Genital Wart reoccurrence after 8 months

[SuperSpanky]

Back in December of 2008 I posted a topic here about bumps in my pubic region.  I went to the dematologist and he diagnosed them as genital warts and lasered them off.  There were about 3 warts on my pelvic area, and another 4 or so on the lower shaft of the penis.  I always use a condom when I have sex, so that's why they weren't anywhere else (only where the condom didn't cover). For what it's worth, I think I had these warts since August of 2008, but didn't realize it until December.

In April of 2009 through June 2009 I dated someone, and we had oral sex twice and protected sex maybe 10 times.  In July 2009 I had oral sex and protected sex with a different girl.

This morning I was looking around and saw what looked like a very small wart on the shaft of the penis right above where the pubic hair ends.  I wasn't sure since this area has a lot of hair follicles and other bumps, but this very small bump had a ridge on it.  I went to the dermatologist and much to his surprise he diagnosed it as a wart and lasered it off.

So, it would seem that after 8 months of having the warts treated, another one popped up.  Or perhaps this one has always been there, but it was missed back in December?

My questions:

1) What is the chance that either of these girls would get genital warts since I had a small one on the shaft?  Condoms were used, and this area should be protected by a condom.

2) I read here that getting warts in the mouth from oral sex is extremely rare.  Is there a chance that either of these girls could get warts in their mouth from performing oral sex on me?

3) When is this going to end?  After a year and having treatment done, shouldn't this be over by now?

4) How long should I wait again before having sex?

5) Can I transmit these warts to other areas of my genitals by touching the warts and then touching myself?  From my readings here it seems that this is rare, but can't be entirely ruled out.

Thanks.

[Edward W Hook, MD]

You are asking hard to answer questions which we get here often.  Before I address your questions as best I can, I would also like to place your question in context.  Virtually everyone who is sexually active gets HPB and many of those HPV infections are present as warts.  Please remember is that for unvaccinated persons, the minimum estimate of HPV prevalence is 85% (meaning that no more than 15% will not get HPV).  Further, as long as persons treat warts when they are present and troublesome, has unusual skin problems evaluated by trained professionals (as you have done) and as long as women get regular PAP smears, warts will cause very, very few health problems.  Thus while one should never be un-caring about the possibility of giving another person an infection, be it a cold or HPV, if it happens it is not the end of the world.  I hope this doesn't sound disinterested, I am but in the larger scale of things that can do harm to other people, HPV is not near the top of the list.  Now, on to your questions:

1.  If the area was covered by the condom, the chance of transmission is quite small(but I cannot put a number on it- certainly less than a 1 in 4 chance, probably lower).  I say this not only because of the barrier action of the condom but also because of the fact that not every exposure leads to transmission of infection.
2.  In science we never say never and recent studies do indicate that occasionally HPV can be transmitted to the oral cavity through oral sex.  When this rare event happens, it is of no major consequence.
3.  My guess is that the wart you discovered was missed earlier.  Typically if a wart is gone for 4-6 months, it will not recur.  Try not to get too upset by this.
4.  Once your site of infection is healed you can return to condom protected sex.
5.  Once again, we never say never but the chance of you having transmitted infection from your genitals to elsewhere on your body through touching is miniscule.

I realize that none of these answers is as firm and definitive as you want.  sorry, that's where the data take us at this time.  EWH

[SuperSpanky]

Thank you very much for your response. The information provided here has been of invaluable help, both from you and Dr. HHH.

I agree that a wart is rather trivial, but it's just the idea of giving something to someone that is upsetting.  

One thing that I was thinking about, and I hope I could get your opinion on, was the previous warts were dark in color and considerably larger.  If this was a wart from at least 8 months ago, wouldn't it have grown and been a similar color to the previous ones?  This was very, very small and was completely flesh colored (thus how I could have missed it for so long).  I don't want to second guess the dermatologist, but he said it was a wart because it had a "cauliflower" like appearance. Is it possible this was something else like a skin tag or similar?

Finally, in a typical case, how much longer until typically my body will defeat this virus and I don't have to worry about it anymore?  What is the chance that new warts will keep popping up?

[Edward W Hook, MD]

Good questions.  I didn't wnat to 2nd guess your dermatologist on whther what got frozen was a wart or not but I did wonder.  Sometimes ist is easier to jsut "make things go away" and freezing or laser will certianly do that.

The appearance and time course for earlier warts would not precdict the response of a subsequent one, if that it what it was.  the reason for this is that your earlier treatment may have strenghtened your immune response to HPV.

Typically the body develops immunity that controls HPV in less than a year.  I doubt taht you will continue to have them "pop up".  EWh

[SuperSpanky]

Thanks for the information.  I asked the dermatologist when this would finally end and he said it was up to God.  I don't think defering to God in instance was acceptable.

I have read through almost every thread in the archives here pertaining to this matter, but there are two questions that I didn't see anyone else raise.  These are my final questions:

I understand that warts are spread from skin-to-skin contact.  Does this mean if I have a wart on my penis and it touches my pubic area, it will spread the wart there?  Or are warts only transmitted when you first come into contact with an infected partner and you get a wart at the exact location corresponding location on your body?  Or once the body gets the virus, warts will just appear in the genital region?

And finally, in terms of reoccurrence, does this mean after a wart has been treated and it comes back in the exact same location, or just any new wart after having them previously cleared?

[Edward W Hook, MD]

We never say never in science but casual contact of the sort you mention is very, very unikely to spread warts.  

When warts recur they do so in the same, or very near to the same place.  EWH