NATURAL HISTORY

hpv-kling2ALAN KLING, M.D

Dr. Kling is a recognized expert in the field of HPV treatment, Dr. Kling has lectured on HPV at Columbia, Cornell, Mount Sinai, NYU, Yale and many other medical centers, as well as at numerous national meetings. He is up-to-date on the latest advances in the diagnosis and treatment of HPV. Dr. Kling is the recognized go-to-person for HPV-related diagnoses in the metropolitan NYC area.
Dr. Kling’s private practice offices are located on the Upper East Side in Manhattan and in Park Slope, Brooklyn. The offices are comfortable, stylish, elegantly decorated and impeccably clean. You can feel reassured that your consultation and treatment will be performed by an accomplished, experienced, and well-respected board-certified physician.

Q: What is the incubation period for HPV?
A:
The incubation period refers to the period of time between when a person is first exposed to the infection nil the time the infection can be detected. The incubation period is usually 3-6 months after exposure, but can range anywhere from two weeks to eight months an can sometimes be even longer.

Q: How long after exposure does it usually take for something to be detectible?
A:
Changes consistent with HPV can usually be detected within 3-6 months after exposure to the infection.

Q: Am I contagious during the incubation period for the infection?
A:
Yes, you can be contagious during the incubation period. The incubation period averages 3-6 months, but an HPV infection can be established in as little as 2 weeks and as late as 8 months later, or longer. Small and barely noticeable lesions may be less contagious than dozens of large barnacles, but they are contagious nonetheless and they can serve as a source of infection to your partner.

Q: Am I contagious if I do not see any growths?
A:
You can be contagious even if you do not see any growths. Many people shed infectious viral particles even though they do not have any readily identifiable signs or symptoms of HPV. In addition, small growths are not infrequently present, although they can be difficult to see.

Q: Who can get an HPV infection?
A:
Anybody of any age who has sex with another person who has an infection can catch an infection. Up to 80% of people who are sexually active will get HPV by the time they are 50 years old.

Q: Is there any particular group of people who are more likely to have HPV infections?
A:
People of any age, gender, or sexual orientation can get an HPV infection. The greatest frequency of HPV infections is seen in young adults and teenagers.

Q: Why would teenagers and young adults be more likely than other people to have an HPV infection?
A:
Teenager and young adults are in the years of experimentation when people are more likely to have a greater number of sexual contacts and are less likely to use condoms. 50% – 75% of all people who have HPV infections are between 15-25 years old.

Q: How do you get an HPV infection?
A:
Sexual intercourse is the most common form of transmission of HPV, but it can also spread from genital rubbing that may occur with foreplay or any type of skin contact. Virgins have ben observed to develop genital warts as well as abnormal Pap smears.

Q: Don’t many HPV infections go away on their own?
A:
Most HPV infections do go away on their own but until they do (and they do not all go away on their own) the person with HPV infection is contagious and sexual contact should be minimized and at the least one must use condoms.

Q: What if I choose to take a wait and see attitude and see if the HPV will just go away on its own?
A:
If you choose to not get evaluated and treated after exposure you need to take full precautions in order to minimize the chance of transmitting the infection to somebody else. You may be highly contagious during this time.

Q: How long does the usual HPV infection last?
A:
The average HPV infection lasts for several months. The average low risk infection lasts for 6 months and the average high risk infection lasts for 12 months.

Q: Are there infections that can last even longer?
A:
Many people do not have a good natural immunity to HPV infections and have active infections that can persist for years. People who choose not to get treated need to take maximum precautions in order to minimize the chances of transmitting the infection to their sexual partner(s).

Q: How would I know if I have an HPV infection?
A:
Any growths in the genital area  new or old  should be checked out. Just because a bump has been present for a awhile does not necessarily mean that it is harmless.

Q: What should I do if my partner tells me that they were diagnosed with an HPV infection?
A:
You should go to your doctor to be evaluated. If your partner has an HPV infection you in turn have a much greater chance of also being infected.

Q: What are the chances of a person catching an HPV infection or genital warts from their partner(s)?
A:
HPV infection s can be highly contagious If a woman has a positive Pap test her male partners needs to be evaluated because he now has an increased chance of developing genital warts. A woman whose male partner has genital warts has a higher chance of getting an HPV from him.

Q: Do HPV infections go away on their own?
A:
Most HPV infections resolve on their own. There are, however, a large number of people with persistent HPV infections that do not spontaneous resolve. These people have active infections which can be transmitted to their partner(s) at the time of sexual contact.

Q: Can two people who are monogamous get HPV?
A:
Two people who have been monogamous for a long period of time can develop an HPV infection. HPV can lay dormant for years and then get reactivated (when a person is tired, worn down, stressed out, etc) and the partner with the old reactivated infection might now give it to their partner.

Q: What would cause a recurrence in an HPV infection?
A:
Factors which can reactivate a latent infection include tiredness, fatigue, illness, stress, certain medications (i.e. steroids), or an immunocompromised state.

Q: If I have the high risk strains of HPV, does that mean that I will eventually get cancer
A:
Everybody who has the high risk strains does not develop cancerous or precancerous growths. Only a small percentage of high risk HPV strains actually progress into cancers. Most do not.

Q: Are all abnormal Pap tests due to high risk strains?
A:
An abnormal Pap smear is not necessarily caused by high risk strains. Many Pap smears go back to normal on their own and usually do not require immediate treatment. The doctor may obtain a new Pap smear several weeks or months later in order to evaluate whether abnormalities are still present. Treatment may be necessary if an abnormality in the Pap test persists over time.

Q: Why is the term HPV so frequently associated with cancer?
A:
There has been an increased awareness of HPV over the last several years and much discussion concerning it’ s association with cancerous and precancerous conditions. A very large number of people have HPV, and a small percentage of even a large number of people still results in a high number, and this generates concern.

Q: What are the most worrisome types of infection?
A:
The infections which are of greatest concern are those that continue to persist over time and do not resolve. These infections need to be carefully monitored because they have been associated with an increased chance of evolving into cancerous or precancerous growths.

Q: How long does it take for an HPV infection to turn into a cancer?
A:
It can take several decades between the time the person is first was exposed to the infection and the time that it takes for a cancer to develop. The most common age range in which women are diagnosed to have cervical cancer, for example, is when they are 35-50 years old. This indicates that these women most likely contracted the infection when they were young adults or even during their teenage years.

Q: Are there any other factors that influence whether a person will develop a cancer, and how severe it may be?
A:
Women or men who are immunocompromised are at increased risk of developing infections, which tend to require more treatments and be associated with a greater number of recurrences. People who are immunocompromised and have high risk strains of HPV are also more likely to develop more aggressive cancers.

Q: Can genital warts in women or men who are immmunocompromised be treated as easily as they are in those who are not?
A:
Genital warts in women or men who are immunocompromised are associated with a greater number of growths, more extensive involvement, more frequent recurrences, and a more aggressive natural history. Nonetheless, with proper treatment and monitoring, these infections can be managed and contained.

Q: What can I do in order to make sure that I can minimize the chance of giving an HPV infection to my current or future partners?
A:
You need to go to your physician so that you can be properly evaluated. Early diagnosis and treatment are important. Like many things in life, the most important thing is just showing up.

Q: How long do the low risk strains like 6/11 that cause genital warts last before they go away on their own?
A:
Low risk strains like 6/11 have an average duration of approximately 6 months in men.

Q: How long do the high risk strains like 16/18 that can cause HPV-related cancers last before they go away?
A:
High-risk strains like HPV16/18 have an average duration of 12 months in men. This means that 50% of men are positive for the high risk strains of HPV for one year or more before and if they resolve. Their partners are a t risk of contracting the infection during this time. The decision must be made ASAP whether to treat and/or to use condoms in order to minimize the chances of the spread of the infection on the person who is already infected as well as to minimize the chances of them spreading their current or future partner(s).

Q: Do all HPV infections eventually go away on their own?
A:
No, all HPV infections do not eventually go away on their own. If they do and until they do go away, the person continues to be contagious and anybody they come into sexual contact with is at risk from the infection. The person who has the genital warts can infect their partner(s) as long as the infection is active.

Q: How does a genital wart infection in one person spread to additional areas on them?
A:
The person who has the genital warts can continue to spread the infection from the localized confined area(s) originally infected to the normal uninfected tissue surrounding the warts, which can result in an even more extensive infection. Treatment will be even more challenging and the infection even more contagiou if the infection spreads to new locations.

Q: How would I know if my infection is going to go away on its own?
A:
You cannot accurately predict whether an infection will or will not go away on it’ s own. You have to consider yourself contagious during this time if you decide to wait it out and take precautions with your current and future partners in order to minimize the chance of infecting them.

Q: Any guidelines as to which infections will stay away?
A:
More extensive infections which involve a greater number of growths over a large surface area are more likely to recur and less likely to spontaneously resolve. HPV infections in a man who is uncircumcised tend to be more persistent and associated with higher recurrence rates after treatment. Growths which contain the high risk HPV infections are also more likely to persist.

Q: How accurately can I tell on my own whether I have an infection in my genital area?
A:
You should see your doctor and have them monitor your progress. Many HPV infections are difficult to detect with the naked eye. Physicians are able to examine the area carefully with magnifiers, are able to get closer to the areas that need to be examined than you are and also have more experience differentiating the normal from the not normal. In addition, there are areas that are out of your sight line which you cannot see.

Q: Is everything OK if my doctor cannot detect any growths?
A:
Many people with HPV infections don’ t have readily apparent signs or symptoms of infection may nonetheless be asymptomatically shedding the virus which can still cause an infection in their partner(s). There are various tests that can accurately evaluate the presence of infection. You need to discuss this at length with your doctor.

Q: What is the amount of time that it takes between the initial exposure to a contact that was infected and until I will be able to see the genital warts?
A:
The median time for HPV infection to grow into a genital wart is 3-6 months. This is called the incubation period. The incubation period ranges from 1-8 months and many cases are visible within several months.

Q: What are the screening methods for HPV available for women?
A:
There are a number of different screening tests available for women which will result in the early detection and if necessary treatment of HPV infections. These screening tests include Pap smears and HPV DNA tests. Cancers and/or infections can be detected early and a treatment plan can be initiated before the infection has the change to further progress.

Q: How long does the average HPV infection last?
A:
The average HPV infection lasts at least 6 months. HPV infections containing the high risk strains last approximately 12 months.

Q: Can HPV infections go away on their own without being treated?
A:
HPV infection are frequently transient and can resolve on their own without being treated.