Can HPV/ Genital Warts develop between two clean individuals?

[Aly_]

Hi all, hope everyone is doing well during these crazy times. My boyfriend developed a red-ish bump below the head of his penis, on his shaft two weeks ago. It's gone down a bit, but it is still there. It is a red lump that almost blends into the skin if that makes any sense, sort of like how a zit/cyst/ingrown hair is just an elevated, irritated part of the skin. It does not resemble a foreign body like a wart. Plus, he and I have only been with each other, sexually and romantically, and have always been clean (he once in a blue moon gets cold-sores, that's about the extent of what he's got lol - and he's never touched his cold sore and then other parts of his body like his genitals BTW!). We have never even had unprotected sex before, and have always used condoms. I actually just went for a PAP in September, and everything came back normal. I haven't found any bumps on myself personally. To add, we both got vaccinated with the HPV needle back in elementary school (I know this does not guarantee safety from it, just thought that I would bring that up).

He has a new doctor now due to COVID, and he spoke to her about this on the phone. He explained that he has no symptoms, that the genital spot does not hurt, and that it isn't itchy/ it doesn't cause him pain or anything like that. I know some STI's are symptomless, but we both looked at pictures and cases online, and honestly nothing that he is feeling matches the experience of those with HPV or any other STD related for that matter. It also doesn't look like herpes, or syphillis... it kind of looks like a lymphocele to be honest. He also explained to her that we have only been each other's partners and have never had unprotected sex, and that I (his partner) am clean. However, his doctor immediately chalked it up to genital warts. She said "these things tend to slip through the cracks" and it has likely developed, even though she does not know what it looks like, and even though it sounds crazy to us! My boyfriend was very confused, and they are meeting in a few days for an in-person appointment, which she said she could freeze the spot for him and it will be gone forever (something I also know isn't exactly the case because HPV is forever. Outbreaks aren't forever, but HPV has no cure). My question is: is this possible? For someone to develop genital warts/ HPV without exposure to it? Unless exposure is a lot more complex than we both initially thought.

I don't think that he would have ever cheated on me, I know that would obviously be something to consider but it would be the biggest blindside of my life and I would bet my last dollar that this isn't the case. Though, can HPV develop right out of the blue? (Unless it's been with him since birth, which I also find hard to believe, but ik one possibility is passing it off mother to child). It just doesn't make sense to me, like I'm really struggling to wrap my head around this. Then it makes me wonder: could an STD develop in someone not sexually active, like a virgin (hehe Madonna), or is this not really possible. Likewise, it scares me to run the risk of also contracting it if this is what's going on, should I go get tested again as well? I know I'm jumping the gun and should just wait to see what occurs with his doctor, but we both can't stop worrying about it. I feel like my anxiety is through the roof. We've always been so careful, I know this isn't a death sentence or anything but it all feels really confusing and kind of crappy if I'm being real (not to shame anyone with it! But the unknowingness of it all is a not-so-great feeling. :/) If anyone has any insight, it would be so so appreciated. Thank you very much I can also update what happens later on if helpful to anyone else with a similar question!

[Siân]

Hi Aly_,

We certainly can't diagnose what is causing the mark on your boyfriends penis over the internet, it really needs to be seen in person by a doctor so I'm glad he has an appointment coming up. I can help clear up a few things about HSV (the herpes virus, which causes coldsores too) and HPV though.

1. Both HPV and HSV can be spread by skin-to-skin contact - so you don't need to have intercourse to transmit them, and whilst condoms reduce the risks of transmission they don't prevent it entirely the way they do for other STI's transmitted through fluids. More here: HPV & Herpes: Why Safer Sex Isn't Always Safe Enough.

2. Your boyfriend gets coldsores, which means he already carries a strand of HSV. Most commonly, HSV I shows up around the mouth, and HSV II on the genitals but both can affect either area, and they can be spread between the two. It sounds like your boyfriend is careful when he has an active sore, but it is possible for him to spread the herpes virus to your mouth and genitals or his own even when he doesn't have an active outbreak so be sure he avoids touching your mouth or genitals with his when he has a sore. To be extra safe, it's a good idea to use latex barriers like dental dams for oral sex even when he doesn't have an active sore. You might find this useful: Are coldsores herpes?

3. HPV and HSV are incredibly common, and easily go undetected for a long time. The HPV vaccine covers some of the most common strains of the virus but there are others out there. About 2 in 5 sexually active adults carry HPV at any one time, and 8 or 9 out of 10 will carry it at some point in their lives. Most people won't even know it since it's actually the minority of cases that go on to cause genital warts or cancers. A pap smear won't always show up if you're carrying it since it only looks at cells from the cervix, and not all pap smears look for the virus at all.

4. HPV infections are not forever. Neither HSV nor HPV have a cure, but they are different in their longevity. HSV - herpes - stays in the body forever, and people learn to manage their outbreaks. HPV though can be "shed" (got rid of) by the body by itself. Most HPV infections are cleared by the body naturally within 2 years.

Also, we tend not to talk about people being "clean" when it comes to STI's: it implies that someone with an STI is somehow dirty, or bad. We wouldn't talk about someone having a cold being dirty, so we don't talk about someone with coldsores, or HPV being dirty.

Of course, genitals can get spots just like any other part of the body so it's entirely possible that this is just that, a regular old pimple. It sounds like your doctor is jumping to conclusions a little, but hopefully she'll be able to clear this up at an in-person appointment. I know this is a lot of information all at once! Do you have any follow-on questions?

[Aly_]

Hi Siân, thank you so much for this reply! I tried editing my original post after writing "clean" because I realized that language such as this is negative and perpetuates unfair stereotypes, but I couldn't locate the edit button I'm sorry for my incorrect use of language/ignorance, I should have said we're both negative, but even then, I really don't know if this is the case. Everything that you wrote makes a lot of sense though, so thank you so much for that

My only question is (unless I totally missed it), can HPV just develop out of the blue like this? Maybe it was covered right in front of my eyes and I'm still a little confused. I know it can be passed along through skin-to-skin, and I understand it can go undetected, but can it just develop the way anything in the body can develop? I mean, in school (for example) we learned that Chlamydia can't just develop between two people who are negative, like it wouldn't just... happen, I guess? Unless that's wrong too, I feel like so much I've been taught about sex-ed has been wrong lolz. But I was under the impression if my boyfriend and I are both cleared of any STI's, HPV would not be susceptible to developing. Also, if someone does have HPV, and eventually, they have unprotected sex with another individual, is that individual bound to get it? After an outbreak, is it still incredibly contagious? In other words, after his test results come back, should I get another PAP, or blood test, or be specific in this regard with my doctor? I definitely just want to know my risks for precaution. From the sources that you have given though, I understand that HPV/Herpes are incredibly common and will not hinder people in their ability to live their lives.

She did sound like she was jumping to conclusions a bit, I mean, none of what we've both seen online even matches his description at all. I'm definitely worried because it has been there for two weeks and not gone away, but I just hope everything gets cleared tomorrow. Thank you for your patience and for all of your help

[Heather]

Hey there, Aly.

So, HPV, like Chlamydia, is a virus, so, like all viruses, it gets a place via moving from somewhere else. It can't just manifest out of nothing.

So, per his being tested, the only way he, as someone with a penis, can be tested for HPV is via this sore. If the sore is sampled and isn't HPV, then you can be sure he doesn't have it and then there's no need for you to retest for that. I'm with you in that it sounds like this provider was taking a pretty big leap here. At the same time, it is very common for people to say they never had other sexual partners when they have, or that they have been vaccinated when they haven't, so it's not too surprising of a leap. Personally, I'm a bit dismayed at a provider taking that kind of a guess at all rather than waiting until she sees a patient, but so it goes.

Like Siân said, though, that this might be an HSV (not HPV) outbreak seems much more possible to me given you know your boyfriend DOES have oral HSV. I still wouldn't assume you know anything for sure until he gets looked at, but I would make sure that when you get your regular screenings that you let your provider know your partner has oral HSV. All that said, this could be something else entirely that isn't about an infection at all.

You say you both are worrying a lot about this: that is probably something you can address now rather than later. What are the worries you both are having?

[Aly_]

Hi Heather, thank you for the reply This makes sense about the origin of manifestation, so thank you! That's why I didn't really understand why his doctor is still saying that HPV is something that can just happen out of nowhere and "slip through the cracks" of health... idk.

As an update, my boyfriend just finished at the doctor. He asked her if she can do a swab/sample of the sore, but she told him because there isn't any discharge from the spot, that this isn't possible. She also said that she didn't mean to worry him on the phone, because upon her inspection, it does not look like either HSV or HPV. Which is a relief! She asked him if he knew if I had ever done a Pap, and when he told her that I just had one which came back cleared in September, she said that this was a good sign.

After their appointment, she said that because we have always both been faithful like he told her, it is likely nothing to worry about, but that maybe he could see a dermatologist if the spot is really bothering him. He told her that he is still concerned and would like it to be tested just to clear every worry about it, to which she agreed and sent him a requisition for a blood/ urine test to check for any infection. I'm not sure if a blood/urine test can check for all STI's, I thought some required more invasive procedures like actually sampling the spot as mentioned in your post to fully determine what it is going on. I suppose I am jumping the gun again, but we will have to see what his results say so that it can determine what we will both take with this course of action. I just hope him doing those tests will rule out any/all possibilities of what it could be. I think that he just wants an answer due to being paranoid (and myself as well!)

I suppose most of my worries stem from the fact that HPV can lead to cancer, so when she said it could be that, my mind was racing. Cancer hits really close to home in both of our families, as it does for so many people, and we were scared. I feel better that he spoke to his doctor, but I just hope that everything is being ruled out with the tests that he is taking. I unfortunately know so many cases of people, not even in the sexual health sense, where they have expressed concern to a medical professional about something abnormal going on in their bodies, and in response, they have told them not to worry (almost brushing it off in a sense), and then it ends up turning out to be something bad. Or, when conditions just get written off as something, when it really could be something else. Not to knock doctors or anyone in the medical field at all btw!!!! It's just a concern I guess. We were also worried about our future together, if it is an STI that stays in the body for life, what happens when we do decide to have unprotected sex, what happens when we want kids together and keeping them safe from it, etc. My boyfriend's greatest worry was being at fault for passing something onto me, even though I told him that the blame-game really does nothing and it couldn't be anyone's "fault", especially since we've both always been so careful. Lots of anxieties which stemmed from slippery slopes of overthinking, and which do us no good!! Thank you in advance for reading, truly appreciate it

[Heather]

I'm so sorry that you were put through all of this, and that you felt so scared, particularly given your family histories and the stress everyone is already carrying in the pandemic.

It sounds like, in the end, you two did a really great job talking each other through your fears -- what a wonderful relationship it sounds like you have. That's so great.

I can absolutely relate to what you're saying here about medical care, and I understand. It might help you both to feel better to brush up on what testing involves and covers, even though, as you both know, there really isn't a need for most given both of your (lack of) sexual histories. We've just updated our STI testing basics piece recently here: https://www.scarleteen.com/article/bodi ... tested_for

If you want to talk through any of this any more to feel more resolved with it, I'm happy to do that with you.