One of the most common questions I get from my patients who have had had an abnormal pap due to HPV infection is this –
Are they obligated to notify their past, current, future or potential sexual partners that they have or have had HPV?
I believe the answer is a qualified no. And here are the reasons why –
1. HPV is ubiquitous.
Close to three-quarters of adults have had HPV at some point in their lives. Ninety five percent of the time, that infection will clear within 1-2 years with no long-term consequences to themselves or their partners.
Although we can offer treatment or removal for genital warts and precancerous pap smears, there is no medical treatment to clear the HPV virus itself in an infected individual without these conditions. That’s the job of the immune system, which can be helped along in this regard by using condoms, avoiding tobacco and eating a diet rich in fruits and vegetables.
2. Unlike women, most men with HPV have no way of knowing they are infected.
Unless they have a visible genital wart, or a much, much rarer HPV-related cancer, most men who have HPV have no idea they are infected. That’s because there is no available HPV test for men.
Women, on the other hand, if they happen to get an abnormal pap smear during the time they are infected, may very well find out that they have HPV. (I’m not going into the management of abnormal paps here, but suffice it to say that the overwhelming majority of abnormal paps due to HPV will resolve without treatment just as the virus itself resolves. Those that don’t, and which carry precancerous changes, can be effectively treated,)
3. Why then, should a woman be obligated to tell her partner that she has HPV?
Given the ubiquitous nature of HPV infection, unless her partner is a virgin, the odds are pretty darned high that he already has had HPV. He may actually have the infection right now and be the one who gave it to her. On the other hand, he may have had it in the past and already be immune to the strain of HPV she has. Or be infected with another strain she does not have, so that she may actually be the one taking the risk by sleeping with him.
She’ll never know, and he’ll never know. Because he cannot be tested. Or treated.
4. HPV is not like chlamydia.
There is no role for partner notification and treatment in preventing the spread of HPV. The only thing that partner notification accomplishes is to turn women with abnormal paps into pariahs, while the rest of the HPV infected men and women out there continue to copulate in blissful ignorance.
Which is why I don’t believe that every abnormal pap needs to turn into an STD confessional.
I do believe that all sexually active adults have an obligation to themselves and others to prevent the spread of HPV and other STD’s by practicing responsible sexual activity.
That means being tested and treated for those STD’s whose spread we can stem through screening and partner notification, being vaccinated against those we can prevent, using condoms and limiting our numbers of sexual partners.
It’s not a moral message, unless morality means acting responsibly and maturely, and respecting one’s own health and that of others. By limiting one’s partners, I mean confining intimate physical relationships to those who we really care about. (Dare I use the word love?…)
In this context, some women may take HPV infection as a sign that it’s time to stem the one night stands. A few may choose to hold off on relations altogether until their infection clears. The majority, who are already limiting their sexual activity to caring relationships, will make no changes in their behavior except perhaps to use condoms until the infection clears. And if they are already in a caring relationship, they usually end up discussing it with their partner. Because that’s what couples do – they talk about their lives, their health and their fears.
Which is very, very different from mandatory STD partner notification and treatment.
The Good News
The good news for HPV-infected women is that almost all HPV infections will clear. Once HPV is gone, your increased risk for cervical cancer goes with it. As does your risk for transmitting the virus to others. Which takes care of the issue of future partners.
The other good news is that getting regular pap smears will prevent the uncommon but important consequence of HPV infection – cervical cancer.
Genital warts are worth discussing with your partner.
I do think it’s worth discussing with your current partner if you discover that you have genital warts.More often that you’d think, the male partner may have small, previously undetected genital warts that are amenable to treatment. He can visit his doc for a careful exam and get treated if warts are present. That in turn may help you clear the infection faster yourself, since your immune system won’t be under constant barrage with high viral loads from your partner.
Condoms are also worth discussing.
If you have an abnormal pap due to HPV, and you are not using condoms, it’s worth discussing the matter with your partner and asking him to use protection when you have sex. Women with HPV whose partners use condoms will clear the virus and return to normal paps faster than those who have unprotected sex.
There is a role for HPV vaccination.
I also support the use of HPV vaccination. Despite my objections to how it has been priced, marketed and legislated, the vaccine is safe and effective. Getting vaccinated after you’re infected won’t help you clear the infection faster, but can prevent new infections with the 4 strains that the vaccine targets.