HPV, HIV Risks, and Vaccination for Gay Men

Cauliflower/HIV/AIDS

Hello, doctor.
I am a member of the LGBTQ+ community.
Eight years ago, I had genital warts, which were treated over six months, and I received three doses of the nine-valent HPV vaccine.
It has been eight years without a recurrence.
I would like to know what the chances of recurrence are.
Additionally, after receiving three doses of the nine-valent vaccine eight years ago, do I need to get vaccinated again? Eight years ago, I was also tested for HIV and the results were negative.
Should I get tested again? Lastly, my fixed partner and I are both HIV-negative; is there a risk of contracting HIV if we have unprotected sex once or twice?

John, 30~39 year old female. Ask Date: 2022/11/08

Dr. Liao Zhongxin reply Internal Medicine

A.
According to the data from the Centers for Disease Control (CDC), there are three main routes of HIV transmission: 1.
Sexual transmission: Engaging in oral, anal, or vaginal intercourse or other exchanges of bodily fluids with an HIV-infected individual carries a risk of infection.
2.
Blood transmission: (1) Receiving or coming into contact with blood or blood products contaminated with HIV.
(2) Sharing needles, syringes, or diluents with individuals who are injecting drug users and are HIV-positive.
(3) Receiving an organ transplant from an HIV-infected donor.
3.
Vertical transmission from mother to child: Infants can acquire HIV from their infected mothers during pregnancy, childbirth, or breastfeeding.
The latency period after HIV infection has two interpretations: 1.
Symptoms resembling a cold may appear approximately 2-6 weeks post-infection, indicating primary infection.
2.
The period from HIV infection to the onset of clinical symptoms generally lasts 5-10 years (currently referred to as the asymptomatic or subclinical phase).
However, as mentioned earlier, the progression of HIV infection can vary significantly.
During the window period or latency phase, many patients may be asymptomatic, which can lead to continued engagement in high-risk behaviors, creating gaps in HIV prevention and control.
B.
Regarding the efficacy duration of the HPV vaccine, current follow-up data on participants extends up to approximately 12 years, so it is not yet confirmed how long the protective effect of the HPV vaccine lasts.
The latest data indicates that "Cervarix" provides protection for at least 11 years, "Gardasil" (quadrivalent) offers protection for at least 12 years, and "Gardasil" (nine-valent) provides protection for at least 8 years, but long-term efficacy still requires ongoing observation to be determined.
C.
Regarding U=U (Undetectable = Untransmittable), further information can be referenced from the data provided by Kaohsiung Veterans General Hospital.

Reply Date: 2022/11/08

More Info

Understanding HPV, HIV Risks, and Vaccination for Gay Men
Hello! It's great that you're seeking information about HPV and HIV, especially as a member of the LGBTQ+ community. These are important topics that can significantly impact your health and well-being. Let's break down your questions one by one.

1. Recurrence of HPV (Warts): Since you mentioned that you had treatment for genital warts (caused by HPV) eight years ago and have been free of symptoms since then, it's important to note that while the risk of recurrence exists, it is generally low if you have been treated effectively. The immune system can often clear HPV infections over time, but some strains can remain dormant. Regular check-ups with your healthcare provider can help monitor any changes.

2. Need for Additional Vaccination: The nine-valent HPV vaccine (Gardasil 9) is designed to protect against the most common and high-risk types of HPV. After completing the three-dose series, you are considered protected against those strains for a significant period. Current guidelines do not recommend additional doses after the initial series unless there is new evidence of exposure or a change in your health status. However, it's always a good idea to discuss your vaccination status with your healthcare provider, especially if you have concerns.

3. HIV Testing: Since you were tested for HIV eight years ago and received a negative result, it is advisable to get retested, especially if you have had new sexual partners or engaged in behaviors that may increase your risk. The CDC recommends that sexually active individuals, particularly those with multiple partners or those in high-risk categories, get tested at least once a year. Regular testing is a key component of maintaining sexual health.

4. Risk of HIV with Unprotected Sex: If both you and your fixed partner are confirmed to be HIV-negative, the risk of transmission during unprotected sex is significantly reduced. However, it is not zero. Factors such as the presence of other sexually transmitted infections (STIs), the viral load of an HIV-positive partner (if applicable), and the type of sexual activity can influence the risk. Engaging in unprotected anal sex does carry a higher risk for HIV transmission compared to vaginal sex, so it's essential to weigh the risks and benefits carefully.

5. Prevention Strategies: To further reduce your risk of HIV and other STIs, consider the following strategies:
- Condom Use: Consistent and correct use of condoms is one of the most effective ways to prevent the transmission of HIV and other STIs.

- Regular Testing: As mentioned, regular testing for HIV and STIs is crucial, especially if you have new partners or engage in high-risk behaviors.

- Pre-Exposure Prophylaxis (PrEP): If you or your partner are at higher risk for HIV, discussing PrEP with your healthcare provider may be beneficial. PrEP is a medication taken by HIV-negative individuals to reduce the risk of contracting HIV.

- Vaccination: Continue to stay updated on vaccinations, including the HPV vaccine, which can help prevent certain types of cancers associated with HPV.

In conclusion, maintaining open communication with your partner about sexual health, regular check-ups, and preventive measures are key to ensuring your safety and well-being. If you have any further questions or concerns, don't hesitate to reach out to a healthcare professional who can provide personalized advice based on your specific situation. Stay informed and take care of your health!

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