People are with a high or low-risk infection and don’t know!

Esther

So, you’re thinking of dating someone

As some of you know, I’ve been attempting to date even though I have been tested for HPV. Recently, I disclosed this to someone, and I wished I had a handy resource to point him to that could answer his questions succinctly and non-scary about STD tests.

.Ta-da!

Hopefully, this resource will be helpful for some of you when you’re disclosing or for those of you who have hurriedly Googled HPV test and are seeking answers. My purpose here is not to persuade anyone to undertake sexual activity they’re not comfortable with. An STD panel needs to be tested regularly. Or to say to people that they must or should date someone with an STI. But I did want to have something handy to refer to for people who want to make a decision.

Disclaimer and Scope

Disclaimer: not a doctor, not a scientist. Open to correction.

If your prospective partner just disclosed to you – woohoo! You find someone honest enough to tell you about their sexual health, which can be a scary and difficult thing. NOT EVERYONE WITH AN STD WILL DISCLOSE. This is not always deliberate: many people with HPV will never even know they have it. That’s because women are only routinely asked about high-risk variant (more on that later) after a certain age (e.g. 25 in the UK); men are not commonly examined at all for the high-risk virus. And nobody is commonly checked for low-risk viruses unless they have visible genital warts. So, a LOT of people are walking around with a high-risk or low-risk infection (symptomatic or asymptomatic) and don’t know.

Additionally, medical professionals may give mixed advice, and many doctors advise patients not to disclose their STD infection. The reasons for this are varied, but I won’t dive into them now. Anyway, your partner has disclosed, so this post is here to help you learn a bit more about it and figure out the next steps.

The first and most basic thing to know is that viruses infect the skin. There are over 100 STI strains tested, and some of them prefer the genitals and are sexually transmitted. That’s our focus here.

Step 1: Questions to ask your partner before you get down to making decisions:

Do they have a high-risk or low-risk virus? The high-risk type is typically detected during co-exam with a cervical smear. It doesn’t usually cause any symptoms. The low-risk type usually causes genital warts (benign skin growths/bumps). Low-risk type is usually diagnosed by sight or occasionally by biopsy.

Is their infection still active? If they were diagnosed through a cervical smear, have they had a negative result since then? If they had genital warts in the past, have they been treated? Have they had recurrences of the STD warts in the last six months, or was it a long time ago?

Do they know the strain type of their virus? (Not everyone will know this, and it can be hard to find out depending on where you are and what checks have been done)

Step 2: Understanding the prevalence

HPV is an incredibly prevalent virus. More than 80% of people will get a form of genital virus in their lifetime (and actually, the linked study suggests this will happen by age 45). So, if you’ve had other sexual partners in your life, there’s a good chance you’ve already been exposed to it and may have already had or currently have an infection. And if you will have partners in the future, you’ll probably be exposed again. This is not to say you must willingly expose yourself right now. But it’s important to place your partner’s disclosure into context.

It is not rare. It’s not weird. And it’s not a marker of someone being promiscuous, unsafe, or unclean. It’s an unavoidable consequence of skin contact with other humans.

In the modern world, we are hyper-aware of STIs. STD Profile testing and awareness are quite recent phenomena. If you’ve never heard of it, don’t feel bad, but know that many people you know, probably you, have had it.

You could have it right now. Could you pause before judging your potential partner?

Step 3: Understanding the nature of immune suppression

I bet you Googled HPV right away and saw scary things saying it is incurable’ or ‘it is for life’. Maybe your prospective partner even told you that.

It is ‘incurable’ because there are only exams and treatments for the symptoms (warts or cell changes). Still, like most viral infections, the body’s immune system eventually controls the virus. Annoyingly, it takes much longer than it would with a cold or flu. But for most people, this will happen between 6 and 24 months after infection.

The science of STI immune suppression is evolving. Recent findings suggest some virus fragments may remain in the skin even after immune control. And it seems like some people don’t fully control the infection, so it can recur later in life. That’s only a small number, though (otherwise, many more women would develop pre-cancers and cancer in their older age). So, for most people, it’s clinically considered as good as going from a few months to a couple of years. We don’t say ‘chickenpox is for life’, although technically, the virus remains in the body, and some people can reactivate as shingles. Similarly, it’s not quite accurate to say ‘HPV is for life’.

Once it becomes immune suppressed, it is unlikely to transmit to you. So, a partner who is telling you about their infection many years ago is not very likely to give you that strain. And if your partner has an active infection right now, it won’t be that way forever.

It is not the same as HSV/herpes, where some people can get regular ‘outbreaks’ for life.

Step 4: Understanding the risk to you

In general, with STDs, you need to be aware that condoms mitigate but don’t fully prevent viral transmission. Also, unlike with HSV/herpes, there aren’t antiviral drugs that can reduce transmission. So, proceeding to give an infected partner oral sex or to have genital-to-genital contact with them, even with condoms (and potentially dental dams), does pose some risk of transmission to you.

Of course, you may test and have had their type of HPV or STI already, especially if you’ve had an active sex life beforehand. In that case, you are unlikely to get reinfected with the same strain.

But if you do get infected, what’s the outlook?

If your partner has a low-risk variant (genital warts) and has actual bumps, they are highly contagious. Some sources give a 60% transmission rate. However, not everyone who gets the low-risk version will develop warts, as some carry the virus asymptomatically. 

If your partner has a high-risk variant, there are some potential health risks to you. The immune system suppresses the virus in most people, and no health issues arise. But in some people, the virus persists and can cause cancerous cell changes. There are a variety of cancers caused by Papilloma. Most of these are pretty rare, and are not screened for. If you have a cervix, cervical cancer is the most prevalent risk, but attending your regular STD smear exam is a good way to pick up persistent infections and get monitored and treated if necessary. If you don’t have a cervix, oral cancer rates, especially for men, are rising. Unfortunately, healthcare providers do not recommend screening tests for oral HPV as a method to prevent cancer. So there’s not much you can do about it.

If you don’t have a cervix, you will probably never know for sure if you have a high-risk infection or not. And even if you do have a cervix, you must undergo screening at the exact time you have the virus. In countries where a three-yearly smear cycle is standard, you could potentially miss the infection if it does not last that long.

Bearing in mind that you probably will get a high-risk variant of some sort at some point in your life, if you have a few sexual partners, the risks are the same. But they are something to bear in mind and think about if your potential partner has an active high-risk infection right now.

Step 5: Understanding the impact on your sex and love life

One of the most stressful things about getting an HPV diagnosis is worrying about telling other people. Disclosing is freaking scary, and rejection (or the fear of it) sucks.

So yes, this is something to bear in mind if you are thinking about the risks of the virus. However, it is worth considering that you may not need or want to disclose forever. Disclosure is a grey area once you get past the point of having an active infection. Once you’ve got a negative high-risk infection, or once you’ve gone for a decent length of time (probably 6 months +) with no wart regrowth, you may feel comfortable not disclosing to partners. Or, you may feel you want total transparency in case of recurrence. It’s up to you. We also have many members of this forum who have disclosed to partners who have been fine with it.

Step 6: Understanding your options

One option is to say no to this potential partner and walk away. This is your prerogative; you must do what feels right and comfortable. As someone with the disease, I’d ask that you do it gently. And remember that walking away this time doesn’t mean you will never get it.

Seek Vaccination

Option two is to seek vaccination if you haven’t had it already. It may be free in your country’s STD healthcare test system, or you may need to pay. It takes a few months to complete the course of three shots. Gardasil 9 covers the two strains that cause 90% of warts, plus 7 prevalent high-risk strains. You also need to be aware of kits that people can have types are not covered by the vaccine.

Proceed with Precautions

Using sex toys, or your hands, is fine, as long as you wash your hands before touching your genitals and don’t share toys. You may feel comfortable receiving oral sex (bearing in mind that they could have a concurrent oral STI infection, but there’s no way to know unless they have actual oral warts or an instant kit – but the same is true of anyone you meet). There are lots of other fun things you can do that are sexual or otherwise while you wait.

Accepting the Risk

Option four is to proceed with a full sexual relationship, accepting the risk of transmission, given the prevalence in the population screening and the likelihood that you’ve come across it before or will in future. Using condoms while an infection is active is still a good idea because it can lower the STD viral load shared between you and, therefore, make immune suppression quicker.

Nobody can define your comfort level, and it’s up to you whether you go ahead with sex, get a kit for the variant and have a relationship with someone who tests positive with HPV. Think it through and weigh up how you feel.