Guidance for a male with HPV
May 6, 2013 3:48 PM Subscribe
I am a male with HPV. What are my responsibilities on disclosure to potential partners - when and how should I do it? What boundaries does this draw for me as far as what I should and should not do in the bedroom to keep my partners safe?
A few years ago, I was in a long-term relationship with a woman who ultimately asked me to stop using a condom, assuring me she was clean and telling me she was on the pill. About six months later, after noticing a very small (1-2mm) wart at the base of my penis, she tearfully confessed that she'd been diagnosed with HPV some years before, but thought it had cleared up.
Needless to say - kind of awful, and I broke up with her, but I guess not the worst thing in the world; HPV seems pretty common and usually harmless.
However, here I am a few years later, and the original wart is gone, but another one of the same size has appeared elsewhere on my penis. I find this a little annoying, since I was kind of hoping it'd clear like it often does, but I guess it's a thing I have to live with for now.
But: now I've met someone I like, and if I'm reading the situation correctly we will probably end up sleeping together. So I have a few questions:
(1) What are my responsibilities as far as disclosure here? I've read all kinds of things on the Internet ranging from "there's no reason to tell them" to "you must always disclose everything." To be perfectly honest, because of my past experience, I lean toward disclosure. But in that case - how do I bring this up? Right before it seems like we're going to have sex? I guess that's as good a time as any. If anyone has any experience or advice for that, it'd be great to hear.
(2) What can we do, and what should we avoid? There is the obvious one: I'm always going to wear a condom when having sex, of course. But - well, honestly I'm mostly wondering about oral sex. I've read the information that's been put about in the past few years that says that HPV might be responsible for a rise in cases of throat cancer. Because of that, I have kind of sadly given up on the idea of ever receiving a blowjob again.
A complication: as it stands I'm not about to give up giving oral sex; I really love going down on a woman, and since it's my own risk I feel like I'm taking on in doing so, I don't mind - I don't smoke, but I figure it's about like smoking a cigarette every time, since I'm pretty much just exposing myself to a low risk of throat cancer.
Is this a crazy way to look at it? Is oral sex safe enough that I'm just being paranoid? How in the world do you tell someone "hey, you can go ahead with that blowjob you were about to give me, but by the way you might get throat cancer"? Should I just avoid oral sex altogether? Or is this something I really shouldn't be fussing about?
Thanks in advance for any advice anyone can give me.
A few years ago, I was in a long-term relationship with a woman who ultimately asked me to stop using a condom, assuring me she was clean and telling me she was on the pill. About six months later, after noticing a very small (1-2mm) wart at the base of my penis, she tearfully confessed that she'd been diagnosed with HPV some years before, but thought it had cleared up.
Needless to say - kind of awful, and I broke up with her, but I guess not the worst thing in the world; HPV seems pretty common and usually harmless.
However, here I am a few years later, and the original wart is gone, but another one of the same size has appeared elsewhere on my penis. I find this a little annoying, since I was kind of hoping it'd clear like it often does, but I guess it's a thing I have to live with for now.
But: now I've met someone I like, and if I'm reading the situation correctly we will probably end up sleeping together. So I have a few questions:
(1) What are my responsibilities as far as disclosure here? I've read all kinds of things on the Internet ranging from "there's no reason to tell them" to "you must always disclose everything." To be perfectly honest, because of my past experience, I lean toward disclosure. But in that case - how do I bring this up? Right before it seems like we're going to have sex? I guess that's as good a time as any. If anyone has any experience or advice for that, it'd be great to hear.
(2) What can we do, and what should we avoid? There is the obvious one: I'm always going to wear a condom when having sex, of course. But - well, honestly I'm mostly wondering about oral sex. I've read the information that's been put about in the past few years that says that HPV might be responsible for a rise in cases of throat cancer. Because of that, I have kind of sadly given up on the idea of ever receiving a blowjob again.
A complication: as it stands I'm not about to give up giving oral sex; I really love going down on a woman, and since it's my own risk I feel like I'm taking on in doing so, I don't mind - I don't smoke, but I figure it's about like smoking a cigarette every time, since I'm pretty much just exposing myself to a low risk of throat cancer.
Is this a crazy way to look at it? Is oral sex safe enough that I'm just being paranoid? How in the world do you tell someone "hey, you can go ahead with that blowjob you were about to give me, but by the way you might get throat cancer"? Should I just avoid oral sex altogether? Or is this something I really shouldn't be fussing about?
Thanks in advance for any advice anyone can give me.
I would let your partners make their own choice on whether they want to give you unprotected oral sex, after you give full disclosure. Just let them know the ways that HPV can and can't be transmitted, and then it is out of your hands, unless you want to say no.
posted by cakebatter at 4:10 PM on May 6, 2013 [1 favorite]
posted by cakebatter at 4:10 PM on May 6, 2013 [1 favorite]
The strains of HPV that cause warts are not the same ones that cause cancer. It's possible to have more than one strain at the same time. So you having warts or not tells you nothing about whether or not you have any of the strains that cause cancer, and right now, as far as I know, there's no test for those strains in widespread medical use for men.
But in that case - how do I bring this up? Right before it seems like we're going to have sex?
Right before like the clothes are coming off and the condoms are coming out? That seems way late and a bad time, and it seems like it could lead to problems. I feel like most people don't do well with hearing surprising new information right on the spot like that, and even if it seems fine at first, the person could get really angry later, feeling like you put them in a bad position even if that's not totally fair.
I'd say when it's clear you both like each other, it would be best to bring it up at a non-sex time. Maybe send this person an email telling them you really like them, and giving them just the facts about the HPV in a brief, frank, and unemotional way.
posted by cairdeas at 4:17 PM on May 6, 2013 [4 favorites]
But in that case - how do I bring this up? Right before it seems like we're going to have sex?
Right before like the clothes are coming off and the condoms are coming out? That seems way late and a bad time, and it seems like it could lead to problems. I feel like most people don't do well with hearing surprising new information right on the spot like that, and even if it seems fine at first, the person could get really angry later, feeling like you put them in a bad position even if that's not totally fair.
I'd say when it's clear you both like each other, it would be best to bring it up at a non-sex time. Maybe send this person an email telling them you really like them, and giving them just the facts about the HPV in a brief, frank, and unemotional way.
posted by cairdeas at 4:17 PM on May 6, 2013 [4 favorites]
Directly from the Centers for Disease Control: "The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers."
There are also over 40 kinds of HPV, not all cause cancer. Get your info from the CDC or other more medical sources.
Tell them ahead of time, not during any sexual activity, but get your strain of HPV figured out so you are telling them correct information, and you should always encourage safe sex and yourself and parters to get regular exams.
posted by Crystalinne at 4:26 PM on May 6, 2013 [2 favorites]
There are also over 40 kinds of HPV, not all cause cancer. Get your info from the CDC or other more medical sources.
Tell them ahead of time, not during any sexual activity, but get your strain of HPV figured out so you are telling them correct information, and you should always encourage safe sex and yourself and parters to get regular exams.
posted by Crystalinne at 4:26 PM on May 6, 2013 [2 favorites]
If you are worried about getting cancer or transmitting a cancer-causing strain of HPV, look into getting the vaccine. Talk to your doctor to be sure, but I believe you will still be eligible despite having had one strain of HPV. Since there are multiple strains, my understanding is that it will still protect you against the ones you do not have.
But also, note that most cases of mouth and throat cancer aren't caused by HPV. Smoking is a much bigger risk factor than occasional oral sex. This doesn't mean "never disclose" or whatever (though honestly I think it's forgivable if you don't always disclose) but it does mean "worry less."
posted by Now there are two. There are two _______. at 4:40 PM on May 6, 2013
But also, note that most cases of mouth and throat cancer aren't caused by HPV. Smoking is a much bigger risk factor than occasional oral sex. This doesn't mean "never disclose" or whatever (though honestly I think it's forgivable if you don't always disclose) but it does mean "worry less."
posted by Now there are two. There are two _______. at 4:40 PM on May 6, 2013
I would also encourage your partner to become vaccinated. Gardasil protects against 90% of genital wart strains.
As for disclosure, I was diagnosed with the high risk cancer causing strain and disclosed to my partner before things reached that point. Turns out that he had the wart causing strain and we had to wait another month for things to heal from his recent removal. There's a risk, certainly, but the extra month confirmed the strength of our feelings for each other and changed the equation from 'wow, i really want to be with this person, but [x] might happen' to 'hot damn, i finally get to bang this awesome guy.' Condoms will not fully protect you from transmitting HPV, but condoms plus the vaccination helps the odds against what has become such a prevalent infection.
MeMail me if you have any other questions.
posted by icaicaer at 5:08 PM on May 6, 2013 [2 favorites]
As for disclosure, I was diagnosed with the high risk cancer causing strain and disclosed to my partner before things reached that point. Turns out that he had the wart causing strain and we had to wait another month for things to heal from his recent removal. There's a risk, certainly, but the extra month confirmed the strength of our feelings for each other and changed the equation from 'wow, i really want to be with this person, but [x] might happen' to 'hot damn, i finally get to bang this awesome guy.' Condoms will not fully protect you from transmitting HPV, but condoms plus the vaccination helps the odds against what has become such a prevalent infection.
MeMail me if you have any other questions.
posted by icaicaer at 5:08 PM on May 6, 2013 [2 favorites]
Important piece of advice: people who have an STI or STD are not dirty or unclean. Please do not use those terms to describe yourself or the partner from whom you contracted HPV. It is an important thing to do so as not to increase the already harsh stigma against those with various STIs. Thanks.
posted by These Birds of a Feather at 7:13 PM on May 6, 2013 [7 favorites]
posted by These Birds of a Feather at 7:13 PM on May 6, 2013 [7 favorites]
This is such a complicated issue. I really admire that you're thinking in a nuanced and responsible way about this.
The great majority of people will contract HPV at some point in their lives and condoms are not a guaranteed protection because the virus can be present on parts of skin not covered by the condom.
There's not really a good test for the infection.
There are dozens of kinds of HPV. The vaccine targets 4 of these types, 2 types that cause about 70% of all cervical cancer, and 2 types that are the main causes of genital warts. It is true that the kinds that cause warts are not associated with cancer. It's also true you can have multiple types at once.
Some experts estimate that 50 percent of sexually active people are exposed to HPV at some point. But others are convinced that as much as 70 percent or even all sexually active adults have been infected by HPV because there are so many types, and in most cases the infection is transient, coming and going. Your ex probably was told or genuinely believed she had "cleared" the infection because that is a common scenario.
If I was your potential sexual partner, I would probably want to know in advance. I'd want to use condoms and get the vaccine. But I'm not sure that's a totally rational response. It's more like, it would increase trust if I knew my partner was sharing that information with me.
I don't think you have to write off oral sex, I think you should just discuss this with your partners. It's a bummer, but it's not the end of a fun sex life.
posted by latkes at 7:22 PM on May 6, 2013
The great majority of people will contract HPV at some point in their lives and condoms are not a guaranteed protection because the virus can be present on parts of skin not covered by the condom.
There's not really a good test for the infection.
There are dozens of kinds of HPV. The vaccine targets 4 of these types, 2 types that cause about 70% of all cervical cancer, and 2 types that are the main causes of genital warts. It is true that the kinds that cause warts are not associated with cancer. It's also true you can have multiple types at once.
Some experts estimate that 50 percent of sexually active people are exposed to HPV at some point. But others are convinced that as much as 70 percent or even all sexually active adults have been infected by HPV because there are so many types, and in most cases the infection is transient, coming and going. Your ex probably was told or genuinely believed she had "cleared" the infection because that is a common scenario.
If I was your potential sexual partner, I would probably want to know in advance. I'd want to use condoms and get the vaccine. But I'm not sure that's a totally rational response. It's more like, it would increase trust if I knew my partner was sharing that information with me.
I don't think you have to write off oral sex, I think you should just discuss this with your partners. It's a bummer, but it's not the end of a fun sex life.
posted by latkes at 7:22 PM on May 6, 2013
Gardasil protects against 90% of genital wart strains.
Unfortunately, this isn't true. Not to say you shouldn't get the vaccine or recommend that your partners do, but be realistic about it too.
posted by latkes at 7:27 PM on May 6, 2013
Unfortunately, this isn't true. Not to say you shouldn't get the vaccine or recommend that your partners do, but be realistic about it too.
posted by latkes at 7:27 PM on May 6, 2013
Wait, have you tested positive for HPV, or are you basing your diagnosis solely on the wart you've seen?
posted by These Birds of a Feather at 7:57 PM on May 6, 2013
posted by These Birds of a Feather at 7:57 PM on May 6, 2013
Gardasil protects against 90% of genital wart strains.
Unfortunately, this isn't true. Not to say you shouldn't get the vaccine or recommend that your partners do, but be realistic about it too.
IANAD and I'm not sure how the author of that Discover blog post is drawing her conclusions, but I don't think her interpretation of the NEJM study is fair from a cursory read of the article and abstract (available at http://www.nejm.org/doi/full/10.1056/NEJMoa0909537). While the supplementary appendix (http://www.nejm.org/doi/suppl/10.1056/NEJMoa0909537/suppl_file/nejmoa0909537_appendix.pdf) describing the exclusions she's discussing is a bit confusing (so much for my "cursory" read), this still looks like good research to me and pretty significant evidence of good efficacy. Many of the subjects that she notes were excluded to show 90% efficacy in the per-protocol population were excluded because they tested positive for a strain of HPV before receiving the full set of vaccinations. That's specifically what the per-protocol population is designed to allow you to examine: how effective is the vaccine (which is marketed as a vaccine, not a treatment) in preventing HPV-negative individuals from contracting HPV when given as instructed. They also present data from an intent-to-treat population which includes both HPV-positive and HPV-negative individuals and the evidence of efficacy still looks pretty strong in that group to me. 90% effective against genital warts may be an idealized figure that is unlikely to be reached in real world situations, but I strongly disagree with the Discover author's conclusion that "When the real-world analysis was conducted, the numbers plunged—right down to plum nothing." Can anyone else determine how she is drawing that conclusion?
posted by holympus at 2:16 PM on May 7, 2013
Unfortunately, this isn't true. Not to say you shouldn't get the vaccine or recommend that your partners do, but be realistic about it too.
IANAD and I'm not sure how the author of that Discover blog post is drawing her conclusions, but I don't think her interpretation of the NEJM study is fair from a cursory read of the article and abstract (available at http://www.nejm.org/doi/full/10.1056/NEJMoa0909537). While the supplementary appendix (http://www.nejm.org/doi/suppl/10.1056/NEJMoa0909537/suppl_file/nejmoa0909537_appendix.pdf) describing the exclusions she's discussing is a bit confusing (so much for my "cursory" read), this still looks like good research to me and pretty significant evidence of good efficacy. Many of the subjects that she notes were excluded to show 90% efficacy in the per-protocol population were excluded because they tested positive for a strain of HPV before receiving the full set of vaccinations. That's specifically what the per-protocol population is designed to allow you to examine: how effective is the vaccine (which is marketed as a vaccine, not a treatment) in preventing HPV-negative individuals from contracting HPV when given as instructed. They also present data from an intent-to-treat population which includes both HPV-positive and HPV-negative individuals and the evidence of efficacy still looks pretty strong in that group to me. 90% effective against genital warts may be an idealized figure that is unlikely to be reached in real world situations, but I strongly disagree with the Discover author's conclusion that "When the real-world analysis was conducted, the numbers plunged—right down to plum nothing." Can anyone else determine how she is drawing that conclusion?
posted by holympus at 2:16 PM on May 7, 2013
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Umm, you know you can receive oral sex with a condom - aka the covered blow job - right?
posted by DarlingBri at 3:58 PM on May 6, 2013 [3 favorites]