HPV? And between lesser and higher CIN grade?
3) Should I envisage female condoms?
4) How about oral sex (receiving)?
5) Given my situation would you say that disclosure is preferable? It's a tricky one because of the distance.
6) I have recently disclosed my status to my previous long-term/casual/on-off partner. He didn't know what HPV was but he seemed OK with it. What should I tell him to watch out for in the future...? I feel bad. Most likely I infected him as he's had a limited number of partners before being exclusive with me for years (unlike me).
7) Let's hypothesise I have sex with him (previous partner) again in the future, are added exposures to my HPV going to make much of a difference?
I believe my potential new man may be HPV-free because of the limited number of partners he's had. Any advice you could give me to help me take the best decision would be gratefully received!
A related discussion, High Risk Dysplasia was started.
I will! I am proud of the courage I had and feel better for it. If he's prepared to let me go over this then it's his loss.
All the best to you, and thank you again for your precious help.
M
All the best to you, and thank you again for your precious help.
M
MEDICAL PROFESSIONAL
Feel free to tell him I disagree with his decision. In any case, good luck and best wishes.
Thank you so much! I have talked to him and he's taken it rather well. For now he thinks this means we can't have sex until I'm clear (who knows when?!), but hopefully he'll change his mind when he's in possession of the facts.
MEDICAL PROFESSIONAL
By far the most likely is nothing: he'll never develop symptoms or a health problem of any kind. There could be a very small risk of genital warts, and a microscopic risk of penile cancer. However, even cancer is no big deal: as with most skin cancers, those on the penis start small and are easily curable.
One last question:
I'm about to tell my partner. What are the risks for him?
I'm about to tell my partner. What are the risks for him?
MEDICAL PROFESSIONAL
Yes, disclosure is primarily an issue for active HPV infections, not past ones that have cleared up. Once your paps have cleared up (or if you have treatment such as LEEP or other procedure to remove abnormal cells), you can safely assume you are no longer infectious and disclosure will not be necessary. (You may still choose to do it; in entering committed relationships, many couples disclose past sexual and STD histories. But that's a relationship issue, not one of disease prevention.)
As for my personal views, that's why I said "one size doesn't fit all". I can envision some personal circumstances when I would disclose and others when I might not, such as condom protected sex with a casual, one-time partner.
I agree it would be good if more people were more aware about HPV. OTOH, don't go overboard about it. You're suffering a relatively minor inconvenience in common with all women who have had abnormal pap smears (probably 20% of the population).
As for my personal views, that's why I said "one size doesn't fit all". I can envision some personal circumstances when I would disclose and others when I might not, such as condom protected sex with a casual, one-time partner.
I agree it would be good if more people were more aware about HPV. OTOH, don't go overboard about it. You're suffering a relatively minor inconvenience in common with all women who have had abnormal pap smears (probably 20% of the population).
Thank you Doctor. I am 37 and my partner is 38 so vaccination isn't an option for him. I guess I am closer now to accepting the fact that I should, in fact, tell him about my HPV infection (over the phone unfortunately!).
Do you sort of recommend disclosure in my case because it is "an active genital HPV infection"? I see from previous posts that you lean a bit more towards non-disclosure with people who HAD genital warts or whose infection goes further back in time. So when my pap smear is clear again of abnormalities and/or when I test negative, will it be less of a moral/practical necessity to disclose? I feel as if I am now sexually handicapped for the foreseeable future, on top of the implications for my health (cervical cancer looming). But hopefully my partner will be understanding, and if not, well...
Finally, when you say "but others would disagree", does this include you?
I understand there is no straight answer but I'm just curious.
I wish the population at large were more aware of HPV. Despite being so common and not being part of the usual sexual screenings it is an STI and as such it carries the same stigma as more serious and preventable STIs. It really isn't fair when ones thinks how careless so many people are.
Do you sort of recommend disclosure in my case because it is "an active genital HPV infection"? I see from previous posts that you lean a bit more towards non-disclosure with people who HAD genital warts or whose infection goes further back in time. So when my pap smear is clear again of abnormalities and/or when I test negative, will it be less of a moral/practical necessity to disclose? I feel as if I am now sexually handicapped for the foreseeable future, on top of the implications for my health (cervical cancer looming). But hopefully my partner will be understanding, and if not, well...
Finally, when you say "but others would disagree", does this include you?
I understand there is no straight answer but I'm just curious.
I wish the population at large were more aware of HPV. Despite being so common and not being part of the usual sexual screenings it is an STI and as such it carries the same stigma as more serious and preventable STIs. It really isn't fair when ones thinks how careless so many people are.
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
Many people would recommend disclosure of an active genital HPV infection (whether high or low risk, and with or without warts or pap smear abnormalities) to all partners. But others would disagree; one size doesn't fit all. But in generaly it's a good idea, at least out of courtesy. Some partners may wish to consider HPV vaccination (if they are under the usual age cut-off of 26 years).
Disclosing HPV infections to partners usually makes no difference in their risk (over the long term) in catching HPV, getting complications from it, or transmission risk to other partners they may have. Why not? Because almost everybody gets genital HPV anyway, often several times. For every partner who has a diagnosed infection, there usually are several others who are infected and don't know. Every sexually active person should expect to have one or more genital HPV infections, often with the high risk types. Even with the highest risk HPV strains, the large majority of infected people don't get cancer.
Here are two past threads that discuss these issues in more detail.
http://www.medhelp.org/posts/STDs/hpv-QA/show/742564
http://www.medhelp.org/posts/STDs/HPV-Transmission/show/1522088
These comments and the other threads pretty well address some of your questions. But to be explicit:
1) High vs low risk, and with or without pap smear abnormalities, all genital HPV infections detected by DNA testing should be assumed to be highly infectious for partners. However, many partners will be immune, if they have previously been infected with the same HPV type; and if infected, most people will never know it and will not develop cancer or other serious outcomes.
2) You can assume your HPV infection other genital tissues other than the cervix; and cervical secretions can contaminate the vagina, labia, etc. Condoms reduce but do not eliminate the potential for HPV infection; even with consistent condom use, most susceptible, exposed partners probably will be infected.
3) Female condoms might work better to prevent HPV, but this hasn't been studied. Most couples probably wouldn't consider it worth the hassle.
4) Oral sex is inherently lower risk for HPV than genital or anal sex. Oral infection might occur, but as for genital, most infections remain asymptomatic and clear up on their own.
5) See my opening comments.
6) In my opinion, there is no reason to say more at all to your past partner. You've done as much as can be expected; what he does with the information now is entirely his problem, not yours.
7) There would be no harm to either you or your partner. Once infected with a particular HPV strain, a person will not be reinfected. As far as we know, couples do not "ping pong" their mutual HPV infections back and forth. There would be no harm to either you or your partner.
I hope this has been helpful. Best wishes-- HHH, MD
Many people would recommend disclosure of an active genital HPV infection (whether high or low risk, and with or without warts or pap smear abnormalities) to all partners. But others would disagree; one size doesn't fit all. But in generaly it's a good idea, at least out of courtesy. Some partners may wish to consider HPV vaccination (if they are under the usual age cut-off of 26 years).
Disclosing HPV infections to partners usually makes no difference in their risk (over the long term) in catching HPV, getting complications from it, or transmission risk to other partners they may have. Why not? Because almost everybody gets genital HPV anyway, often several times. For every partner who has a diagnosed infection, there usually are several others who are infected and don't know. Every sexually active person should expect to have one or more genital HPV infections, often with the high risk types. Even with the highest risk HPV strains, the large majority of infected people don't get cancer.
Here are two past threads that discuss these issues in more detail.
http://www.medhelp.org/posts/STDs/hpv-QA/show/742564
http://www.medhelp.org/posts/STDs/HPV-Transmission/show/1522088
These comments and the other threads pretty well address some of your questions. But to be explicit:
1) High vs low risk, and with or without pap smear abnormalities, all genital HPV infections detected by DNA testing should be assumed to be highly infectious for partners. However, many partners will be immune, if they have previously been infected with the same HPV type; and if infected, most people will never know it and will not develop cancer or other serious outcomes.
2) You can assume your HPV infection other genital tissues other than the cervix; and cervical secretions can contaminate the vagina, labia, etc. Condoms reduce but do not eliminate the potential for HPV infection; even with consistent condom use, most susceptible, exposed partners probably will be infected.
3) Female condoms might work better to prevent HPV, but this hasn't been studied. Most couples probably wouldn't consider it worth the hassle.
4) Oral sex is inherently lower risk for HPV than genital or anal sex. Oral infection might occur, but as for genital, most infections remain asymptomatic and clear up on their own.
5) See my opening comments.
6) In my opinion, there is no reason to say more at all to your past partner. You've done as much as can be expected; what he does with the information now is entirely his problem, not yours.
7) There would be no harm to either you or your partner. Once infected with a particular HPV strain, a person will not be reinfected. As far as we know, couples do not "ping pong" their mutual HPV infections back and forth. There would be no harm to either you or your partner.
I hope this has been helpful. Best wishes-- HHH, MD
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