Hpv, men, and disclosure

[Born2B]

Hello Doctors,

Thank you so much for such an informative, helpful forum you run here.  I've read virtually all of your previous comments regarding hpv, and wanted to ask some questions that I hadn't seen answered.

First, my situation:

I am freshly single out of a 2 year relationship with a woman who was diagnosed as having an irregular pap (LSIL) about a month into our relationship.  I do not know if this was passed to her by me or by her previous partner, but for the purposes of these questions, I'm going to assume it was given to her by the partner before me.  She had one treatment and was clear of the infection a little over a year later. We had protected sex for about 7 months before stopping the usage of condoms, though oral sex was a regular part of our sex lives.  I am uncircumcised, and have had no symptoms of anything hpv related.

Here are the questions I have regarding hpv transmission, and future disclosure:

1.  My guess is that my first exposure to hpv was orally, and it is possible I wouldn't have come into contact genitally until we stopped condom usage (though obviously condoms aren't foolproof).  Can hpv be transmitted to different parts of the body AFTER another part of the body has been infected with the same strain?  For example, is it possible that my genitals could contract it months after contracting it orally?
2.  Can hpv spread to all parts of the body through a single transmission point?
3.  If an hpv infection is cleared in a particular part of the body, is it a safe assumption that it is cleared in other parts as well?
4.  There have been recent reports that hpv may be linked to prostate cancer and heart disease.  Do you have any thoughts on these reports?
5.  It has been over 2 years since I was first exposed to a high risk hpv strain - should I disclose this information to future partners?  What are the chances that I've cleared the infection as an uncircumcised male?
6.  Is there any way at all for men to be tested?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

You are asking some of the most common and basic questions about genital HPV infections.  I'll reply briefly to your specific questions.  However, I recommend that you also read the thread linked below -- as well as the several other threads linked there.

http://www.medhelp.org/posts/STDs/HPV-concerns/show/1819004

1) You can assume you have had (and maybe still have) a genital infection with the HPV strain that caused your partner's abnormal pap.  If so, it's from genital sex, not oral.  Condoms reduce but do not entirely prevent genital to genital transmission; even with consistent condom use, you can assume you have  (or had) a genital HPV infection.

2) HPV spreads locally.  For example, an infection acquired on the penis may spread to the scrotum or anal area, but as far as we know, it doesn't travel through the body.

3) Excellent question -- without a clear answer.  To my knowledge, this has never been studied.  My guess is that if someone has infection at more than one site -- e.g. both genital and oral -- that when it clears at one site, it will also clear at the other.

4) If there is a link between HPV and these problems, almost certainly it is indirect -- and for sure HPV isn't the only cause (and almost certainly not the main cause) of either heart disease or prostate cancer.

5) You need not say anything to future partners.  What to say (and not to say) to partners is discussed in one or more of the other threads linked above.

6) There is no readily available test for HPV in men, and no need for it. You're going to get HPV, probably several times -- we all get it.  Knowing that an asymptomatic infection is present doesn't provide any useful information, does not protect health, and doesn't protect partners.

HPV is a complex issue, but the bottom line is that it's mostly harmless.  You are much more concerned about it than you should be.  It's a part of life -- not worth a lot of worry.

Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

"am I correct in thinking that the risks of penile cancer for uncircumcised men, even with an hpv 16 infection are extremely low to the point that it should be something I don't concern myself with in the future?"

Yup.  Also, penile cancer is a pretty minor health issue.  Nervous men immediately think penile destruction or amputation.  But almost all penile cancers start out like most skin cancers:  a minor lesion that is easily cured by superficial removal, not amputation etc.  It usually takes years of neglect to reach a serious stage.  You will be fully protected against a serious outcome by getting care if you notice any wart-like lesions or unexplained penile sores.

"Should I adopt the same approach towards oropharyngeal cancers?"

Yes.  This remains a rare disease.  The large majority of people with oral HPV-16 don't get cancer.

"Should I bother having regular checkups in those areas to ensure that no cancer has developed?"

No.  The most I would do is have regular dental check-ups, as you should do anyway, and ask your dentist to let you know if s/he sees anything amiss.  This approach could change in the future -- research is underway to address whether other kinds of check-up might have a role in pharyngeal cancer prevention.

Thanks for the thanks.  I'm glad to have helped. Take care.

[Born2B]

Dr. Handsfield,

Thank you so much for your reply.  I'm aware that uncircumcised men are at a larger risk for penile cancer due to hpv than circumcised men, but am I correct in thinking that the risks of penile cancer for uncircumcised men, even with an hpv 16 infection are extremely low to the point that it should be something I don't concern myself with in the future?  Should I adopt the same approach towards oropharyngeal cancers?  Should I bother having regular checkups in those areas to ensure that no cancer has developed?  I believe I read a study once that estimated that .7% of all hpv 16 infections turn cancerous.  That seems low enough that if you're going to worry about cancer, there are others that should be much higher on your list.

I appreciate all of your advice and will do my best to not worry about this in the future - a little knowledge can just be a dangerous thing, especially with google right there at your fingertips.

Thanks for understanding and for all of your help.