Follow up to HPV Clearance

[goeagles81]

Hey Doc,
I am confused about something I wanted to see if you could clear up for me.  I am under the impression that HPV is caused only by strains 6/11... so if I have a genital wart does that mean it has to be one of those strains?  In your post to my "HPV Clearance" question you stated how "Almost everyone has it, or has had it etc..."... I know they may have/had hpv but isn't that different from warts since most strains do not cause any symptoms/harm except a few strains?  When disclosing this info. to a partner... would saying that I have HPV be enough or would I have to go into detail about having the wart strain? I could deal with the fact I had HPV if I had no symptoms but the fact that I have a strain/visible symptoms that only 1% get is what is hard for me to accept.  It's hard for me to be apart of that 1%.  I recently had a biopsy performed on two growths. A week later the derm called me with results "Results came back normal tissue... minor irritation which is common in young males... But I want to send the tissue back for a closer evaluation just to be sure and make sure they did not miss anything." I was relieved until I got a call the next week "Turn's out to be verruca, they said the growth was "consistent" with a wart. They cannot give a 100% diagnosis which my doctor said they are "covering there *** legally" I want you to come back if you find another and we'll take another culture.  My question is...

1.) How can one biopsy be normal and the other abnormal? Is it possible two difference scientists did the inpections thus two different opinions?

[H. Hunter Handsfield, M.D.]

Thanks for looking for the answers before posting.  A warts/HPV FAQ will be available in the next week or two; sorry for the delay.  Some quick responses to your complex questions, overt or implied:

HPV isn't "caused" by types 6 and 11.  Genital warts are mostly caused by HPV types 6 or 11. If you had warts, you probably were infected with one of those types.

Disclosure:  as you know, I don't believe this is ethically required after some months pass and the infection appears to be gone, although others disagree with me on this.  If you disclose, it's probably best to say that you had warts, without worrying about the specific type.

I'm not sure what you mean by being "part of the 1%", or where the 1% figure comes from.  Maybe you mean the risk of persistent infection, but I never used that percentage.  It's probably more than 1%.  It isn't specific strains that persist or not.  Any particular HPV strain or infection may or may not persist.  Most clear up, but there is no way anyone can predict which infections will or will not persist.

A biopsy is simply a snip of tissue examined under a microscope.  A biopsy may miss the abnormal tissue; the doctor might take a sample right next to the infected area, for example, so having different results from different biopsies is entirely possible.  The abnormal result should be considred the definitive one--that is, you have genital warts.  (Yes, pathology labs often use cautious terminology for medicolegal reasons.  But you can be certain about the result.)

Good luck--  HHH, MD

[goeagles81]

2.) What is a biopsy?  Closer visualization or test for the HPV Virus? Because he said no virus was present but I am under the impression men cannot be detected for HPV.
3.) Is there any reason to believe that the first diagnosis may have been correct over the second? My derm. just seemed unable to give me a 100% diagnosis as he wants me to come back with another biopsy if I get another wart... Well what if I never get another one?  Should I assume I have it and proceed to inform partners from here on out?

I'm sorry for the long post it won't happen again

I look for the HPV FAQ Post but could not find it...

Could you lead me in the direction

Thanks for all your help Doc
-Frank

[goeagles81]

Sorry,
I mean to say GW is caused by strains 6/11 not hpv

[H. Hunter Handsfield, M.D.]

I figured you meant something like that.  My correcting response was intended as much for other readers who might not know.

HHH, MD

[goeagles81]

I have just read numerous times that 1% of the population exposed with genital warts will actually get symptoms (wart on genitals) and that the other 99% will not show anything.

[goeagles81]

Factsheet
HPV - Wart Virus
Date   09 February 2005




HOW COMMON IS THE WART VIRUS?
Wart virus is very common - 75% of people from 15 to 49 years of age who are sexually active, have wart virus, or have had it in the past. Only 25% of sexually active people in that age group show no signs of ever having HPV. Most people who have HPV have no idea that they carry the infection.
Only 1% have visible warts
4% have HPV found on a Pap test
10% have sub-clinical HPV that can be found with special pathology tests.
60% have had HPV in the past but have no signs of it at present

http://www.fpahealth.org.au/sex-matters/factsheets/71.html


Here's one of many sources I have found that state this fact.  Does that mean that most have the wart strains and do not show symptoms or just out of all people only 1% with hpv cause symptoms? Just seems to me like although HPV is very common... genital warts is not.

Thanks For all your help doc

[H. Hunter Handsfield, M.D.]

Based on a quick look, that appears to be a reliable website.  But they are behind the times.  A very recently published research study, considered highly reliable by the experts, indicates that almost 50% of women who acquire HPV types 6 and 11 develop visible warts.  That rate surprised me a lot; I have always said 10% or less.  But the study was well done.  It was a research study, in which the women involved were probably especially on the alert, and they were having regular exams by the investigators. My bet is that only about half of them would have known they had warts otherwise.  But that still suggests that at least 25% of people who acquire genital HPV 6/11 will develop overt warts.

But HPV 6 and 11 indeed are in the minority; the "high risk" types, those associated with cervical cancer and with most pap smear abnormalities, are quite a bit more common.  And there are many other types as well.  The large majority cause no symptoms and do not lead to serious health problems.

HHH, MD

[SunnyTriangle]

This is probably a real ridiculous question, and I don't expect an answer, but is it safe to assume that our idol HHH has probably had HPV in his lifetime, even if it was transient and he didn't know it?  The stats would support that, and it would make me feel a whole lot better too!!! :P

[H. Hunter Handsfield, M.D.]

Your "idol"?? I hope not!

Let's just say I had my day, and I assume I have been infected with HPV.

HHH, MD

[SunnyTriangle]

COOL!!!!! :))))))))))))))

[Cupcake20]

A related discussion, Genital Warts Help was started.