Fredo,

Hello from a new forum user and thanks for all the great work you are doing here! Like many of us, I am finding myself very frustrated by all of the contradictory information out there concerning HPV. I know that there are no definitive answers to many important questions, and I’m sure you’ve addressed some of my concerns many times in these forums, but I would greatly appreciate more clarity on the following:

1. Research suggests that most HPV infections “clear on their own” within 6-24 months from when they are acquired. Does this time period begin as soon as a person AQUIRES the virus, or only once the virus has become ACTIVE, after being dormant? Or is a long-dormant infection considered a “persistent infection”, active or not?

2. When we say that most HPV cases "clear on their own", what exactly is meant by "CLEAR"? Does it mean the virus is completely gone from the body or that it's just become latent? My understanding is that most cases vanish completely, while a small percentage stay latent and crop up again in the future when the immune system is compromised.

3. HPV can be contagious when active, even if there are no symptoms… but is it contagious even when it is dormant?

4. Once HPV is active, can it go back and forth between being active and dormant?

5. I’ve seen you mention in a forum that there are some types of HPV that are prone to staying in the body longer than others. Can you say which types these are?

Thank you so much for your time and keep up the good work!

A quick follow-up to my first post:

I was searching around the forums for more information and I came across this quote from you, Fredo:

"Most cases of HPV are cleared naturally by the immune system, 90% of cases by 24 months (and many much sooner). This is not proof the virus can then not be transmitted, but many experts believe the risks of transmission diminish over time in someone who has had no recurrences. Bottom line is you may not always have HPV."

WHAT??? Even if the virus is CLEARED, this is not proof that it can not THEN STILL be transmitted? How can something still be transmitted if has cleared the body? This is a perfect example of why I am so confused.

Please help!

Hi jreyn,

Thanks for your post and your questions, which get to the heart of what most everyone wants to know.

There is much about HPV that hasn't been answered, so much that we just don't know. What's clear is that in medical research studies (where subjects are followed over a length of time with HPV DNA tests), most of those who tested positive for HPV at the beginning will eventually test negative, about 90% at the 24-month mark. It isn't clear if this means the virus is totally gone, or if it's been suppressed by the immune system to a level that's undetectable.

So what might it mean if, say, the virus is still present in a latent, undetectable form? Well, that's one of the unknowns, but most of the experts I've worked with over the years don't think it's likely the virus will then cause issues way down the road (unless the immune system is compromised for some reason), and I'd say most of them believe the risks of transmitting the virus to a new partner probably diminish and might even become remote. This hasn't been proven for sure, though.

The reason for the uncertainty is that there just isn't much in transmission studies, say, where someone who had HPV at some point is now testing negative and is then followed into new relationships and the new partner is tested to show they're HPV negative and also followed to see if they then contract the same type.....etc etc...you see the problem! These studies would be incredibly difficult to design and execute over the years it would take to give us solid evidence. So, much of our discussion has to remain theoretical.

It seems kinda harsh to tell someone with an HPV diagnosis they should bring this up with ever single partner for the rest of their lives, even years after the last abnormal Pap test or episode of genital warts. The thing that's so very frustrating is there isn't a way to determine all this for sure, and I wish I have something better and more complete to offer.

I do hope this helps, though. Please post anytime you have questions.

Best,
Fredo

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ASHA Moderator

Fredo,

Thanks for the response and for the clarity. I must say that your answer took me by surprise. ASHA's own website has a link to a video for health care professionals about how to talk to their patients about HPV (http://www.ashastd.org/TalkAboutHPV/TalkAboutHPV.htm). In this video, it is stated that "Most sexually active couples share HPV until the immune system eliminates the virus" and that "When HPV infection goes away, the immune system remembers that HPV type..."

I don't think I'm being too critical here. Why on earth would ASHA instruct doctors to use language such as "goes away" and "eliminate" if in fact, there is no conclusive evidence that any HPV infection ever completely leaves the body?? Furthermore, everywhere I look, experts refer to HPV infections that DO remain an issue after two years as “persistent” infections, distinguishing them from ones that get "cleared". The implication has always seemed to be that if you acquire HPV, you have a 90% chance to clear it completely and a 10% chance of it remaining ANY issue after two years time. If this isn't really the case, then such language is very misleading, particularly since, as you've pointed out, Fredo, health care professionals usually err on the side of caution and are very conservative in their answers to patients whenever there is room for doubt!

I understand your need as a moderator here to err on the cautious side as well, but do you get the impression that MOST researchers "off the record" feel that transmission chances are remote after a negative DNA test? Finally, have there been any studies where an HPV-positive patient tests negative at the 24-month mark, then tests positive again in the future for the SAME type of HPV and WITHOUT further sexual contact?

Thanks again for your time and for fielding such tough questions!