HPV Transmission: Can You Get It Even with Safe Sex?

Some questions regarding HPV positivity: Is it because of unprotected sex that one contracts HPV?

Hello Doctor,
1.
I would like to ask what HPV infection actually means.
Does it refer to the presence of the HPV virus in a person's bloodstream, or is it similar to warts, where HPV targets a specific area? If I avoid touching that area, will I never be infected? For example, is it safe to kiss, hold hands, or share food with someone who has HPV?
2.
Currently, my HPV test result is positive with a viral load of 56.
Is it possible to determine whether the HPV is located in the vulvar area or in a specific part of the cervix? Or can I only know that this person is HPV positive without knowing the exact location? Just like how warts can be treated by freezing, burning, or excising the specific area, is HPV treated in a similar manner?
3.
Is HPV only transmitted through unprotected sex? My partner insists that she has always practiced safe sex with every partner.
If that’s the case, why did she test positive for HPV? Excluding low-probability scenarios like vertical transmission or rare cases, is it true that HPV can only be contracted through unprotected sex? (Can oral sex transmit HPV?) I visited two other clinics, and they said that even though my girlfriend is HPV positive, I can continue having sexual relations with her as long as I use condoms.
If my girlfriend claims that she has always engaged in safe sex, how did she contract HPV? (I maintain a clean lifestyle and have never engaged in casual sex or one-night stands.) If using condoms still carries a risk of contracting HPV, why do doctors not recommend waiting for the HPV to clear before resuming sexual activity, but instead suggest that using condoms is sufficient?
4.
If the HPV test shows a high viral load, but my girlfriend states that her last sexual encounter was six years ago and she has been celibate for over a year, does this mean that the HPV cannot clear from her body on its own? Or could she have been unfaithful?
5.
To be honest, I am uncertain about committing to one person for life, and I do not want to take on the risk of contracting HPV, especially since there is currently no cure and only a limited vaccine (which covers only nine types, while she has a type outside of those nine).
I worry that if we break up, I might transmit this virus to my next beloved partner, and I do not want to make someone I care about sick.

Niming, 20~29 year old female. Ask Date: 2023/08/24

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the human papillomavirus (HPV) is primarily transmitted through sexual contact.
Infection occurs during sexual activity through contact with skin, mucous membranes, or bodily fluids, and condoms can largely prevent this mode of transmission.
Additionally, contact with objects that carry HPV can also lead to infection of the external genitalia.
Since the virus is not visibly detectable, it is difficult to determine the exact time and location of transmission, and the specific sites of infection within the body cannot be completely confirmed.
Therefore, your concerns may not have definitive answers.
It is advisable to follow the recommendations of your treating physician and to have regular follow-ups.
Thank you! Wishing you safety and health, Dr.
Zhang.

Reply Date: 2023/08/24

More Info

Understanding HPV Transmission: Can You Get It Even with Safe Sex?
Human Papillomavirus (HPV) is a complex and often misunderstood virus, particularly regarding its transmission and the implications for sexual health. Let's break down your questions and concerns about HPV transmission, safe sex practices, and the overall management of HPV.

1. Nature of HPV Infection: HPV is primarily a skin-to-skin contact virus, meaning it can be transmitted through direct contact with an infected area, such as genital warts (also known as condyloma or "菜花"). It does not circulate in the blood like some other viruses. Therefore, if a person has HPV on their genital area, touching that area or engaging in sexual activities that involve contact with that area can lead to transmission. Activities like kissing, hand-holding, or sharing food do not pose a risk for HPV transmission, as the virus requires direct contact with infected skin or mucous membranes.

2. HPV Testing and Location: HPV tests typically indicate whether the virus is present but do not specify the exact location of the infection. For women, HPV testing is often done via cervical samples, which can indicate whether the virus is present in the cervix. However, it does not confirm whether the virus is also present in the vulva or other areas. If a person has visible warts, treatment is usually localized to those areas, but the presence of HPV can still exist in other areas that are not being treated.

3. Transmission and Safe Sex: While using condoms significantly reduces the risk of HPV transmission, it does not eliminate it entirely. This is because HPV can be present on skin areas not covered by a condom. Therefore, even with consistent condom use, there is still a possibility of transmission. Oral sex can also transmit HPV, which is why it is important to consider all forms of sexual activity when assessing risk. The notion that HPV can only be transmitted without a condom is a misconception; while the risk is lower with condom use, it is not zero.

4. HPV Persistence: If your partner has a high viral load of HPV and has not had sexual contact for a significant period, it could indicate that the virus is persistent. HPV can remain dormant in the body for years, and some strains are more likely to cause long-term infections. It is also possible that your partner may have had contact with someone else who had HPV, leading to the current situation. Open communication with your partner about sexual history and health is crucial.

5. Concerns About Future Relationships: Your concerns about transmitting HPV to future partners are valid. While there is currently no cure for HPV, many infections resolve on their own, and vaccines can protect against the most common high-risk types. If you are in a relationship where HPV is a concern, discussing vaccination options and regular screenings with your partner can help manage risks. If you decide to end the relationship, it is essential to inform future partners about your HPV status, as transparency is key in maintaining healthy sexual relationships.

In conclusion, while safe sex practices, including the use of condoms, significantly reduce the risk of HPV transmission, they do not eliminate it entirely. Understanding the nature of HPV, its transmission routes, and the importance of communication with partners can help you navigate your sexual health more effectively. Regular screenings and vaccinations are also essential components of managing HPV risk. If you have further concerns, consulting with a healthcare provider who specializes in sexual health can provide personalized guidance and support.

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