TRANSMISSION

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: How do you get HPV?
A:
HPV is transmitted by skin-to-skin contact. HPV is most commonly transmitted by sexual contact. This does not exclusively mean intercourse. A person can get the infection from rubbing during foreplay. The infection is more likely to occur in areas where there was a lot of friction which can result in small breaks in the skin. The virus can then invade the skin through these small fissures and establish a dwelling place for itself in the skin.

Q: What ways other than sexual contact can result in the further spread of an HPV infection on myself?
A:
Genital warts are very contagious. A person who already has warts can spread the infection to previously uninfected areas on themselves in multiple ways, including in areas where they wear tight clothing, from abrasion during exercise or sports, drying themselves with a towel vigorously after taking a shower and even by cleaning themselves very thoroughly but perhaps too hard after a bowel movement.

Q: What precautions can I take in order to avoid spreading the infection?
A:
A person who has an infection in the genital area needs to be mindful of the fact that they need to thoroughly wash their hands before touching themselves in the genital area.

Q: Can you infect somebody with HPV even if you can’t see any growths in the genital area?
A:
A person may not have easily recognizable growths on their skin but can still have HPV and be highly contagious. A person who is infected is a carrier who can potentially transmit the infection to a current or future partner.

Q: What is asymptomatic transmission?
A:
Asymptomatic transmission is when a person without any apparent signs or symptoms can still spread the infection to another person with whom they come into contact. Asymptomatic transmission is a very important way that the HPV virus is spread.

Q: Why is asymptomatic transmission so common?
A:
Asymptomatic transmission occurs frequently because of the large number of people who have small inconspicuous growths or no growths at all although they are carriers of the infection and are nonetheless shedding the virus. People who are asymptomatically shedding the virus frequently do not even know that they have an HPV infection are less likely to recognize the need to practice safe sex and use condoms.

Q: Is there a greater chance of my getting infected from a person with lots of large genital warts or by asymptomatic transmission from a person who is a carrier?
A:
There is a greater chance of you getting the infection from a person with multiple large genital warts because more virus is being shed by these warts. People who are asymptomatic shedders of the virus shed fewer viral particles but are also less likely to use condoms. The use of condoms would decrease the chance of a person who is asymptomatically shedding the virus from infecting their partner(s).

Q: What are the chances that a person who does not use condoms will get an HPV infection from somebody who has an HPV infection?
A:
Approximately 40%.

Q: What is the incubation period for an HPV infection?
A:
The general range of the incubation period is from 1-9 months. The average incubation period for an HPV infection occurs within 3-6 months after contact.

Q: If I do not develop genital warts during that time, does that mean that I will not get an HPV infection?
A:
If you do not develop the infection within 3-6 months of contact, there is a reasonably good chance that you will not develop the infection but the chance of developing an infection is still present. You should be mindful to use condoms until you know that you are clear of an infection for a 6 month period of time. There still remains the chance that you acquired a low grade infection and are a carrier who can infect others.

Q: If I don’t get an HPV infection within 6 months does that mean that I am immune to the virus?
A:
Nobody is naturally completely immune to the virus. You may have a good natural resistance to the virus where your body is able to suppress the growth of the virus even though you may have been infected, but at another time in your life when you are tired, worn down, stressed out , or have a chronic disease or other condition which is decreases your resistance the virus can then awaken from it’s latent state and cause an active infection.

Q: What areas in the man are most likely to be most contagious with HPV?
A:
The anatomic sites in men which have the highest concentrations of HPV DNA are the head of the penis (glans), the foreskin and the shaft of the penis. The foreskin has the highest concentration of HPV DNA when it is present, which is only in the uncircumcised man. The scrotum and inguinal area may also contain HPV DNA, but the occurrence of infection in these areas is less common than the other sites.

Q: How commonly does HPV occur in the urine, semen and urethra?
A:
The occurrence of HPV in the urine, semen and urethra is low.

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

Q: Can HPV be transmitted from the mother to the child during pregnancy?
A:
HPV infections transmitted from the mother to child during pregnancy are rare. The main time when the child will be infected is during the birth process while the child passes through an infected birth (vaginal) canal. Delivery by Cesarean section should theoretically decrease the frequency of this type of transmission, but this is not an absolute and infection has nonetheless been documented in babies delivered by C-section.

Q: Is HPV transmitted more easily from a man to a woman or from a woman to a man?
A:
HPV infection is more easily transmitted from a man to a woman. The larger surface area on the vulva and vaginal area makes this region more susceptible to infection.

Q: Can you get an HPV infection from oral sex?
A:
HPV infections can be transmitted by oral sex and the increased incidence of oropharyngeal cancers has been attributed to the increased incidence of oral genital sex.

Q: What is the best way to avoid this?
A:
Minimize oral sex when growths are present in your partner’ s genital area. If you have any cuts, breaks or fissures on your lips, tongue or in your mouth, minimize any type of contact to the genital area in order to avoid giving the HPV virus the opportunity to get into a break in the skin in the mouth area where it can more easily establish an infection.

Q: What are the chances of a person getting an HPV infection during their lifetime?
A:
50%-80% of sexually active adults in the United States will have been exposed to an HPV infection by the time they are 50 years old.

Q: How frequently do HPV infections ever go away on their own?
A:
Most HPV infections clear up on their own but many do not. A person who is in contact with a person who has an HPV infection that may eventually resolve can still get infected while the other infection is in an active stage.

Q: Does that mean that the chances are that most of the time I won’t get infected?
A:
You can still get infected from somebody who still has an active infection when you come into contact with them, although their infection may eventually clear up on it’s own. This should not be especially comforting to you if you nonetheless caught the infection during the time when it was active.

Q: How do I prevent that from happening?
A:
You need to use a condom.

Q: Any particular type of condom?
A:
Latex condoms give the best protection.

Q: If I see a growth in my genital area can I just wait and see whether it goes away on it’s own and not rush to treat it?
A:
You can take this tact of “watchful waiting” but you need to use condoms during this time and preferably see your physician to discuss your options about getting it removed.

Q: What is the downside of waiting to see if it goes away on it’s own?
A:
The infection can potentially spread to and infect additional areas on you, especially in areas where there was friction i.e. from working out, tight clothing, rubbing. You also have a higher chance of spreading it to a partner during this time, even if you use protection.

Q: Should I wait to see if the growths go away?
A:
You can wait to see if the growths go away. Many people feel uncomfortable with the idea of leaving it to chance to see whether contagious growths go away on their own. You also need to be mindful of the fact that the visible growths can go away but you may still be contagious and a carrier who can still infect your partner(s).

Q: What if the genital warts don’t go away on their own?
A:
This would indicate that you may have less of a resistance to the infection. Genital warts occur more frequently in men compared to women. Men have a less robust immune response, manufacture fewer antibodies against the HPV virus and develop less of a resistance to HPV infections than women.

Q: Do different people have a lower resistance to HPV infections than others?
A:
Men have a lower immune resistance to HPV infections than women. This is why genital warts occur more frequently in men than women. The frequency of HPV infections in women goes down as they get older but it stays the same for men.

Q: What does it mean if a person has a persistent HPV infection?
A:
Infections that persist and do not go away on their own are more likely to contain the high risk HPV strains. A person can also have persistent infection with low risk strains when they have less of a natural resistance to infection.

Q: What are the chances that an HPV infection will go away on its own?
A:
70% of abnormal Pap smears in women clear up on their own within one year after they were initially diagnosed. 90% of all abnormal Pap smears will clear up on their own within a two year period of time.

Q: Do most people who have an infection know that they have it?
A:
Most people who have an HPV infection are without symptoms and do not know that they have an infection.

Q: Is the HPV infection gone for good if a person was diagnosed with an HPV infection and it was then treated or went away on its own?
A:
Once you have an HPV infection it does not go away. The infection can become latent and it always has the potential to recur. The person who was infected with HPV becomes a carrier.

Q: What does it mean to be a carrier?
A:
A carrier has a low grade HPV infection which is not associated with any growths or symptoms indicating it’ s presence but the carrier is still contagious and may be asymptomatically shedding the virus which can then potentially infect their current or future partner(s).

Q: How common is asymptomatic shedding?
A:
Asymptomatic shedding is very common. 50%- 80% of sexually active adults in the United States have had an HPV infection by the time they are 50 years old. These individuals can potentially infect their current or future partners who have not yet been exposed to the infection. Asymptomatic shedding is one of the reasons that HPV infections are so common and are occurring in epidemic proportions.

Q: How is HPV spread?
A:
HPV is most frequently spread by sexual contact. HPV is not spread exclusively by sexual intercourse. HPV can be transmitted by rubbing during foreplay or oral sex. There are many cases where people who are virgins (both male and female) getting an HPV infections.

Q: Can HPV be spread by non-sexual ways?
A:
The main way that HPV is spread is through sexual contact, but there are nonetheless cases of HPV being spread when there has been no sexual contact. Non-sexual means of transmission are possible and most likely do occur but are not a common way of acquiring the infection.

Q: Can HPV infections in the genital area be spread from hand warts?
A:
Although hand warts can potentially under certain circumstances infect the genital area, this is not a common occurrence. A hypothetical situation might be where a person has hand warts (caused by types not associated with genital HPV strains) which then infect their own genitals by touching the area. The strains of HPV that most commonly associated with hand warts have zero potential to progress into HPV-related cancers.

Q: Do warts on the finger ever contain the high–risk genital HPV strains?
A:
There have been reported cases of finger warts that were biopsied and HPV DNA typing demonstrated the presence of high risk HPV 16/18 strains. This is an unusual and highly unrepresentative situation but it has been reported.

Q: What are some other examples of how HPV infections can be acquired that does not involve sexual contact?
A:
f a friend or colleague who recently touched their own genitals, the virus gets transmitted to the other person’ s hand, the hand subsequently touches their own genitals and an HPV infection is established through pre-existing breaks in the skin. This is a hypothetical but viable explanation of how certain infections have been spread.

Q: Can you get HPV through a blood transfusion?
A:
HPV is not spread by blood transfusions.

Q: Is there a blood test for HPV?
A:
There is no common commercially available blood test for HPV.

Q: Can HPV spread through inanimate objects?
A:
It would be highly unusual for a person to catch an HPV infection through an inanimate object. It is unlikely that a person would catch an HPV infection from a toilet seats, bathtub, shared underwear, bathing suits, clothing, etc The HPV virus on an inanimate object does not survive after a short period of time.

Q: How does the actual infection occur?
A:
The transmission of the virus most commonly occurs after there is friction, mechanical trauma and/or abrasion to the skin. Breaks in the skin occur during sexual contact or rubbing. The HPV virus is then able to gain entry into the skin and establish an infection at that site.

Q: What is the most common age for a person to get an HPV infection?
A:
The age group when people have the greatest chance of getting new HPV infections is when they are 15-25 years old.

Q: Why do so many infections occur at those ages?
A:
The age range between 15-25 years of age is a time of sexual experimentation. People are more likely to have a greater number of partners during this time.

Q: Is there a point in time when it is too early or too late to get an HPV infection?
A:
A person can get an HPV infections at any time throughout their lifetime.

Q: How common is HPV on college campuses?
A:
Studies performed at large university centers established that more than 50% of college-aged women acquire an HPV infection between their freshman and senior year of college.

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