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Transmission of std
Feb 28, 2008

am being treated for anal warts (yuk). I am married and read that the virus could be transmitted to my wife if she masturbates me because the virus is present in precum. Is this true? Is normal vaginal intercourse a risk in transmitting the virus to my wife? Originally I understood that the virus could only be transmitted via direct skin contact with the infected area. Could you please enlighten me. Btw I am an australian and last week visited SFran for the first time. What a wonderful city. Regards Jim

Response from Dr. Frascino

G'day Jimbo,

I think somewhere along the way someone got their virus acronyms confused. The virus that causes anal warts is HPV (Human Papilloma Virus) and is indeed transmitted by direct skin-to-skin contact. This virus is not found in pre-cum or cum, for that matter. HIV (Human Immunodeficiency Virus), on the other hand, can be found in pre-cum, cum and other bodily fluids.

I'll reprint some information about HPV below.

Glad you enjoyed S.F. I love the land down under as well, except for that awful tasting vegemite stuff you chaps seem to be addicted to.

Be well.

Dr. Bob

HPV and HIV May 17, 2006

Hello, My boyfriend has HIV and I do not. We have protected vaginal sex daily and he performs oral sex on me regularly. I also perform oral sex on him, but only for a few minutes, and never to the point of ejaculation. We have also engaged in some light rimming. He has a good Infectious Disease Specialist. I get tested regularly for HIV.

Recently, after seeing a commercial on television that talked about the correlation between HPV and cervical cancer, he mentioned that his last two girlfriends (they were before he knew he had HIV, and they had unprotected sex) had abnormal cells that were scraped off/frozen from their cervices (sp?). Anyway, this kinda freaked me out. I have never noticed any lesions on him. He can't go in for an examination yet, because his health insurance is not in effect yet.

I have not noticed any lesions on myself, but thanks to our public school system sex education, we don't have any information on HPV. Thank God for that commercial.

1) Can we still have oral sex? 2) Can he be tested for HPV? 3) If I have it, will I have an outbreak? 4) Does this disease go away or will he/we have it for the rest of his/our lives? 5) If I have the cancerous type, and the abnormal cells are removed, am I contagious to him for reinfection? 6) Is [male condom] protected sex good enough if we don't see any lesions?

Response from Dr. Frascino

Hello,

The first step is to learn a bit more about HPV. I'll post an item from the archives below that addresses the basic facts about HPV. It addresses most of the specific questions you raise. The next step is to find out if your boyfriend has HPV or not. His HIV specialist will screen him. If you have additional questions after that, write back and I'll try to assist.

Be well. Stay well.

Dr. Bob

Human papillomavirus (HPV) February 22, 2006

What Is HPV?

How Is HPV Detected?

Can HPV Infection Be Prevented?

How Are HPV Infections Treated?

The Bottom Line

NOTE: In the U.S., counseling and referrals are available on a national human papillomavirus (HPV) hotline. Call toll-free at 877-HPV-5868 (877-478-5868). Hours are from 2 p.m. to 7 p.m. Eastern Standard Time Monday through Friday.

What Is HPV?

There are over 100 viruses known as human papilloma virus (HPV). They are common. One study found HPV in 77% of HIV-positive women. HPV is transmitted easily during sexual activity. In fact, it is estimated that 75% of all sexually active people between ages 15 and 49 get at least one type of HPV infection.

Some types of HPV cause common warts of the hands or feet. Infections of the hands and feet are usually not transmitted through sexual activity. Several types of HPV cause genital warts on the penis, vagina, and rectum. Those with HIV can get worse sores in the rectum and cervical area. HPV can also cause problems in the mouth or on the tongue or lips. Other types of HPV can cause abnormal cell growth known as dysplasia. Dysplasia can develop into cancers of the penis and anus, and cervical cancer in women.

Dysplasia around the anus is called anal intraepithelial neoplasia (AIN). The epithelium is the layer of cells that cover organs or openings in the body. Neoplasia means the new development of abnormal cells. Anal intraepithelial neoplasia is the new development of abnormal cells in the lining of the anus.

Dysplasia in the cervical region is called cervical intraepithelial neoplasia (CIN). One study found AIN or CIN in over 10% of HIV-positive men and women. Another study showed that women with HIV infection have a much higher rate of CIN than HIV-negative women.

How Is HPV Detected?

To detect HPV, health care providers look first for dysplasia or genital warts. Dysplasia can be detected by Pap smears. They are usually used to check a woman's cervix. They can also be used to check the anus in men and women. A swab is rubbed on the area being checked to pick up some cells. They are smeared on a glass slide and examined under a microscope.

A new HPV test called a reflex test is being used to follow up on Pap smear results that are not clear. It can indicate who needs more careful examination or treatment. The reflex test identifies which types of HPV are present and can indicate if aggressive treatment is needed.

Some researchers believe that anal and cervical smears should be checked each year for people with elevated risk:

People who have had receptive anal intercourse.

Women who have had cervical intraepithelial neoplasia (CIN).

Anyone with under 500 CD4 cells.

However, other researchers think that careful physical examination can detect as many cases of anal cancer as anal Pap testing.

Genital warts can appear anywhere from a few weeks to a few months after you are exposed to HPV. The warts might look like small bumps. Sometimes they are fleshy and look like small cauliflowers. They can get bigger over time. Your health care provider can usually tell if you have genital warts by looking at them. Sometimes a tool called an anoscope is used to look at the anal area. If necessary, a sample of the suspected wart will be cut off and examined under a microscope. This is called a biopsy.

Genital warts are not caused by the same HPV that causes cancer. However, if you have warts, you may have also been exposed to other types of HPV that could cause cancer. Can HPV Infection Be Prevented?

There is no easy way to tell if someone is infected with an HPV. People who don't have any signs or symptoms of HPV infection can transmit the infection.

Condoms do not totally prevent transmission of HPV. HPV can be transmitted from person to person by direct contact with infected areas that aren't covered by a condom. To get the best protection from condoms, use them every time. Put them on before any contact with a possibly infected area.

Men and women with HIV who are sexually active may want to have a regular Pap smear, anal and/or vaginal, to check for abnormal cells or early signs of warts. A positive result can be followed up to see if treatment is needed. Promising preventive vaccines against some HPV types are being developed.

How Are HPV Infections Treated?

There is no direct treatment for HPV infection. Some people "clear" an HPV infection (are "cured"). They can later be infected with HPV again. Dysplasias and warts can be removed. There are several ways to do this:

Burning them with an electric needle (electrocautery) or a laser.

Freezing them with liquid nitrogen.

Cutting them out.

Treating them with chemicals like Trichloroacetic Acid (TCA), Podophyllin or Podofilox. NOTE: Podophyllin and Podofilox should not be used by pregnant women.

Other, less common treatments for warts include the drugs 5-FU (5-fluorouracil) and Interferon-alpha. 5-FU is a cream. Interferon must be injected into the warts. A new drug, imiquimod (Aldara®), has been approved for treatment of genital warts. Cidofovir (Vistide®), originally developed to fight cytomegalovirus (CMV), might also help fight HPV. A new drug called HspE7 has shown benefits in early research.

HPV infection can last for a long time, especially in people who are HIV-positive. Dysplasia and warts can return. They should be treated as soon as they are found to reduce the chances of the problem spreading or returning.

The Bottom Line

Human papilloma viruses (HPV) are fairly common. Different types of HPV cause warts or abnormal cell growth (dysplasia) in or near the anus or cervix. This abnormal cell growth can result in cervical or anal cancer. Genital HPV infections are transmitted through sexual activity.

HPV infection can last a long time, especially in people with HIV.

A Pap smear can detect abnormal cell growth in the cervix. It can also be used to check the anus of men and women. Although Pap smears may be the best way to detect early cervical cancer, careful physical examination may be the best way to detect anal cancers.

The signs of HPV infection -- warts or dysplasia -- should be treated as soon as they show up. Otherwise, the problem could spread and be more likely to return after treatment. ________________________________________ Our thanks to AIDS InfoNet, which provided this article to The Body.



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