Genital Wart Reoccurrence after 2+ years clear?

[toomanyquestions123]

Hi Dr(s):

Dec 07/Jan 08 I was diagnosed/treated for 3 very small genital warts. I was prescribed Aldera (spelling?)- and the warts cleared in about 1 week. My doctor was very pleased with my body's reaction. He also advised me that there was no need to disclose my HPV history- due to prevalence of the virus and tendency for people to be asymptomatic. He did, however, take the position that the virus was in my body for good. I have read this forum, and heard from various other sources the idea of your body "clearing" HPV.

I've had no reoccurrence since the primary episode. And have had sexual partners that (as far as I know) did not end up with visible warts.

Yesterday, I noticed a small bump on the area I believe is the perineum (a little less than an inch below and to the right of my vaginal opening).

I'm definitely a worrier- especially when it comes to how my actions effect other people. My current boyfriend (of about 5 months) and I had the discussion about me having HPV a few months into our relationship, so he knows I had a history of it- but that I was clear for nearly 2 years prior to involvement with him. After my last annual and him clearing an STD screening- we opted to start having unprotected sex. I brought it up to him yesterday after I found the bump that I was fearful that I was contagious at that point- and perhaps my HPV was no longer dormant.

I guess my questions are:
1. Is it likely that after over 2 years clear of the warts, it would reoccur?
2. Is there such a thing as a reinfection- or if I had strain 6, could I have picked up strain 11? (I had my annual in January, and my GYN said everything looked good.)
3. In regards to my boyfriend- if it is the a wart- is it suggested that we abstain from sex now/after treatment? Or is it sort of a moot point because we've been intimate and unprotected for months now?

Sorry to be so wordy!

[toomanyquestions123]

I had my appt a few hrs ago. My gyn felt it was not a wart- he didn't think it looked like one at all- and although he still said he felt the virus stays in your system at some level- he thought it would be really strange for me to have another episode 2 years later.

I have had some tearing in the perineum (I'm only 24- no babies!) after sex- top level paper cut sort of tears- that heal about a day later for the past few years. (Ive tested and cleared for HSV-2.) He felt maybe the bump was scar tissue- and had some concern that I had persistant tears in the same spots- so he prescribed me a low dose steriod cream to try and rule out lichen sclerosus and a few other skin conditions he listed off that I don't quite remember. If it persists, he suggested a biopsy.

I'm relieved- but still a bit nervous about having a "unknown" bump in the region.

[Edward W Hook, MD]

Great. Glad to hear this.  Thanks for sharing.  EWH

[Edward W Hook, MD]

Please let us know what she/he says.  EWH

[toomanyquestions123]

Thank you so much for the quick response, Dr.
I have an appointment with my GYN tomorrow so it should get straightened out then!

[Edward W Hook, MD]

Welcome to our Forum.  Your questions are good ones and ones that we encounter frequently on our forum.  The question of HPV clearance is a common question and, for better or worse, one that you will get different answers about from different sources.  In one recent post we addressed the question this way - "Many HPV biologists believe HPV DNA usually or always persists indefinitely.  However, even with the most sensitive tests available in research labs, the virus becomes undetectable, typically over several months to a year or two -- longer for the high-risk (cancer-associated) HPV types, shorter for low risk and wart-causing strains like HPV-6 and -11.  After that, it is uncommon for that particular infection to reactivate -- i.e. recurrent warts or newly abnormal pap smears are infrequent -- and subsequent transmission to sex partners is rare.  So for practical purposes, the infection is completely resolved and can be considered cured.  "Uncommon" doesn't mean these things never happen; they do, but infrequently.

So you can understand how some experts interpret these issues into conflicting messages:  "Most HPV infections are cured by treatment and/or the immune system" versus "HPV persists and is never really cured".  My own perspective is the first of these:  people should consider themselves cured when all signs of their HPV infection are gone and there is no recurrence within a few months."

In your own case, particularly given your own characterization as a "worrier" I think the first thing to do is to be sure that this is really a wart.  there are many normal skin conditions that can be mistaken for warts in the genital area.  Thus I would suggest you ask you doctor about this lesion.  

Let's now go on to your specific questions:

1.  As stated above, it does occur but rarely. IF (and I emphasize the "if")  this is a wart, it is more likely to be a more recently acquired infection.

2.  Re-infections are thought to be very rare.  When a wart resolves following therapy it is thought that immunity plays a role in this.  In your own case, the treatment you received (Aldara or imiquimod) is thought to enhance immune responses as well making recurrence even less likely.

3.  If it si a wart, it is a moot point.  If it is a wart he should be evaluated. If nothing is seen, there is nothing to be concerned about.  if he has a wart he is unaware of, he needs treatment.  

Hope these comments help.  Also, just in passing, have you considered the HPV vaccine.  It is recommended even for women who have had a prior HPV infection.  EWH