Follow up HPV Type 6 Questions and recent exposure

[InAsia101]

I posted about 6 months ago about possible HSV2, HPV and HIV. I was diagnosed with HPV type 6 and had 3 warts on my penis cryo'd off.  I then had a HSV test several months ago,  less than 3 months post exposure but type specific and a very sensitive German one. The dr said 97% i dont have HSV2. However, I went back to the doctor today as it has been over 6 months since my original cryo therapy for HPV type 6 and I was also concerned there was herptic sores as well which had appeared separately. The doctor examined me and said no in relation to herpies - rather he said it was a benign skin condition but upon closer examination he noticed an additional wart on my penis which wasn't their before so he provided cryo treatment for this single wart. This kind of depressed me as I thought I was wart free it being 6 months since it was first diagnosed and treated. He said it was just one in the same area.

Questions - One, how common is it to have an additional wart 6 months down the track after initial treatment? The dr who is an std expert said pretty common and 99% of his patients who don't engage in anal sex clear it in 1-2 years. Secondly the doctor said I can be reinfected with the same type as the virus lives in the skin - but this didn't seem to gel with my understanding of immunity - I thought you couldn't ping the same type back and forth; and thirdly, stupidly, for the first time in 6 months I engaged in drunken but protected (as far as I can recall) sex with a csw. The condom covered the area of the 'new' wart (which I was unaware of). I hope I didn't pass it to her but I know condoms are not 100% protection. Afterwards we discussed this and she said she had nothing but I'm afraid I/we could have passed something to each other even with me using protection. What are the chances of such and should i get any further tests? I have since decided to give up alcohol altogether as it has always resulted in poor judgment and regretful behavior.

[Edward W Hook, MD]

As you point out, it is not a therapuetic vaccine.  IT would prevent new infection with HPV 6 but not established infection although my guess is your infection is not treated and no longer present.

Time for this threatd to end.  EWH

[InAsia101]

therapeutic that is!

[InAsia101]

Thanks ill probably get it but while I understand the vaccine is not therapudic would it increase my immune response to a re-infection of type 6 again or it spreading to other uninflected generic skin or is this unknown? Thanks in advance and ill leave it here for questions.

[Edward W Hook, MD]

1.  Yes, I would agree with his assessment as well.  If you were going to fail therapy, I suspect that would have occurred already.

2.  The vaccine would cost you about $500.  I recommend it for most patients and in particular those who are likely to have other, new partners.  If your only conern is recurrence of the warts you have already had diagnosed, the benefit is somewhat more marginal.  Other than cost however, there is little downside to the vaccine. Up to you.  EWH

[InAsia101]

Just a few follow ups if that's ok:

1. The dr agreed with your analysis in in terms of this simply being an unapparent wart at the time of initial diagnosis rather than a reoccurrence. In light of this would you agree that the prognosis is pretty good in the sense that of there are no further detected warts in the next 6 months I 'should' remain wart free? He explained the infection is like scattering seeds over the skin but some grow faster than others.

2. He suggested some time ago that I get a HPV vaccine shot however I saw little value in it at the time as I'm a 35 year old male and it's not therapeutic. Having said that the dr said it would protect those parts of the genital skin that have not already been infected with type 6 and of course the 3 other HPV types the vaccine blocks. Despite my age he recommended it. Considering the ping pong effect would the vaccine strengthen my immune system again re-infection of type 6 or protect other parts of the genital skin not yet infected? I understand there are no studies on the vaccine's effectiveness in persons over 26 but is appreciate your input - if there is any value in getting it I'm minded to.

[Edward W Hook, MD]

Welcome back the Forum.  This question is a continuation of your earlier interaction with us 6 months ago and, similarly, if I had to guess (there is no way to be sure) I would suspect  that additional wart recently noted was present but unnoticed at the time you were evaluated in January.  Warts are VERY slowly progressive and this may have been comparatively unapparent when you were initially seen.  Since warts are typically otherwise asymptomatic, this may have simply, slowly progressed to the point where it has become apparent.

The doctor you spoke with is correct.  People with naturally occurring HPV infections can become re-infected with the same HPV types, as well as other types.  The immune response to naturally occurring HPV infection  is modest and may not prevent re-infection.  FYI, in contrast, the response to the HPV vaccine is much stronger than to naturally occurring infection, and does prevent recurrence.

Finally, your risk of having gotten, or transmitting something in the course of your recent condom protected exposure is quite small.

I hope these comments and clarifications are helpful  EWH