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Dear Dr. Kate: I’m SO Confused About HPV!

Thu, Nov 19, 2009

Advice, What's Up Doc?

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photo by db*photography
An
anonymous poster on our site — calling themselves “medical knowledge” — recently wrote the following in response to an edition of our advice column about HPV. So we asked our own Dr. Kate — of Gynotalk.com — to clear things up, as it were. First, the anonymous comment:

80% of sexually active people have HPV. Although it is transmitted sexually, that does not make it an STD as most of the strains of HPV do not cause “disease” at all. If you do not have warts or abnormal paps it is really not necessary to tell a partner because… TADA… you don’t have the strains 16 and 18 that cause cervical cancer or 6 and 11 that cause warts. I’m assuming the letter writer has an abnormal pap because that is the only medical reason for getting tested for HPV in the first place. In this case, I would tell him that you may have a strain that transmits cervical cancer, and encourage him to tell all his past and future girlfriends to visit the doctor once a year to prevent the disease. I would then keep your own appoitments. Oh and in men, strains 6 and 11 also cause warts, but strains 16 and 18 do nothing in 99.9% of men. If you are a man and have 16 and 18, however, you will likely cause abnormal paps in any future partners so it is VERY important to tell these partners to go to the gynecologist every year to prevent progression to cervical cancer. For a clue if you have 16 and 18, look to past partners and ask them if they have had abnormal paps. And BTW, the HPV test CAN be performed in men it just ISN’T because it is completely unnecessary and medically irrelevant. You will not find many doctors who will perform a test for the sole purpose of figuring out who gave what to whom.

Paging Dr. Kate! Here is her eminently wise — and replete with actual medical knowledge — response:

The writer has some facts, but takes most of them out of the proper context. It is estimated that 80% of sexually active adults will be infected with HPV at some point, but they don’t all have it now. While not all infections with HPV cause clinical disease, it is still accurate to call HPV a sexually transmitted infection (STI). As for the focus on the strains, there are many more strains of HPV that cause both warts and cancer — these four listed are simply the most common ones, but they’re far from the only ones.

Yes, most women under 30 who are tested for HPV have an abnormal pap…but screening for HPV in all women over age 30 is becoming routine (and is already recommended). Yes, most men will not develop penile cancer from strains 16 and 18, but they will still infect their partners until they clear the virus (not forever). The sentence starting “For a clue” is awfully misleading — just because past partners haven’t had an abnormal pap or cervical dysplasia (that they know of), doesn’t mean a gentleman is free of the infection.

Finally, the HPV test has been designed for women, at the time of pap smear collection — the paddle may scrape cells of the penis that will show HPV infection, but since it wasn’t designed for men, it is not an accurate test in most cases.

– Dr. Kate
Gynotalk

MORE ON EMandLO.com ABOUT HPV:

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

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4 Responses to “Dear Dr. Kate: I’m SO Confused About HPV!”

  1. Sue Says:

    So, I’m still confused. Will HPV go away on its own? What does having HPV mean if you don’t have the strains that lead to cervical cancer or warts? Is the best policy just to assume that a guy has HPV? I feel like the information out there on HPV is fragmented and unclear at best.

  2. impetuousoddity Says:

    I’m with you Sue.

    Don’t we naturally develop antibodies to fight viruses? So like Sue says, will it go away on its own? My GYN says to get the vaccine, so I’m assuming I don’t have HPV even though I’ve had unprotected sex with some partners. :hangs head in shame: Do the tests always read accurately?

    Ugh, so many questions unanswered….

  3. Dr. Kate Says:

    I know how confusing this can be – even many doctors have a difficult time keeping it all straight.

    HPV often DOES go away on its own (yes, from antibodies that we develop), but there’s no way to know for sure when and if it leaves without frequent testing.

    You can test positive for HPV infection without having any disease (meaning cervical dysplasia, or precancerous changes) – and hopefully the infection clears before disease develops.

    Even if you have HPV, you can still get the vaccine. It won’t help the infection clear faster, but will help you from being reinfected with those strains in the future. HPV isn’t like chicken pox – we think that you can be infected with a particular strain, clear it, and then be reinfected again. So the vaccine can help everyone.

    As for assuming that all guys have HPV…most guys will have HPV at some point, and it’s reasonable to guess that he may have it when he’s with you. This doesn’t mean don’t have sex with him – just use condoms (to reduce the risk), get the vaccine (to reduce it further) and get tested (with pap and HPV tests).

  4. Brock Says:

    I am BEYOND confused because none of the information related to HPV seems to focus very much on HPV in men…particularly gay men.

    I will share my story and perhaps you may have some answers for me.

    About two months ago, I noticed a small bump (what looked like a skin tag) on the outside of my anus. I made an immediate appointment with the doctor and was bluntly told that I had a minor case of genital warts. I was shocked as I’ve only slept with three people (I’m 24) and all have been in long-term monogomous relationships. The few external lesions were frozen by cryosurgery and I was told to use Aldera which worked wonderfully, but was unfortunately VERY painful. Luckily, I am currently visually free of GW.

    However, I expressed concern to my doctor that I feared something may also be inside my anus, so I was sent to consult a surgeon. Upon inspection, he noticed two lesions and said that I’d need to go under anesthesia to remove the internal warts as they can multiply and in some men (predominantly gay men who seem to suffer most from anal warts), it can cause problems when going to the bathroom.

    After the surgery (and a very, very horrendous recovery) I was told at my follow-up visit that the surgery had been more extensive than the surgeon had expected. After analysis of the removed tissue by the pathologists, I was told that I had had anal dysplasia…a possibly pre-cancerous condition. Luckily it was caught early. Still, I have to go to constant check-ups and have anal pap smears.

    I have never shown any symptoms on my penis.

    But all the doctors contradict one another.
    I have been left so very confused by it all. Is it possible that I can clear the VIRUS? I don’t mean the symptoms (as I’m aware that they often go away on their own), but the VIRUS that causes these symptoms. Might there be a time that I’m not contagious? Women with cervical dysplasia seem to clear it up in 6 months-3 years. What’s the information on men (or women, for that matter) with anal dysplasia? Is it entirely different? My doctor said I wouldn’t benefit from the HPV vaccine and yet you say, it’d be smart even for those infected to get it.

    I’m afraid to touch myself, let alone let anyone near me. I’ve had to see a counsellor just to deal.

    I know that this post may be full of misguided or untrue statements, but I am not here to defend them, but to learn and hopefully get some straight-up answers.

    Please help.


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