HPV disclosure advice
January 10, 2015 4:15 PM   Subscribe

Hi, single hetero male here. YANMD, but I did correspond by email recently with my actual doctor about HPV disclosure. She told me that I do not need to disclose potential HPV exposure to any future partners. Does that sound right to the hive mind? I thought being an adult was all about having unsexy conversations about sex. More details below -

What I Know:

I know HPV is just one of those things that comes with being sexually active, and that most people get it at some point or another, and that often it comes and goes without causing harm or even symptoms. I also know it's all a kind of guessing game for men, since there's no test and you can't really know whether you've acquired it (unless it causes warts) or how long it takes for it to clear your system.

My situation:

From last summer through fall, I was seeing a woman who learned that she had HPV just before we were involved. She had a high-risk strain (though no colposcopy or anything at this point, not sure the extent of dysplasia), and she also had a low-risk strain that caused HPV.

She had a visible wart before we were intimate, and never again while we were dating, so never from June through October. I have never had any visible warts, though I gather you don't always see them.

What my doctor said:

My doctor said that I should not assume I have either strain of HPV and that I do not need to disclose the exposure to any future partner, unless and until I see an actual wart that needs to be treated.

My concern:

Do you agree with my doctor? I'm particularly interested in the opinions of women. There is, of course, part of me that would happily avoid having that conversation if consensus says disclosure is not necessary.

But there's a part of me that thinks, what if I have warts and don't know it and give it to someone? Or what if I have a higher-risk strain and pass that along? I feel like most people would want to know about this possibility beforehand.

posted by anonymous to Health & Fitness (35 answers total) 2 users marked this as a favorite
Speaking as a lady, I would prefer to be warned so I could make an informed decision. It sounds like there isn't much you can to do conclusively find out if you're infected or not, but I'd still like to know so that I could consider the risk.
posted by sciatrix at 4:23 PM on January 10, 2015 [8 favorites]

I think everyone's personal risk tolerance is different. Probably better to err on the side of telling too much, so that, as sciatrix said, we can make an informed decision. :)
posted by The Biggest Dreamer at 4:31 PM on January 10, 2015 [3 favorites]

I do not agree with your doctor at all. Especially if you may be able to transmit one of the high-risk strains (visible warts are not necessary to transmit). Please tell your partners about the possibility and let them act accordingly. I'm pretty appalled by your doctor's advice.

Data point: I'm a cis/hetero woman.
posted by quince at 4:32 PM on January 10, 2015 [4 favorites]

As I understand it, the high-risk strains don't cause warts - is she sure that what she had before you were intimate was a wart. Did you use protection? I know it doesn't protect 100% against warts because of surrounding skin but I think (IANAD) that it would protect from forms that affect the cervix.

I've had what I thought were genital warts but could have been skin tags, and the doctor told me I didn't need to disclose after they had been treated. Sexual health doctors see A LOT of HPV though, and I think they sometimes forget that not everyone is as blase as them about STIs!
posted by Dorothea_in_Rome at 4:35 PM on January 10, 2015

Tell. the. woman.
posted by harrietthespy at 4:37 PM on January 10, 2015 [2 favorites]

As a lady with HPV, I agree with your doctor. There is no need to disclose.

I just can't see how this conversation benefits anyone. You can't prevent HPV transmission 100% with a condom so the only risk mitigation the lady could take is to not have sex with you. You would have to then have a conversation about how HPV is not usually harmful and your lady friend might have it too already, so really having sex with you is not much of a risk to her at all, and then it gets all weird.

You would be having a difficult conversation about a very unlikely harm. I vote skip it. I'm fine with having HPV and care not one whit what I could have done differently. It's an occupational risk of having sex.
posted by crazycanuck at 4:43 PM on January 10, 2015 [12 favorites]

I am a lady. I would prefer to be warned but I also wouldn't hold it against you, or even think twice if you didn't warn me and I later found out this was your situation. Unlike, for example, if you had been exposed to just about any other std ever, where I would be very pissed you didn't tell me.

The reason I wouldn't mind in this case is because HPV is so prevalent that I pretty much assume everyone has it anyway.
posted by lollusc at 4:45 PM on January 10, 2015 [2 favorites]

HPV is what killed my mother. It caused throat cancer of all things (last on the list).

When I talked to my doctor about getting tested for a full battery of STDs (I'd been inactive for a while and was considering getting active again and thought a full bill of health might help seal the deal). He told me there was no test and I should just assume I had it and to not worry about it because it wasn't something to worry about.

From the above link: Most sexually active adults will have HPV at some time in their lives.

Read up, make an informed decision.

I don't think I would disclose, but because the conversation would be of little benefit if she's aware of how the disease works, and probably counterproductive if she's not.
posted by cjorgensen at 4:49 PM on January 10, 2015 [2 favorites]

I'm with crazycanuck and lollusc. I also think that disclosing this--especially in the "I mean, I probably don't! But she did, and so there's a slim chance that I might, and then you might..." kind of way that this would necessitate would make you come off as sort of a hypochondriac. You were exposed to something that's super common, that most people already have, and that you may or may not have actually gotten. That seems sort of over the top, to me.
posted by MeghanC at 4:57 PM on January 10, 2015 [3 favorites]

i'm on team MeghanC/lollusc/crazycanuck.

everyone can feel free to think i'm a shitty jerk but i had an irregular pap a while back* and while it often came up in conversation with people i was dating i did not make a point of disclosing it before the first sexual encounter because i don't bang anyone young or inexperienced enough to have not been exposed to HPV like 4000000000 times already.

i have a pussy and had sex with people with the same parts as me and different parts than me during this period.

that being said, be religious about condom use, and don't be one of those shitty penis-havers who think that it only matters during penetration and who randomly rubs your parts against your partner's parts without a barrier or asking for permission. WHY. WHY DO PEOPLE DO THAT.

*it seems to have been one of the strains/cases that clears itself out, i know nobody cares but i just wanna throw a tiny party here because WHEW. also so other people know it's Not Always A Huge Deal
posted by Juliet Banana at 5:21 PM on January 10, 2015 [11 favorites]

Disclose. Especially because HPV can cause more problems for women than men (cervical cancer most obviously, though as others have pointed out there's other risks). If nothing else, be religious about condoms when first becoming intimate and even mention this coversation ("My doctor said it wasn't a risk and that I probably didn't need to disclose, but that's not my decision to make, your health and opinions matter to me.") The individual lady can make her choice from there. After swooning, because that is one sexy sentence IMHO
posted by theweasel at 5:26 PM on January 10, 2015 [5 favorites]

I'm on team disclosure - even though the risk is small, and if it's not their first time or they never got vaccinated, they've probably been exposed.

I remember feeling slightly ticked off when a partner of mine disclosed after the deed that he knew he had oral herpes. It may not be a big deal, but if you know you have something, and we're all adult enough to be having sex in the first place, the knowledge is important even if the risk isn't so much.

HPV is more mysterious in that there's no way for you as a male to know if you have it, the body often sheds the virus over time, and not all strains are dangerous. In any case, I think it's responsible of you to disclose, and if I were the lady in question, I would greatly respect the guy's honesty.

PS - from personal experience, some [ignorant] people people may FLIP OUT if they find out you "kept something" from them (in my case, I found out I had something entirely curable *after* being intimate and alerted the relevant parties immediately), and maybe these same types would react badly and naively if you disclosed before any intimacy. But this is also a great way to filter out crazies, so good riddance!
posted by Drosera at 5:31 PM on January 10, 2015 [3 favorites]

I would want you to tell me -- I don't look like I'm immunocompromised but I am. The thing about other people's immune systems is that you can look and feel healthy, but because of other stuff, like a lupus flare their body might be more vulnerable at specific times.
posted by spunweb at 5:33 PM on January 10, 2015 [8 favorites]

I know this is a pretty controversial discussion, but I believe that people should be able to discern risk for themselves, and not have other people discern that risk for them. My personal comfort level in living with the inconvenience of something, even if the statistics seem to bear out that someone would get something anyway, is secondary to how other people feel about being exposed to something without having a say in it. Are there there people who would want to know about HPV so that they can make informed decisions? I think so (as I would). Perhaps that potential desire should be respected. If they don't care, a conversation about it shouldn't turn them off.
posted by SpacemanStix at 5:37 PM on January 10, 2015 [3 favorites]

From everything I've read in the last half hour you should just assume anyone you are having sex with has been exposed to HPV.
posted by cjorgensen at 5:41 PM on January 10, 2015 [3 favorites]

I think that's mostly right. There are really three types of people: People who have never had sex and don't have HPV, people who have had sex before and know they have been exposed to HPV, and people who have had sex before and have been exposed to HPV but don't know it.
posted by Justinian at 5:48 PM on January 10, 2015 [7 favorites]

I am a lady who had a high-risk strain of HPV that eventually led to (very) early-stage cervical cancer; I had a minor surgical procedure to remove the adenocarcinoma in situ and have at least temporarily cleared the HPV, but the situation has caused a good deal of ongoing stress and I will require close monitoring for recurrence the rest of my life.

That said, I don't think that disclosing here is an absolute must, for the reasons cjorgensen and others laid out. If a potential partner knows at all how HPV transmission works, she will know that the risk of cancer-causing HPV she is taking with you is not necessarily any higher than the risk with any other sexual partner whose HPV status is unknown (and the high-risk HPV status of any man is unknowable at this point since there is no test for it). If the potential partner doesn't know or can't understand how HPV transmission works, you would, as crazycanuck says, "having a very difficult conversation about a very unlikely harm."

I have no idea who gave me HPV, and it doesn't really matter. Every single one of the small handful of men I have ever had sex with could have given it to me, including the ones with whom I used a condom every time. I was pretty unlucky, and most people aren't; them's the breaks when you have sex with other people who have had sex with other people. If I were to divorce my husband and have sex with someone who disclosed exposure like you described above, I guess I would think it was cute? and unusually responsible? and good for you to try to do the right thing? but I really would not expect it since almost everyone who has ever had sex with another human who has had sex with another human has been exposed unknowingly to HPV at some point in the chain.
posted by My Top Secret Sock Puppet Account at 5:51 PM on January 10, 2015 [4 favorites]

For all practical purposes, everyone who is sexually active can be assumed to be carrying HPV. I have it, have never disclosed to partners, and don't have any particular feelings about that. HPV is spread independent of condom use (which is how I ended up with it; I've never had unprotected sex ever).

I mean, what would I even expect the outcome of such a disclosure to be? My partner irrationally refuses to have sex with me? When of course they have it, too, and so will their next partner?
posted by Sara C. at 6:12 PM on January 10, 2015 [2 favorites]

I don't care if "everybody has it," I'd want to know. If you carry a high risk cancer strain (or are likely to), I'd like to make the decision that you're so awesome I want to risk that, or that I'd rather not because I can't have sex with you without thinking about diseases, or whatever it is. I'd really rather not be unpleasantly surprised because "everyone has it, who cares." Some people do care.
posted by jenfullmoon at 6:41 PM on January 10, 2015 [8 favorites]

Unfortunately there is no real way to know if a man is carrying a high risk strain. Any man you meet may be carrying such a strain and men aren't tested for it.
posted by Justinian at 6:53 PM on January 10, 2015 [1 favorite]

People are allowed to be irrational in terms of their choice to not to have sex with you. I think if you consciously decide to avoid mentioning a health concern, even if it's one that you think is silly, it's a lie of omission, and if I found out I'd feel angry about the omission and offended that you made a decision about my boundaries re: risk assessment without taking my concerns seriously.
posted by spunweb at 7:24 PM on January 10, 2015 [4 favorites]

I agree with that. I'm just not sure people need to be irrational in terms of their disclosure requirements. But this is one of the few tough calls on disclosure issues, IMO. Usually it's pretty clear cut and erring on the side of disclosure is better.
posted by Justinian at 7:27 PM on January 10, 2015

Yeah, if it wasn't that he sounds like he'd been having sex with someone with two strains who'd had a recent outbreak I'd totally feel different.

Tbh the amount of pain and the length of outbreak I've heard are possible with lupus or fibro +herpes or hpv sounds pretty dreadful. It's one thing to say, meh the odds are he's got hpv but probably not a kind I've got to worry about, but it'd give me pause to be like oh, wait, your most recent ex had a recent outbreak while you guys were doing it.
posted by spunweb at 7:34 PM on January 10, 2015

My personal opinion is that one should disclose the following:
x. HIV
x. Hep B
x. bacterial infections like chlamydia, gonnohrea and syphilis (if for some bizarre reason you know you have it but haven't been treated. which would be baffling)
x. genital warts if you actually know you have them
x. whether you've had an outbreak of genital herpes

And I think that there is no pressing need to disclose the following:
x. oral herpes (unless you have a coldsore or feel like you are just about to get a coldsore)
x. exposure to strains of HPV.

My reasoning behind this is that these are two viruses where the stigma far outweighs the risks. Most people have been exposed to HSV1 (coldsores), however only some people actually get outbreaks. The chance of transmitting HSV without a sore is possible but unlikely.
Likewise, pretty much anyone sexually active has been exposed to HPV at some point. Many people will clear the virus over time. Others might be at risk for cervical cancer but this is usually detected in time with regular pap smears.

I think that disclosing these things as if they are worth disclosing just adds to the stigma and makes people needlessly fearful. The people who are going to lose out the most? The people who disclose unnecessarily. Meanwhile, millions of carriers of HSV and HPV are out having sex anyway.

However, I think that once you have the question in your head about whether you should disclose, you probably need to say something. Just try not to make it into a huge deal.

"Hey, my ex partner had a couple of abnormal pap smears caused by HPV, so there's a slight chance that I've been exposed to that. My doctor says that I'm probably fine and that pretty much everyone sexually active has been exposed to it at some point anyway, but I am fastidious about condoms just to be on the safe side."

(is fastidious the right word? hmm)

My rules for life are pretty much treat all blood and semen as if it could be infectious and assume that any sexual partner might carry HPV or HSV. That's working pretty well so far.
posted by kinddieserzeit at 9:24 PM on January 10, 2015 [3 favorites]

I am a woman. I consider it extremely unethical and immoral to take someone's choice away from them when it comes to any kind of STI/STD. In my opinion, people are entitled to feel protective regarding their own sexual health regardless of whether anyone else considers it irrational or hypochondriacal and every person has the right to make decisions with informed consent. It's not your choice, and it never will be. Respect her right to make her own decisions even if that means you have to keep your penis in your pants and move on.

Regardless of what other people are advising, consider that at least 5% of American women have persistent infections with high-risk strains of HPV that will go on to cause cancer. Disclosure is particularly important here because you know that a more dangerous strain of HPV could have been passed to you. Most men won't know if they have a high-risk strain, that's true. But guess what? You're not one of them. You know the chance you might have a high-risk strain is higher than normal. So don't ignore that.

Even though a potential partner may still choose to have sex with you, she needs to be aware of it both so that informed consent can happen and so that she can mention it to her doctor. Her doctor might advise her to get more frequent pap tests (instead of every three years), or to be co-tested (pap and HPV at the same time, usually only recommended for women over 30). But that can't happen if you're not honest and open with her.

Lastly, I hate when people act like their desire to get off is more important than their potential partner's right to informed consent. That's bullshit. Don't do it and don't buy into the shitty justifications other people use so they can rationalize away the fact that they didn't do the right thing. That's crap. Be a better person. You don't have to have a long conversation about it, I actually think kinddieserzeit's script is great even though I completely disagree with them about HPV and HSV-1 disclosure (especially since HSV-1 is fast replacing HSV-2 as an actual STD rather than just being an oral disease.)
posted by i feel possessed at 9:45 PM on January 10, 2015 [6 favorites]

Also, I think these kinds of statements are extremely troubling:

I just can't see how this conversation benefits anyone.


For all practical purposes, everyone who is sexually active can be assumed to be carrying HPV.


while it often came up in conversation with people i was dating i did not make a point of disclosing it before the first sexual encounter


I think that disclosing these things as if they are worth disclosing just adds to the stigma and makes people needlessly fearful. The people who are going to lose out the most? The people who disclose unnecessarily.

As though someone's wish not to be stigmatized or to have unimpeded sex trumps their partner's right to say no if they deem the risk unacceptable. Don't be like this. Taking away their ability to give informed consent is a really gross thing to do.
posted by i feel possessed at 10:17 PM on January 10, 2015 [9 favorites]

I'm a member of team shrug and move on, too -- there isn't a test for men, so all you can say is that you have had sex with someone who had it, but that doesn't say anything about whether or not you have it yourself.

I am sure that I've been exposed, just from the most basic of odds if nothing else, but there isn't really a meaningful conversation that can be had about that. I don't see something that is realistically discloseable here. If a test becomes available for men, then that would change things.
posted by Dip Flash at 10:42 PM on January 10, 2015

As though someone's wish not to be stigmatized

I actually wasn't saying that the OP shouldn't disclose in case he is stigmatized, but rather that I think that this kind of disclosure creates more problems because it creates a false sense of panic when someone knows that their partner has been potentially exposed to HPV, and a false sense of security when their partner doesn't know that they have been exposed.

Potential scenario: Let's say that a man has a female ex-partner who had abnormal pap smears. He starts dating another woman and before they have sex he says to her, "I'm pretty sure that I have been exposed to HPV. Let's use condoms to be safe." She hears "I have an STI", panics, doesn't have sex with him and they stop seeing each other. The man may or may not carry a strain of HPV.

This woman starts dating someone else. She asks him whether he is STI-free. He says that he was tested after his last partner and everything came back negative. She is relieved, has sex with him without a condom, and is not worried. That guy may or may not carry a strain of HPV.

I think that the OP does need to disclose because he is concerned about this and I think that he'll probably feel like he's hiding something if he doesn't.

However, I really think that the culture around sex need to change. People are better off just assuming that their partner has STIs unless a test proves otherwise, and in the case of HPV there is no test unless you are female and it has caused an abnormal pap smear.

This line of thinking isn't because I'm trying to justify my own behaviour in not disclosing (I have nothing to disclose - I've never had an abnormal pap smear or a genital wart), but rather that as a sexually active female-bodied person, I've had to learn about risks and how to protect myself. I'm super paranoid about STIs but I would be bemused if someone disclosed their potential HPV exposure to me.
posted by kinddieserzeit at 2:29 AM on January 11, 2015 [7 favorites]

Mod note: From the OP:
I really appreciate everyone's advice, both on the disclose and non-disclose front. It's a lot to think about.

What's I've realized is that, as a few people have pointed out, perhaps the fact that I'm asking the question means not disclosing it would feel like I'm hiding something.

To whit: I always assume people don't disclose the non-wart causing, i.e. high-risk strains. Frankly, I learned about my own exposure because of the low-risk, wart causing strain. That previous partner would've felt bad if she exposed me to something that shows up, i.e. the visible stigma of a wart. I would feel bad about that too, if I didn't disclose. There's an irony in there since a wart is far less serious than the possibility of cancer. So, best to disclose for both because that's where my conscience is orienting me.

Thanks for helping me see that! Feel free to keep telling me if I'm crazy though. Like I said, lots of comments here with lots to think about.
posted by taz (staff) at 3:03 AM on January 11, 2015 [2 favorites]

I would get a second opinion from another doctor. If you get the same advice then I'd consider yourself in the clear.
posted by whoaali at 10:47 AM on January 11, 2015

"I'm pretty sure that I have been exposed to HPV. Let's use condoms to be safe."

Not sure this is still really an answer to the OP's question, but also keep in mind that HPV is spread independent of condom use, which is why the vast majority of sexually active adults already carry it and are exposed to it with every new partner.

So there isn't really a conversation to be had about it in the way that there is with STIs one can actually protect oneself from (or STIs where the stakes are high enough that the choice not to have sex with the person would be a reasonable one). The only way not to be exposed to HPV is never to have sex. With anyone. Period.
posted by Sara C. at 11:01 AM on January 11, 2015 [2 favorites]

Yes, it's true that condoms don't provide complete protection but if I recall correctly, they provide something like 70% more protection from HPV and HSV than not using condoms at all. Apart from abstinence, they are the only chance of protection.

(Last comment from me, because I know this isn't supposed to turn into a back and forth, but I just wanted to clear that up.)
posted by kinddieserzeit at 3:36 PM on January 11, 2015

I still think it's bizarro world to assume the only reason someone would not be comfortable having sex with the OP in this situation is because they can't/won't understand the words he's using or they're in a panic. Or tbh, that's theres at all something unfair about their making a different risk assessment with another partner. Thats frankly not OP's business.

Sex isn't like cookies and dating's not snack time at play school; just because Timmy got some snack doesn't mean it's unfair that Joanie didn't. You also don't have to bring enough for the whole class, lol, which might be kind of a relief in terms of this metaphor.
posted by spunweb at 5:50 PM on January 11, 2015 [2 favorites]

One positive effect of disclosing could be to encourage your prospective partner to get the Gardasil shot, if she hasn't already. I don't know how old your partners are likely to be; officially 26 is the maximum age cutoff but a lot of doctors and clinics will administer it off-label afterwards. It is very effective protection against the most dangerous strains.
posted by en forme de poire at 8:55 PM on January 11, 2015

Data point: I was very glad when someone told me ahead of time that he thought he'd been exposed to a not particularly scary strain of HPV. It made me more, not less inclined to have sex with him, in that he valued my health and trusted me with a difficult conversation.
posted by tangerine at 10:48 PM on January 11, 2015 [1 favorite]

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