Unfortunately, there are many myths and misconceptions about genital HPV, and in some cases these can cause real harm. Bad information can cause a person to suffer terrible anxiety unnecessarily, to doubt a partner’s faithfulness, or even to undergo painful and expensive treatment that could have been avoided. Most dangerous of all, misinformation may lead people to neglect a very simple procedure that saves lives.
But why? One reality is that some aspects of the virus are still poorly understood, even by medical researchers. At the same time, much new information about HPV has been learned in recent years, reversing some previous assumptions about the virus. The result is that older publications may be inaccurate, when they mention HPV at all. Likewise, healthcare professionals, writers, and educators who have not kept up with recent research findings may continue to spread misconceptions.
Another difficulty is that to some degree, the overall topic of genital HPV is complex and confusing to everyone, lay person and scientist alike.
Below we take on some of the most common myths and misconceptions we’ve encountered on the topic of genital HPV and offer clear and accurate information in response.
Myths and Misconceptions
It is true that a higher number of sexual partners over the course of a lifetime does correlate with a higher risk for STIs, including HPV. This is not because of any moral judgment concerning “casual” sex as compared with “committed” sex, but simply because the more sexual partners you have, the more likely you will have a partner who (knowingly or unknowingly) is carrying an STI.
However, STIs can be passed along as readily in a loving, long-term relationship as in a one-night stand. And HPV is the virus to prove it. At least one study of middle-class, middle-aged women, most of them married with children, found that 21% were infected with cervical HPV. In other studies, according to Nancy Kiviat, MD, a researcher at the University of Washington, about 80% of people who have had as few as four sexual partners have been infected with HPV.
The virus can remain in the body for weeks, years, or even a lifetime, giving no sign of its presence. Or a genital HPV infection may produce warts, lesions, or cervical abnormalities after a latent period of months or even years.
As mentioned above, most people who are infected with genital HPV never know it. In most cases, a person is diagnosed with HPV only because some troubling symptom drove him or her to a healthcare professional, or some abnormality was revealed in the course of a routine exam.
But even after an HPV infection is diagnosed, there is simply no way to find out how long a particular infection has been in place, or to trace it back to a particular partner.
In a monogamous relationship, therefore, just as in an affair or even in an interval of no sexual relationships at all, an HPV diagnosis means only that the person contracted an HPV infection at some point in his or her life.
As for ordinary genital warts, says Doug Lowy, MD, chief of the Laboratory of Cellular Oncology at the National Cancer Institute, “These are caused by HPV types that are virtually never found in cancer.” These are the “low-risk” types, 6, 11, 42, 43, and 44. When not causing genital warts they may cause a transient abnormality in Pap test results, or most often produce no symptoms at all.
It is worth keeping in mind that both men and women may be infected with, and infectious for, high-risk HPV, regardless of whether or not they have genital warts.
To help sort out the various possibilities, a woman with an abnormal Pap test will likely have follow up testing. A Pap is a screening test, not a diagnostic one, so a provider will help determine the next steps to take, which may include additional testing or procedures such as colposcopy and biopsy.
But this very effective system of protection can work only when each woman takes responsibility for the first step herself, by getting screened regular intervals. More than 50% of all new cervical cancers are in women who have never been screened or have not been screened in the past five years.
The limiting factor here is the state of the immune system itself. According to Thomas Sedlacek, MD, adjunct professor of obstetrics and gynecology at Allegheny University, if an individual’s immune system is impaired—by the use of certain medications, by HIV infection, or by some temporary trauma such as excessive stress, serious illness, or surgery—it may be unable to prevent a recurrence. However, if the immune system is weakened only temporarily, most likely the recurrence will be short-lived.
The concern about life-long recurrences may be based on a misconception rather than a myth. It’s true that at present there is no known cure for genital HPV. As a virus, it will remain in the infected person’s cells for an indefinite time–most often in a latent state but occasionally producing symptoms or disease, as we have discussed elsewhere. Recent studies from the Albert Einstein College of Medicine and from the University of Washington suggest that HPV may eventually be cleared, or rooted out altogether, in most people with well-functioning immune systems. However, in at least some cases the virus apparently does remain in the body indefinitely, able to produce symptoms if the immune system weakens.
The most recent evidence for this comes from a study under way at the University of Washington, which has found a number of genital HPV infections among lesbian women—even in some women who had never had sex with a man. Genital HPV in lesbians has not yet been extensively studied, but researchers suspect the prevalence rates will be lower than among heterosexuals. Even so, the rates will not be low enough to rule out the risk of cervical cancer altogether, so a regular screening is a smart health measure for gay and straight women alike.
According to recent guidelines drafted by the CDC, “examination of sex partners is not necessary” as follow-up to an abnormal Pap test. It’s certainly possible—even likely—that the partner is or has been infected with the virus, although highly unlikely that he will ever show any symptoms. Nor is it possible to determine whether he can spread HPV to a future partner.
However, if a woman has external genital warts, her partner may still consider scheduling a medical exam. It may be useful for a male partner to talk with a healthcare provider to gain more information. And of course, if a man starts to notice symptoms of his own, such as unexplained bumps or lesions in his genital area, he should get medical attention at once.
That is not to say condoms are useless. In fact, studies have shown condom use can lower the risk of acquiring HPV infection and reduce the risk of HPV-related diseases, as well as help prevent other STIs and unintended pregnancy. For these reasons, condoms should play an important part in any new or non-monogamous sexual relationship.
Adapted from “10 Myths About HPV” by Sandra Ackerman. Reprinted from HPV News (c) 1998 The American Sexual Health Association