hpv-kling2ALAN KLING, M.D

Dr. Alan Kling is recognized as one of the foremost specialists in the field of HPV infections. Throughout his years as an HPV specialist, Dr. Kling has contributed to research and lectured at various medical schools, including Columbia, Cornell, Mount Sinai, NYU, and Yale as well as having been a part of a number of national panels on HPV and HPV prevention. His extensive research has allowed him to keep up with the latest HPV treatment protocols and to educate others in the field as well. While HPV is an important field of dermatological study for many physicians, Dr. Kling has clearly separated himself from the pack, making him the top HPV treatment specialist in NYC today.

Dr. Kling's private practice offices are located at his Park Avenue practice on the Upper East Side and in Park Slope, Brooklyn.

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 anD can sometimes be even longer.

Q: How long after exposure does it usually take for something to be detectable?
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 or physical contact with a person who has an HPV infection can contract 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: Do HPV infections go away on their own?
A: Most HPV infections are transient and go away on their own. If and until they do go away on their own, the person with the HPV infection may be highly contagious. Sexual contact should be minimized during this time and safe sex should be practiced. Many people opt to seek treatment rather than go through a period of abstinence and uncertainty concerning whether the infection will actually go away.

Q: What if the HPV infection does not go away on its own?
A: A number of people have HPV infections that persist and do not spontaneously resolve. These people have active infections which continue to be contagious and their partners may be infected after sexual contact.

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 HPV infection lasts for 6 months and the average high risk HPV 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 new or old growths in the genital area 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: 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 may be tired, worn down, stressed out o have other conditions that predispose to reactivation. The partner with the old reactivated infection is now at risk of giving 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 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 and cause a cancer.

Q: Are all abnormal Pap tests due to high risk strains?
A: An abnormal Pap smear is not necessarily caused by high risk strains. Most Pap smears go back to normal on their own and 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 abnormal Pap test persists over time.

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. Anal, rectal and oropharyngeal cancers also develop several decades after the patient first contracts the HPV infection.

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: What is the difference in the behavior of genital warts in people who are immunocompromised compared to 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 and treated. 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.

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. This means that 50% of patients are positive for the high risk strains of HPV for one year or more before and if they resolve. Many patients are contagious for even longer periods of time. Their partners continue to be at risk of contracting the infection during this time and safe sex should be practiced.

Q: Do all HPV infections eventually go away on their own?
A: All HPV infections do not eventually go away on their own. The infected partner may have a persistent infection that does not resolve on its own and this person continues to be contagious to others. Other people have only a partial spontaneous resolution of the infection and also continue to be contagious. 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 area(s) originally infected to the normal uninfected skin surrounding the warts. This will result in an even more extensive infection. Treatment will the be even more challenging and the infection even more contagious if the infection spreads to new locations.

Q: How would I know if my infection is going to go away on it’s own?
A: You cannot accurately predict whether an infection will or will not go away on its own. You have to consider yourself contagious during this time if you decide to wait it, safe sex practices need to be taken with your partner 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 men who are uncircumcised tend to be more persistent and associated with higher recurrence rates after treatment than in men who are circumcised. Growths which contain the high risk HPV infections are also more likely to persist in uncircumcised men compared to circumcised men.

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 during self-examination.

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 but in some cases growth can be detected as early as 2 weeks after contact while in other cases growths are not detected until over a year after contact.

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 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 chance to further progress.

Q: How long does the average HPV infection last?
A: The average HPV infection lasts at least 6 months. Low risk HPV infections have an average duration of 6 months. High risk HPV infection have an average duration of 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 but may be highly contagious during this time. The genital warts may decrease substantially in size but still be contagious. Maximum precautions should always be taken in order to protect your partner.

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