Dear Dr G,

I am writing to you burdened by guilt over my past sexual encounters, hoping you can help me resolve this remorse.

I am a 30-year-old man with a troubling secret from my past.

A few years ago, I discovered a small, flower-like growth on my penis. The doctor diagnosed it as a genital wart.

I was shocked to learn that genital warts are linked to the Human Papillomavirus (HPV), a sexually transmitted infection (STI).

I was even more horrified to find out I could easily transmit the virus to my partner, potentially causing cervical cancer.

When I told my then-girlfriend that my past actions might have caused the warts, the relationship ended quickly. I haven’t dated since.

In fact, I have avoided sex for the past few years due to the risks.

I want to ask Dr G about the issue of my “flowers in the pants.”

What exactly is HPV? I thought it only affected women.

Is the virus contagious with every sexual encounter? How can I reduce the risk of transmission to my loved ones?

I feel I’m wasting the “golden years” of my sex life. I understand HPV is incurable, but should I remain sexless for the rest of my life?

Regards,

Flower Felix

Genital warts result from the transmission of the Human Papilloma Virus (HPV) during sexual contact. Of the 170 HPV subtypes, more than 40 spread through genital and anal contact, with HPV 6 and 11 commonly linked to genital warts. HPV transmission occurs in both men and women, with risk factors including early sexual activity, multiple partners, poor hygiene, and smoking.

HPV is often thought to affect women more, but it actually poses a greater risk to men. Firstly, HPV is 60% more transmissible from women to men than vice versa. Secondly, men are 26% less likely to develop natural immunity compared to women during sexual intercourse.

Lastly, while both genders can clear the virus naturally, women have more effective immunity as they age compared to men. This leads to a higher persistent disease burden in men, increasing their risk of recurrent disease. Nearly all sexually active people are infected by HPV at some point, making it the most common STI globally. Ninety percent of affected individuals show no symptoms, and the virus often resolves spontaneously within two years.

However, in those with lower immunity or persistent STI risks, HPV can persist in the genitalia, leading to recurrent warts and increased cancer risk. Diagnosing HPV in men is less accurate than a PAP smear in women. The visible “flower-like” lesion suggests an HPV infection. Normal skin tags can often be mistaken for genital warts. Scraping the lesion for DNA analysis of the virus subtype is the most accurate diagnosis method.

Most genital subtypes, including HPV 6 and 11, are low risk. While high-risk subtypes like HPV 16 and 18 are rare, close monitoring is crucial to prevent disease progression. Vaccination is the most effective protection against HPV. Although vaccines are recommended for boys and girls at age 13, protection is evident up to age 45.

The US’ Centers for Disease Control and Prevention indicate that male condoms may reduce HPV transmission risk, although less effectively than for other STIs. This is because HPV can transmit through genital skin not completely covered during sexual contact. Vaccination remains the best treatment for HPV infections.

Many believe vaccination is futile beyond the initial sexual debut, but data shows only 13% of men and 16% of women contract two or more HPV subtypes. Thus, protection against non-contracted viruses remains important.

Despite being incurable, HPV vaccination ensures 100% antibody seroconversion within seven months of inoculation. Enhanced antibodies play a vital role in preventing disease recurrence and progression.

Genital warts have been documented since ancient Greece, with viral causation only determined in 1907. Today, nearly 80 million Americans have HPV, with 14 million new cases annually, leaving 1% of sexually active adults with recurrent warts. HPV is highly contagious with each sexual contact, but its manifestations can vary from dormant to insidious.

Since nearly all sexually active adults encounter HPV, it’s fair to view the disease as mostly harmless, but enhancing immunity is key to reducing transmission risks. When individuals with HPV insist on abstinence as the only prevention, Dr G’s view is that vaccination and monogamy are crucial to not wasting future “golden years.”