A: The short answer is that it is very unlikely you would experience another outbreak of warts, or infect a partner, fifteen years after your symptoms disappeared.

To explain a bit more fully: Scientists have detected more than 100 different strains of HPV. Approximately 30 types can affect the skin in the genital area, producing cell changes that sometimes lead to warts or pre-cancerous lesions. Your outbreak was caused by one of these strains. At some point after your symptoms were treated, your immune system kicked in and successfully suppressed the virus so that your symptoms did not recur. By that time, you were already significantly less likely to be contagious to a partner than while you were symptomatic; after fifteen years with no symptoms, passing on the virus is even less likely. Experts are not 100% certain whether the body is actually able to completely eradicate the virus, or whether you do in fact carry your strain forever. Practically speaking, though, this doesn’t matter much, because the effect is the same: you remain symptom free, and highly unlikely to infect a partner.

In terms of your immunity or susceptibility to HPV in the future, you can consider yourself “immune” to the strain with which you were initially infected. However, it is still possible for you to contract a different strain. (In fact, you have probably been exposed to other strains already, simply because HPV infection of some type is VERY common.) Much of the time, your immune system will fight off the HPV strain so that you never see symptoms. Taking all these factors into consideration, it is technically possible, but not very probable, that you could contract a different strain of HPV and experience symptoms again.

Hopefully, this information will help you make an informed decision about whether or not to tell partners about your history with HPV. The following web resource has a great breakdown of how an HPV infection progresses and resolves (don’t be deterred by the fact that the source is the American Society for Colposcopy and Cervical Pathology; the general information on HPV applies to both men and women).

A: HPV can be effectively passed through any genital-to-genital contact, or sometimes through oral-genital contact. So, yes, it can easily pass between females.

A couple other things to think about:

1. HPV is sneaky. It’s possible to have it for years, lying dormant, and have it flare up later. The pap doesn’t test for the presence of HPV directly, but rather for abnormal cells present on the cervix. It’s entirely possible that she had an HPV infection at the time of her earlier pap, but it just hadn’t yet affected her cervix.

2. HPV found on the cervix (where a pap smear would find it) isn’t generally treated by medicine. Did they specifically say that she’d tested positive for HPV, or just that she should take some medicine for it? I wonder if what she’s getting is actually Gardasil–which is an HPV vaccine rather than a treatment and would administered before someone actually caught the virus. If that’s what it was, it’d be a series of three shots spaced out over several months. You may want to follow up and find out what she is being treated with and for.

Of greatest concern is the time it takes to get results. Please give me information for all the common STDs. Thanks.

A: Here are our best answers, broken down by disease.

> Chlamydia – standard used to be a bacterial culture (takes a few days to come back), but more common nowadays and more preferred for accuracy is a bacterial DNA PCR or SDA (both are types of NAAT). This can give results overnight. Both tests most commonly use urine samples. Window period is 2 days to 2 weeks.

> HPV – HPV testing done in the form of a visual inspection plus an application of acetic acid in a clinic can give you immediate results as to whether or not a lesion is HPV. This is the only way one can test for warts. Pap smears need to be read by a cytologist in a lab; depending on how busy your clinic’s lab is, this could take a few days or as long as two weeks to receive a result. Window period can be a few weeks to a few years; unfortunately, if someone gets an HPV outbreak or abnormal pap smear, it could be the result of HPV exposure from several years ago.

> Gonorrhea – same as Chlamydia. Time does not vary by specimen location per se; that said, some labs require a different collection tube for oral/throat specimens, and that can take a couple of extra days. Window period 2 days to 2 weeks.

> Herpes – visual inspection is the starting point, and suspicious lesions or rashes can be swabbed for viral culture. The culture takes a couple of days to grow in the lab, and may take an extra day for the lab to run typing on the viral DNA to distinguish between HSV I and HSV II. Blood Ab tests should take about a day to come back as reactive or not, and another day to run typing between HSV I and HSV II. Window period 2 days to 2 months; some people may contract HSV but never have obvious symptoms of an outbreak.

> HIV – we don’t have statistics about how many places use rapid tests vs. DNA tests; that said, in San Francisco, most clinics use rapid tests as a starting point to check for antibodies; any reactive test is confirmed with multiple Ab tests (Western blot and Elisa) and a PCR and/or a viral load. It is less common for clinics in this area to send tests to an outside lab for Ab. Ab and PCR tests should be available from a lab in a couple of days. Window period varies state-to-state; in California for antibody testing, it is 2 weeks to 6 months, with 98% of people developing antibodies 3 months after contracting HIV. DNA PCR tests are accurate 6 weeks after exposure.

> Syphilis – the blood test is an Ab test, either VDRL or RPR. Both of these take multiple steps: one to find an initial reactivity, and another to confirm that it is due to the syphilis bacterium. People with a history of syphilis infections will always test positive on the first step, so their specimens will always require multiple steps. The first step of this test can usually be completed in a day or two, with another day or two for subsequent steps on reactive specimens. Window period up to 2 months.

> Trichomoniasis – most clinics do not send specimens to outside labs for testing, though there is a culture available. Clinicians can diagnose trich off of a wet mount: a sample of discharge smeared onto a microscope slide examined in your doctor’s office. It is rare to test men for this infection, as they seldom have symptoms, but if a woman tests positive for trich she can request medication for her partners. Window period 1-2 weeks.

One thing we’d note about the more sensitive tests: they can sometimes be too sensitive and give false positive results. We have heard clients say that they test positive on a test, ask for a retest, and then show up negative. Also, depending on what lab your clinic or doctor’s office uses, test results may be delayed. We hear from local clinics that specimens they send to the local Department of Public Health Lab can take as long as 2 weeks to return results to them, but private labs may return results overnight. Your provider’s office may have either financial or contractual considerations as to which labs they use.

Reliable sources to get information about testing and window periods are:
http://www.labtestsonline.org/
http://www.ashastd.org/

A: Condoms can greatly reduce the chance of transmission, but HPV can occur on skin surfaces in the genital regions not covered by a condom. Of the more than 100 types of HPV about 30 are sexually transmitted and only two are linked to cervical cancer.

An estimated 5.5 million new HPV infections occur each year in the US, accounting for about a third of all STD transmission. It’s a very communicable STD.

Recent studies show that about 70% of infected females will clear the infection in 12 months and 90% will clear within 2 years. The incubation period for the virus is 2 to 3 months. Many or most men may carry the virus and never present with symptoms.

With all that said – telling your other sexual partners is a good idea, if for nothing else to make sure the females in the group have their regular pap smears. The cervical cancer associated with HPV is very slow to develop and regular pap smears can lead to successful early intervention. How far back to go? Theoretically in a perfectly safe world, up to two years. Practically, probably less time. One thing we do find is that it’s quite common for men and women who practice swinging or open sexual relationships to go for regular check up or STD testing.

The good news is that there is not as much of a stigma attached to this virus because it’s quite common. It’s quite likely 25 million or more folks in the US currently have HPV.

Here is a great resource with info on HPV – hpvinfo.com. We use the site’s information while we work here at SFSI.

I recently had a normal pap smear, which included HPV testing. We rarely engaged in penile/vaginal sex, and only once (accidentally) without a condom. My primary exposure to his HPV was oral.

I have no health insurance, so I am being judicious about this — is it indicated I should go for testing of my throat? What is the name of the test I want?

A: The research on HPV is very new so there is a lot of information and studies that are still missing. What we do know is that cancer is only caused by a few of the hundreds of possible strains of HPV. A doctor or dentist can do a visual test to see if there are any HPV lesions in your throat. We recommend regular visits to the dentist because they are trained to detect any abnormalities in the mouth and throat, including those from sexually transmitted diseases. At this time there are only visual tests for HPV in the throat, and it is difficult to detect if there are no lesions present.

For more information on HPV you can call the American Social Health Association (ASHA) at 1 (800) 227-8922 Monday through Friday from 9am to 6pm EST or The Center for Disease Control’s STD 24 hour hotline at 1(800) 342-2437.