I am on vacation for another week. But I've invited Dr. Lori Brotto to handle the Savage Love Letters of the Day. Dr. Lori Brotto is a clinical psychologist and sex researcher at the University of British Columbia in Vancouver. You can follow her on twitter @DrLoriBrotto, take part in her studies here and hear her chat about cultivating sexual satisfaction here. Dr. Brotto will be answering your questions all week.
I just got a call from my Dr. that I tested positive for HPV. I know that pretty much everyone has a strain of this and it’s not a huge deal. She said there was nothing to worry about because it wasn’t one of the cancer causing strains and that there was nothing to be done except to check it again in 6 months or a year. The dilemma is that I am 45 years old, married and monogamous with the same guy for the past 16 years. Prior to that I was with one guy for 7 years. I did have other partners before that, when I was in my teens.
I totally trust my husband’s response that he hasn’t been with anyone else. He’s a good guy and I can’t imagine he’d lie to me about this. And I think he’d also trust me to be reasonable about any infidelity that might have occurred.
However, I’m confused as to why my test turned up positive? From all that I’ve read it seems that if I was infected 25 years ago my body would have rid itself of the virus by now unless it was one of the bad strains, which would then be causing pre-cancerous lesions. I’ve had a PAP every year since I was about 18, and this is the first non-regular result. My Dr. did say that they have new PAP screening guidelines, so a lot more cases are showing up.
A lot of the online literature seems unclear/contradictory. I’m very healthy, don’t smoke, but I am going through some stuff related to long-term anxiety and stress that is finally being dealt with. Could something like that cause me to be so immune compromised that my body wouldn’t repress the virus? Also, as for sex, now what? Am I contagious in a way that is going to be a problem for my husband? I assume he also is infected but will there be a back and forth situation? I don’t seem to have any noticeable warts or any symptoms at all. But I’m feeling a little contaminated.
I just don’t know what to think about all of this so any insight would be really helpful.
No Clever Acronym
PS - I am definitely going to get my son vaccinated for this in a few years, when he’s old enough!
Dr. Brotto's response after the jump...
Even if you have been living in a cardboard box for the past decade, I am sure you have heard chatter about HPV, or Human Papillomavirus – a sexually transmitted infection that has been around for nearly a century. If your genitals have come into contact with those of another person, there is a high chance that you have been exposed to one of the over 40 different strains of HPV. Being a carrier of HPV does not mean you’ve been sexually reckless since if we were to test for the virus among your circle of friends, about 8/10 would also screen positive for HPV, even though most would not show symptoms, warts, or other signs of infection. Since 2006, the first vaccine against HPV has been approved and available in the US, Canada (where I’m writing to you from) and around the world. There are now two different HPV vaccines to choose from (Gardasil and Cervarix) and they are given typically in 3 shots over a 6 month period—ideally before someone has had their first romp and been exposed to the virus, as early as 9 years old. These vaccines protect against some of the HPV strains that will cause cervical cancer in women (types 16 and 18). Gardasil also protects against strains 6 and 11, which are usually the cause of genital warts. Gardasil is also approved for boys aged 9-26 since HPV can be transmitted between partners, and some strains cause cancers of the penis, anus, and oral cavity.
Your dilemma, NCA, is that you’ve just found out about having HPV. Let’s assume that, indeed, you and your partner have been exclusively sexually monogamous since you first hooked up 16 years ago (by the way, penile-vaginal intercourse is not the only way to transmit the virus), it is most likely that one of you (and possibly both) had the virus from a previous lover and what you have is not a new infection. So why would your test turn up positive now? Pap tests, which have been around for many decades, do not test for HPV, but for abnormal cells that might lead to cervical cancer. Currently, women can have the HPV co-test with their Pap smear, which is the best way of knowing if you are a carrier of the virus, but the co-test is not routinely done during a pap screen, unless that test came back with abnormal findings. Also, keep in mind that HPV testing is only sensitive to the cancer-causing strains of HPV, and not all of them. Since most people “clear” the virus (in other words, the body is able to fight it off), it may be that you and your partner have been passing it back and forth to each other in between periods of “clearing” it. And, though most people do clear the virus, age is not on your side as this ability lessens over time.
NCA, you ask whether your current stress may be compromising your body’s ability to clear the virus. Research out of Harvard Medical School shows that everyday stressors can lessen your ability to clear the virus, so this may be contributing in your case. For sanity’s sake, try to reel in that stress and there are plenty of drug-free ways to do that!
Ok, let’s get to sex and your real question. Is there sex after HPV? Of course there is! You’ve been doing the deed fret-free for years while probably carrying HPV (or transmitting it back and forth to your partner). Anxiety over your new knowledge will likely do more damage than the virus itself.
According to gynaecologic oncologist and HPV expert, Dr. Jessica McAlpine (from University of British Columbia), the best proactive action you (and your partner) could take is to get the HPV vaccine NOW. Even though the vaccine will not have the same protective benefits as it would in the sex naïve pre-teen, having the vaccine will improve your ability to fight HPV and reduce the chance of swapping it with your partner. Plus, the vaccine will lower the risk of HPV-related problems in many of your woman-parts (cervix, vagina, and vulva). Unfortunately, you’ll need to shell out your own cash for this as the vaccine is not covered by insurance plans for this type of situation.
Now here is my advocacy pitch. Readers: stop stigmatizing those with HPV, and push our school sex education programs to enforce these vaccination programs. Vaccinate your boys early (and don't pretend that your son is waiting until prom night). And for Christ’s sake, turn off Katie Couric!