Thanks and question about HPV (HPV, 2009)


Dr. Bob. I would like to thank you for being so compassive with all people that ask questions. I am a 49 year old man from Mexico City. I had several encounters with different ladies in a massage parlor. There was neither penetrative vaginal, anal or oral sex. The most I did was fingering one of these ladies. However, I developed a terrible fear of having got HIV. I started reading your forum and 97 days after the last encounter with these ladies and 5 months after the fingering I was tested for HIV 1 and 2 with a MEIA test. The result came out negative. I continued being very anxious, so I looked for psicotherapy and was put also on zoloft (50 mg every day). The Dr. diagnosed OCD. I continued reading your forum and gradually feeling better. However, an urologist recommended me to test for HPV because he said masturbation from an infected lady could transmit the HPV virus. I did it and unfortunately I got HPV 16, is that possible? I labeled all this with my wife, as you always suggest and thanks God she has been very supportive. I am 98% sure now that with these practices and the test after almost 14 weeks of the last encounter I could not get HIV, as you say no way, no how. Nonetheless I am worried about passing the HPV 16 to my wife. The urologist has suggested a treatment with interferon alpha, what do you think about that?. Is that chemotherapy? I fear possible side effects. Dr. Bob I want also to thank you because I know you are a great pianist. I wanted to play the piano since I was a kid. Nonetheless at that time there was not money at home and it was much more difficult to get a cheap keyboard. When I was in my twenties a friend told me that I could not play the piano because I was very old. At 48, one year ago, I decided to buy a keyboard and I started playing and guess what I can play at least simple things. I probably never will play Chopin or List but what I am playing makes me happy, so you have been also a great inspiration in that respect. Thanks a lot. Just a last question, for the remaining 2% doubt of HIV, can I definitely WOO HOO? Muchas gracias querido amigo Alex


Hi Alex,

Your negative HIV-1/2 test at five months is definitive and conclusive. So you can certainly WOO-HOO as far as HIV is concerned.

HPV, however, is another story. HPV is much easier to get than HIV. You can contract HPV merely with skin-to-skin contact. So it looks like it's BOO-HOO as far as HPV is concerned. However, between HIV and HPV, you certainly would rather have HPV! There are a number of effective treatments available depending on the severity and location of the genital warts. I'll reprint below some information from the archives that discusses HPV and its treatment.

Good luck Alex.

Dr. Bob

i ve already asked a question for HPV Jun 15, 2009

hello doctor,

please refer me somewhere else if its not right to be here: viral load : not exist CD4:375

well i am diagnosed positive there are 5 years old. good health though. my main problem are the genital warts inside my arse. is there any chance for people with HIV to get rid of HPV SYMPTOMS?

there is some treatment i am doing every 3 months but there still some.

i would like to get rid of them permantly. is there any chance?


 Response from Dr. Frascino 


Genital warts (from HPV) can be difficult to eradicate when the immune system is compromised. However, aggressive and persistent treatment by an HIV-knowledgeable colorectal surgeon is usually effective. I'll reprint below some information about HPV. I realize genital warts are a "pain in the ass" literally and figuratively, but I'd strongly recommend you continue your treatments. You could also consider a second opinion just to see if more aggressive treatment might be warranted.

Good luck.

Dr. Bob

Human Papillomavirus (HPV)

March 14, 2009

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.)

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. It is estimated that 50% of all sexually active people 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 areas. 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 anal cancer in men and women, or cervical cancer, or cancer of the penis.

Dysplasia around the anus is called anal intraepithelial neoplasia (AIN). Anal intraepithelial neoplasia is the development of new abnormal cells in the lining of the anus. Dysplasia in the cervical region is called cervical intraepithelial neoplasia (CIN). AIN or CIN appear to be more common in people with HIV infection than those who are HIV negative.

How Is HPV Detected?

Many people have HPV infections but don't know it. HPV can go away without causing any problems. To detect HPV, health care providers look first for the problems HPVs cause: dysplasia or genital warts. A Pap test (or smear) is used to check a woman's cervix. It can also be used to check the anus of men and women. They are smeared on a glass slide or mixed into liquid and examined under a microscope. The cells are examined for abnormalities that may indicate abnormal cell changes, such as dysplasia or cervical cancer.

In 2009 the FDA approved two tests that use the sample collected by a Pap test. These tests look for types of HPV that are linked to health problems.

Dysplasia can be detected by Pap smears.

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 HPVs. HPVs can be transmitted by direct contact with infected areas that aren't covered by a condom. 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.

A vaccine called Gardasil was approved in 2006. However, it has not been tested in or approved for people already infected with HPV. For more information on vaccination against HPV, see

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. However, 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 Other, less common treatments for warts include the drugs 5-FU (5-fluorouracil) and Interferon-alpha. 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.

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.