HPV Reinfection

HPV is a skin disease that to establish infection must infect the basal layer. It enters through minor trauma and can infect cells in the cervix, vagina, anus, etc., but won't necessarily infect all cells in all these places. For that reason, you can spread the infection from one spot to another via yourself or your infected partner.

For example, if you don't already have an infection in your anus, having anal sex with an infected partner would increase your odds of spreading HPV to that spot (although it can also migrate there from HPV that's active in your vulva or vagina). Would you consider this new anal HPV infection "reinfection"? I don't think it's exactly reinfection, I think it's just spreading the infection to a new place.

Here is a partner transmission study posted on the CDC website that describes how HPV is spread from partner to partner at multiple sites. There were a lot of instances of the man spreading it himself from penis to scrotum to hand to penis, etc. Bottom line, if you have an active HPV infection, don't scratch!

http://www.cdc.gov/eid/content/14/6/888.htm

I read another study that said that women who use tampons have much less chance of clearing HPV than women who don't. The researchers speculated that the tampons spread the HPV in the vagina. I also wonder whether the act of sex itself could cause the HPV to better establish itself while the infection is active -- just because of the trauma and rubbing.

As long as we haven't developed immunity to the virus, we're susceptible to getting HPV in new places. And, each spot where HPV establishes itself in the basal layer is a potential spot for dysplasia to develop in the future, so it seems to me there would be some value in trying to limit the spread of the infection while it's active in your body (if at all possible).

Now, maybe there is so much viral load during an active infection that it's not possible to limit the extent of the initial infection and maybe a woman has so much viral load that her partner's active infection doesn't really change the course of her own infection.

But, there are at least two research papers that indicate that limiting exposure to a partner's active infection might also help a person clear their own infection. There are the studies by Bleeker that indicate that using condoms can help speed clearance of lesions if couples share the same virus type. His theory is that limiting exposure to a partner's infection limits viral load and helps people clear their own infections.
http://www.ncbi.nlm.nih.gov/pubmed/14566832
http://www.ncbi.nlm.nih.gov/pubmed/14566831?ordinalpos=1&itool=EntrezSystem 2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery _RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

There is also the attached study on genital warts that concludes that continued sex between infected couples hampered effectiveness of treatment. This study suggested couples should stop having sex until the warts of both partners were fully eradicated.

http://dermatology.cdlib.org/134/original/cryo/rasi.html

Joel Palefsky, in his book on HPV and Abnormal Pap Smears also suggests that couples use condoms until any active HPV lesions in both partners have been cleared for three months because "it's common sense." He's an infectious disease expert and does research studies on HPV.

Once we've cleared or suppressed the virus by developing immunity, we don't really know how long this natural immunity lasts and whether it would be protective against a new exposure of the same strain from a new partner or the same partner in the future.

About 1/2 of people never develop detectable antibodies, so antibodies from natural infection aren't nearly the level of antibodies from the Gardasil vaccine. The latest research I read suggests that antibodies don't prevent future infection of the same virus type, but an earlier study suggests that they do. It's hard for researchers to tell what's really going on, since they can't distinguish a new infection from a reactivation of an existing infection.

Also, researchers say that it's possible that immunity is not always humoral (meaning it does not always happen at a system level via antibodies), but is cell-mediated, meaning immunity occurs locally in the cells. Still, researchers don't really know if natural immunity is protective against future infections of the same strain or for how long. Without immunity, there's nothing to prevent additional infection in new places from the same strain of HPV.

We do know that people can get multiple variants of the same strain. For example, when we look at biopsies of dysplasia, we can find two different variants of HPV16 in the same tissue sample indicating that infection with one HPV16 variant didn't prevent a second HPV16 infection with a different variant. So, just because you have HPV16 from one partner, doesn't mean you couldn't get another HPV16 variant from another partner.

I don't know whether it's realistic to worry about a second HPV16 infection, because maybe the odds are low of this happening. I've also wondered whether Gardasil would prevent this second infection, even though it won't clear an existing HPV infection from the basal layer.

During a LEEP or cone procedure, the dysplasia is removed along with the HPV infection that's in the basal layer at the point of the excision. When dysplasia appears to "recur" on the cervix, I've read two research papers that speculate this could occur because of:
1. Not all the HPV was removed from the cervix
2. HPV migrated from vagina or vulva up to the cervix or
3. There was additional HPV infection from an infected partner.

I personally think ongoing sex during an active HPV infection with lesions is a bad idea. I also think, though, that reactivation (virus in some cells going from dormant to active) is probably more likely due to hormonal changes or stress rather than sex with the partner (unless the partner's virus suddenly reactivated at a time when natural immunity in the woman had waned, making her susceptible again). Also, I haven't seen studies on how often "reactivation" occurs and whether this is common or rare. Again, that's because researchers can't really tell when an infection is new versus a recurrence, and they're working on better diagnostics so that they can make that distinction.

Sorry this is so long! I didn't know what people would be interested in versus not. Also, with research, nothing is very definitive, so I think it's really valid to look at all the data and form your own conclusions.

By mikona
Posted August 11, 2008 at 5:44 am
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Thank you so much for posting that Corellin. My gut feeling was that having sex again with my partner was a bad idea. I guess you somewhat confirmed that! I also had strange feeling about my boyfriend, who about 5 months ago had a really weird outbreak of warts on his hand that went away after a few days (before I new I had HPV). Although I never said anything to him, at the back of my mind I thought it was something to do with HPV.
Thanks heaps!!

By flowershoplady
Posted August 11, 2008 at 9:37 am
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thank you, corellin. i've read through this once....and now definitely need to read again (and again?). this is great information, and helps makes many situations more understandable and make 'sense'.

By taylor1
Posted August 11, 2008 at 10:14 am
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dear corellin:

Thank you for posting that great link. I agree with flowershoplady on reading these info again and again.

Thanks again dear,
lots of hugs xoxo

By GormCanor
Posted August 11, 2008 at 11:36 am
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I'm no expert. But I've reading the research too. There is an argument that, due to the latency (or dormant period) to which HPV is prone, 'reinfection' is likely.

When individual cells become susceptible, due to injury from sex, pregnancy, use of tampons etc. HPV can then take hold. Also, when a woman's entire immune system is compromised, as it is during pregnancy or from contracting a cold or simply becoming 'run-down,' latent HPV can flare-up.

This accounts for reinfection, and for those women in long-term monogamous relationships who encounter the disease. As we age, our immune systems weaken and we become more prone to the ravages of a virus we've carried for years.

The take home message, take care of your immune system.

By corellin
Posted August 12, 2008 at 2:43 am
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Hi Mikona -- I couldn't say whether having continued sex with your boyfriend will make a difference or not. It's possible he has developed immunity to the virus and cleared his infection so could no longer impact what's going on with you. It's also possible that you've developed some immunity to the virus so that you no longer have an active infection that could be further spread.

But, if I were you, I'd wait to have sex until I was fully healed from the LEEP, had a normal pap and was testing negative for HPV. Of course, you have to decide whether you truly want to wait that long for sex... but you're only 21! What's the rush? Right now, it sounds like you're concerned about preserving fertility, so it seems to me that the priority is clearing your HPV infection and being healthy.

The hand warts probably aren't related to your CIN3, since they were visible to the naked eye. The type of infection that causes CIN3 (oncogenic) is usually subclinical and you'd need to look for it under a scope or scrape some tissue and send it in to a lab to find the HPV. I know, it's all kind of confusing.

Mikona -- I wish you the best of health and hope your next pap is normal and HPV test is negative! I also hope if you really like that boyfriend, that he sticks with you and gives you time to let your infection fully heal.

By KLS123
Posted August 12, 2008 at 3:35 am
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I just posted a long note on the discussion "can husband make HPV undormant" that pertains to this topic. In my note I discuss "stretch receptors" and pose a possible molecular-cellular mechanism by which sex could possibly lead to recurrent VIN/CIN via mechanoreceptors in the cell membrane that can respond to "stretch" in the cell membrane and cause subsequent chemical changes within the cell - namely, production or activation of proteins that favor DNA mutation and can lead to cell transformation AND VIN/CIN. please read it and tell me what you think!!!

By KLS123
Posted August 14, 2008 at 1:42 pm
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Corellin,

This is SUCH an important topic, and I fear perhaps it is overlooked by the HPV community. Thank you so much for these links and for keeping abreast of current research.

I waited three months after my excisional biopsy before having sex with my partner, and in retrospect I don't think that was long enough, as the area was tender for many months afterward.

Because this virus can more easily penetrate the epidermis to the basal layer in torn or damaged tissue it only makes sense that tissue healing from biopsy or surgery is more susceptible. Also, unlubricated sex is potentially much more dangerous because the mucus is absent and cannot act as a protective barrier, and because friction and micro tearing is increased during sex without lube.

If your partner has an active infection (which is likely if he has been having sex with you) then it is very possible that he can reinfect you. Supposedly your immune system should defend you against reinfection, but it doesn't always work the way we hope it will.

My understanding is that the first line of cellular defense against viral infection is that infected cells release interferon to surrounding cells to protect them from viral invasion. When infected/transformed cells are removed, the supply of interferon is also eliminated (this conclusion I have made is anecdotal and not based on research). That's at the cellular level. Then there are also much more complicated body wide immune defenses involving T-cells and white blood cells etc., which ideally, in a healthy immune system will do the job of recognizing and eliminating a virus we have already been exposed to. However, there are a couple of caviots...First, some viruses are especially good about hiding their presence so that these immune mechanisms don't work as well (I'm not sure about HPV in that respect - but I think this typically occurs when a virus is in a dormant state inside a cell). Second, stress, AIDS, allergies, environmental chemicals, poor diet, and other factors can surpress ones immune system and render it not as effective in the battle to identify and eliminate an invading virus.

So, ladies and gents, a year or two without sex involving skin contact of mucus membranes - what's it worth? Your life? Get creative!

By corellin
Posted August 15, 2008 at 10:12 am
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My thoughts exactly, KLS! Problem is -- unless the medical community supports abstinence during active lesions and up until we've achieved complete healing, our partners are more likely to think we're nuts and less likely to cooperate. I'm just really glad, though, that I held out, because I fully healed from a very extensive LEEP and am now in a wonderful sexual relationship in which I'm experiencing no pain, no bleeding and none of the complications expressed by many women on this message board. I don't know whether that was due to giving myself plenty of time to heal or not (1 1/2 years -- OK, maybe excessive), but we definitely need more research that specifically looks at that. Doctors really don't want to disrupt the intimacy or sexual relationship between partners, which I fully appreciate, but telling people it's OK to have sex 6 weeks after an extensive procedure before the cervix is fully healed and before we know we've developed immunity to the virus is, in my view, potentially reckless.

And, yes, HPV is one of those viruses that "hides" from your immune system -- especially HPV16. It takes a while for your immune system to even recognie that HPV is there before it can mount an immune response.

I also appreciate what you said about unlubricated sex resulting in tears that give the virus more inroad. I'm sure that's what happened with me, and I think they should also add to "risk factors" -- sex with a partner you're not attracted to!

And, cervical fluids aid with immunity & clearance of viruses. I think that's why it's important to let your body do its thing to try to recognize and clear the virus without introducing any additional potential infections during that time or hampering the flow of those fluids in any way (such as with tampons).

As to partner having an active infection -- we don't really know, because men seem to clear HPV more quickly than women and could potentially clear the virus by the time a woman has developed a high grade lesion and has had it for a while. But that's the problem -- we don't know! That's why I just feel so adamant that we need partner testing. I can't help but think the only reason we don't, is because researchers/clinicians have lacked the vision and have not really tried. And - in my view -- ongoing sex can cause problems -- not just if partner has active virus, but if the physical act of sex results in tearing, spreading the virus, introducing other infections or disrupting vaginal PH. And, I think for each woman that will be different and depends on how her body reacts to her partner.

Thanks for your thoughts, KLS!

By KLS123
Posted August 16, 2008 at 5:36 pm
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Hey Corellin,
Ya. I'm thinking my recovery so far has also been a result of taking good care of myself after the surgery and from being very careful sexually since then. I think in the absence of accessible home testing it is best to assume your partner has the infection and to give it some time to clear...protecting yourself from dry/abrasive sex and from skin to skin contact as much as possible...for as long as you can (up to two years depending on your partners general health)

By Jennyjenny
Posted April 6, 2009 at 6:34 pm
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Thank you so much everybody for these reports and links. I've been wondering about many of these things myself. I am posting this reply because I think there needs to be a recent response to get it up to the front of the discussions for others to read.

You don't know how much you are appreciated!

Love and peace.

By cattas
Posted April 6, 2009 at 7:45 pm
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For this reason, i just can't get back into being intimate with my husband. I'm very worried about this. I didn't have clear margins, and i'm doing everying i can to get better on my own...in my headspace. i can not get myself there. how sad.

i also came back from my gyn today. where went just for a chat and he suggested getting the gardasil vaccine to help boost my immune system against the virus. what do you guys think of that?

By concernedhere
Posted April 7, 2009 at 12:06 am
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I went to a gyno/oncologist for my 2nd opinion on 3/25. Now he is part of the cancer center in Hackensack University. I had asked him many questions. One of the questions I asked was about anal HPV and if I cld infect myself in that area. His response was well no, but, HPV has a way of manifesting itself to infect other areas internally that could spread to the anal area. Now this is separate from having any kind of anal sex.

By PrincessRed
Posted April 7, 2009 at 10:43 am
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I guess, I could be a trial/test patient with this...In February I tested positive for HR HPV (I'm assuming this means I have an "active" infection). My biopsy and ECC reports came back benign: no changes in dysplasia, no changes in HPV. My follow-up was set for 6 months (August 2009). I do not plan on having any sort of sexual activity...no penetration, nothing oral, no messing around, not even any kissing! I've eliminated processed/refined sugars and flours, pork and red meat, incorporated more fresh veggies and fruits and vitamin supplements. I'm trying to get plenty of rest and excercise as well...I'd really like to follow-up at a 4 month interval, however, if HPV takes at least 6 months to clear, I'm thinking I'm going to hold out until August. I'm thinking the only thing I have going against me is my age??? We shall see...

By iluvtosinga
Posted April 7, 2009 at 4:46 pm
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Thanks for posting this. I do wonder, that if you already have HPV but have gotten Gardasil to prevent other infections...will it prevent me from getting an infection elsewhere. Meaning this: if I have an infection on my cervix, will getting the Gardasil shot prevent me from spreading that SAME infection to my vulva or anus, since I have gotten the Gardasil shot???????

By flowershoplady
Posted April 7, 2009 at 7:18 pm
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we'll be cheering you on, princessred. and, your age is still to your advantage as for fighting off the hpv infection.....sure, might be even more to your advantage if you were 10 years younger, but 30 is still considered on the younger side as far as your body's ability to kick in its immune system.

By PJ2
Posted April 8, 2009 at 1:45 pm
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Corellin -

I hope you don't mind, but can use some of what you have said here for a talk I am giving on HPV and cervical cancer? I think the points here are very important and didn't want to steal it from you with out asking first!

Thanks,
P

By corellin
Posted April 8, 2009 at 4:49 pm
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Hi PJ -- Absolutely. Feel free to use anything you want. Just realize that I'm not a researcher and am limited to my own personal experience & biases, so please don't quote me as an expert. I'm just trying to share information I've found so that people have more data to make their own decisions. I would suggest taking concerns to their doctors and pressing for answers. My purpose in posting the "reinfection" information was just that I think doctors are so quick to dismiss our concerns and provide an easy answer, not an "evidence-based" answer. Due to the potentiall ill health effects for women (and men), I think we deserve better than that. It's just not as clear cut as, "once you have HPV, ongoing sex with the same partner won't make a difference." I think that doctor's responses skirt the real issue, which is, "what is safe sex for women who have an active HPV infection or dysplasia or are recovering from treatment for dysplasia." I think we deserve a thoughtful, comprehensive, evidence-based answer. That said, abstaining from or limiting sex puts a huge toll on a relationship, and i can understand why doctors are reluctant to suggest we hold back if evidence supporting abstinance/restrictions is not irrefutable. And, I can understand how studies would be difficult to perform. PrincessRed -- thanks for your contribution to science!!

Good luck with your presentation, PJ

By corellin
Posted April 8, 2009 at 4:52 pm
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hi iluvtosinga -- that's a great question about whether Gardasil could prevent infection in new places. We know it can't clear already infected cells, but it seems that, theoretically, it might prevent infection in new places -- for example, if you've never been exposed orally. I just don't know, because I haven't seen any research specifically addressing that.

By corellin
Posted April 8, 2009 at 4:56 pm
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Hi concernedhere -- here's a quote from Joel Palefsky's book, "What your doctor may not tell you about HPV and abnormal paps." He's an infectious disease expert at UCSF whose research focuses on anal HPV & dysplasia. (I've included a link to his bio page at UCSF.)

http://www.ucsfhealth.org/adult/cgi-bin/prd.cgi?action=DISPLAYDOCTOR&doctor id=930

He says, "Autoinfection is another way to get HPV infection. That's medicalese for "infecting yourself" by spreading infection from one area of your body to another area of your own body. If you're infected in one part of your genitals with an HPV type, you can spread it yourself to other parts of your genitals. For example, shaving can possibly spread HPV. If you shave your pubic hair, and you touch an infected area with the razor, you could spread it if you knick yourself with it somewhere else in the genital region. Likewise, you could spread HPV infection from the cervix to the anal canal or vice versa, through wiping or natural movement of fluids. If you're a man, you could spread HPV infection from your penis to your anus or vice versa by scratching yourself in a shedding, infected area, and then scratching an uninfected area. Women can, of course, also infect themselves by scratching."

And, here's a quote from a recent research paper published by the University of Washington in the Jan 2009 issue of the Journal of Infectious Diseases. This is just speculation by the researchers, but gives an indication how they think about HPV, "Vulvar/vaginal infections may later migrate to the cervix (via intercourse or insertion of tampons, for example)."

So, researchers & HPV specialists call HPV a "skin disease" that affects the epithelium and is spread via skin to skin contact or via something inanimate that transfers the shedding HPV to a susceptible part of the body. Dr. Palefsky also talks about how HPV is probably most active & shedding in the early stages of an infection - or maybe when someone has mild dysplasia - but that further along in the infection there may be less shedding so less likelihood of transfer of infectious HPV particles. So, it's not likely that we'll spend the rest of our lives spreading HPV everywhere. And, by the time we've discovered our infection due to an abnormal pap, it's possible that this highly infectious period is past. From Dr. Palefsky's book, it didn't seem like stages of infectiousness were very well understood. The thing that's so frustrating about all this is that so much isn't known, so it's really difficult to say what actions a person might take to make a difference in clearance

By Marjorie64
Posted April 22, 2009 at 9:40 pm
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I'm just confused, I was recently diagnosed with HPV. You talk about it being cured and what not. My doctor informed mine can not be cured is this true? I had CIN 3 on my cervix and she also thinks it spred into my canal. If it can be cured why does she tell me I will keep getting it back? I got the laser surgery done, and she said it could come back with in 6 months. Do you know the odds of it coming back or coming back cancer? I'm 18 and she said she can't do the laser thing to many times other wise I won't be able to have babies. Does HPV limit my chances of having kids and can I give it to them? sorry about all the questions i'm just young and this is so much!

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