STDs: The social contract

May 23, 2005 5:33 PM

Lately it seems that several of my friends are receiving HPV diagnoses, with all the accompanying uncertainty that entails. Given how little research we have on HPV and the relative benignity of the diagnosis, how should the topic be discussed with prospective partners?

HPV, as far as I can tell, can't be detected in men and may have no symptoms except possible genital warts (in specific strains). Condoms do not prevent the spread of it - in fact, you don't even have to have sex. The risk with HPV is that certain strains MAY cause cervical cancer - so how should this be brought up with casual partners without making it sound like a horrible disease? The problem my friends seem to be facing is that most guys haven't heard of it, can't be tested for it, and the necessity of providing a sex ed lecture when the topic arises really does not make sexual encounters fun. Any personal experiences or advice is greatly appreciated.

posted by anonymous to health & fitness (10 comments total)

This week's Savage Love addresses HPV.
posted by samh23 at 5:39 PM on May 23, 2005

It sounds a little like you're trying to justify not telling potential sexual partners about an STD. That's really, really wrong, no matter how awkward and unsexy the conversation might be or how "benign" the diagnosis.

A couple of medical things first: Some types of HPV are absolutely linked to cancer -- there's no maybe about it. And while cervical cancer is the most common, HPV can also lead to several other kinds of epithelial cancers and carcinomas. Even aside from the cancer risk, though, is the fact that most types do cause warts. Now, this isn't a big death sentence or anything, but most people, given the choice, would prefer not to have them.

Just tell potential partners. Yes, it's uncomfortable, but it's part of having sex like a grown-up. The fact that it's difficult doesn't change your responsibility.
posted by LittleMissCranky at 5:58 PM on May 23, 2005

I don't think that's what's going on at all, LittleMissCranky- I think the writer is a woman, wondering how to talk to men about a confusing STD that really doesn't affect men.
posted by ThePinkSuperhero at 7:01 PM on May 23, 2005 [1 favorite]

Maybe not, TPS, but it sure read like that to me. It's not really accurate to say that it doesn't really affect men. It absolutely affects them, both through the charming possibility of genital warts and because the men will spread it to future partners. I assumed that the writer is a woman as well, but that doesn't really change the necessity of informing sexual partners of an STD.

In any case, you discuss this with prospective sexual partners the same way you discuss any other STD. Yes, it's unpleasant, and yes, you might get rejected because of it, but that's just the nature of the game.
posted by LittleMissCranky at 7:41 PM on May 23, 2005

Actually, it can and does affect men. Men can get penile and anal cancer from certain strains of HPV. The problem is that no test for men has been developed commercially. The only commercial test takes cells from the cervix...so men, ya know what with the penis thing, don't seem to have a reliable cell "pickup joint".

The statistics on the spread of this virus are astounding, and a lot of that is because people tend to think that it's "no big deal".

However, there are many types of HPV. Some types cause common, plantar, filiform, or flat warts. Other types cause genital warts.

In women, high-risk types of HPV (such as types 16, 18, 31, and 45) cause changes in the cells of the cervix that can be seen as abnormal changes on a Pap test. Abnormal cervical cell changes may resolve on their own without treatment. However, some untreated cervical cell changes can progress to serious abnormalities and may lead to cervical cancer.

4100+ women in America die each year from cervical cancer.

I'd have to say that discussing it with partners who can spread the virus to other people is certainly an ethical imperative. As to how one does it...one does it before one finds oneself wrapped in his love nest preparing to be taken like a pirate wench.

Ideally, when one realizes that a relationship is moving from the "Hi, how are ya?" stage into the "Wow, I bet you look really good naked!" stage, one sits one's partner down and presents the facts about the situation. The fact that men very rarely show symptoms (unless the strain being carried is genital warts...those they can catch), that there is no reliable test because there is no treatment for men, that they may be contagious for an unknown period of time...or they may not...there's no real way to know.

But to not tell them is to potentially sentence someone else...them or a subsequent partner, to a death sentence.
posted by dejah420 at 7:41 PM on May 23, 2005

According to this, 80% of all women will have HPV by the time they're 50. There's no number for men, of course, because the vast, vast majority show no symptoms and can't be tested for it. If 80% of women have an STD, I wonder, statistically, what percentage of men have it.

An interesting note, as far as I'm aware, the HPV tests they give women only cover the ~20 strains that are linked to cancer... And there are hundreds of strains. So no test for men, and a shoddy test for women.

I suppose if a woman tested positive for cancer-related HPV, she should tell her partner, (though you wouldn't catch her partner having to confess the same thing), and abstinence is the only option... condoms won't protect you from it the way you'd expect them to. But people should also be honest with themselves about the fact that if you're not a virigin, and your partner isn't either, you've both likely got some strain or another, and you'll be sharing it.
posted by FortyT-wo at 7:47 PM on May 23, 2005

You have to tell. If the situation were reversed, wouldn't you want to know before you had sex? I sure as hell would.

As a guy, I'm less concerned about the possible ill effects on me than on spreading the virus to future partners.
posted by grouse at 10:38 PM on May 23, 2005

I think this is a complicated question, not least because it's now thought that most people who contract HPV clear it from thier bodies without experiencing symptoms or getting any treatment. I'm not sure if people clear it once they show symptoms or not. It's also true that viral shedding occurs in the abscense of symptoms and that condoms provide little protection. I disagree with dejah420 who suggests that a laissez-faire attitude toward the STD is contributing to its spread, I think the spread has much more to do with asymptomatic infection and inadequate protections short of abstinence.

I don't suggest that you not tell your partners, but at the same time, I think not telling is a relatively minor infraction in the STD world. There are obviously other commenters here who think otherwise. But I think that HPV is a disease, unlike many others, for which the buyer needs to beware. This means regular paps and self-examinations for both men and women. The ethics of the situation rest on knowing that you've been diagnosed with HPV in the past (but may not have it now). Since most people who have HPV don't know it, the chances are that people who don't have the disease are more likely to be exposed by one of those people than by someone who has it and knows it. Which, again, doesn't make it alright to not tell, but complicates the question a little bit and makes it less black and white (to my mind).
posted by OmieWise at 5:39 AM on May 24, 2005

We're very lucky, those of us who get pap tests every year. Most cases of cervical cancer are absolutely caused by certain strains of HPV, but those strains of HPV do not always progress to cervical cancer, either because the body flushes it out or because screening and access to treatment for pre-cancerous conditions keeps it from progresing to cancer. This is why the brochures all say "may cause". It's not that the cause is in doubt. Here's the NCI fact sheet. Globally cervical cancer is the third-most common cancer. This is largely due to lack of screening.

I'm not sure why you say that there's little research on HPV. What are you looking for?

Are your friends being diagnosed with pre-cancerous conditions or are they just getting back abnormal pap tests that warrant a second test? If it's just an abnormal pap, I think the easiest thing would be to just abstain for the two weeks or so with the explaination that you're being screened for cancer. But not telling at this point is a minor omission. Diagnosis with cervical dysplasia (pre-cancerous lesions) is a different story, and should entail dragging the boyfriend in for treatment. Good patient info here from Rutgers.
posted by desuetude at 7:06 AM on May 24, 2005

Both of y'all get tested for the common STDs. Then s/he may find out that they have it too. This is both the honest way to go, and may change the "freak out" calculus entirely for your potential partner.
posted by BrandonAbell at 3:29 PM on May 24, 2005