STDs Expert Forum
Genital Warts Back or a new Reinfection?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Genital Warts Back or a new Reinfection?

I was diagnosed at 18 with genital warts after my 1st sexual experience.  My gyno actually found 1 little bump on the opening of my vagina, and said I probably would have never known it was there.  He removed it and I never had a reoccurence after the 6 month mark.  He assured me that I built an immunity and was no longer contagious and that I would not need to inform any future sex partners.  I am now 27 (9 years later) and have had multiple sex partners in these past years (7 partners total, with 2 I had unprotected sex with, I was in relationships for 2+ years with each).  This week I found 2 very small bumps on the outside of my vagina, sort of closer to my back bikini line area, on a completely different type of skin membrane than the one I had at age 18 which was more on the inside of my vagina.  I am currently in  a monogomous relationship of 18 months, we do have unprotected sex, and I have not told him about my little wart at 18 since I was told it was not necessary.  I'm currently awaiting biopsy results for these new bumps from the doctor to see if they are HPV.  Pending that they are, I'm wondering if these are a reoccurence of what I had when I was 18, even though they are in the genital area but on a completely different type of skin, and look different as well.  Or could they be a new reinfection from my current boyfriend or a past partner since it takes the system about 1-20 or more months to show any sign of a genital wart infection?  My current boyfriend has told me that he has never had an std.

Also, when I told my current doctor that my doctor at age 18 said I was no longer contagious and didn't have to tell future partners, she gave me a look like I shouldn't have been told that.  Why are there 2 different schools of thought on this (i.e. "you have them forever, and are always contagious" vs. "your body will clear this between 6-24 months, and you are no longer contagious").

Thank you so much for this forum!  
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The topic of HPV and genital warts is a complex one.  I will try to provide some facts.  For addition information on this most common of STDs, I would suggest search for other HPV- and wart-related Q&A on this site, as well seeking addition information on sites such as the American Social health Association web-site (disclosure, Dr. Handsfield and I are both on the Board of ASHA)..

HPV is the most commonly acquired STD.  There are over 100 different types of HPV infections that occur in humans.  Over 85% of sexually active women will have HPV infection at some time in their lives.  In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears.  In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 1 to 2 years.  In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated.  With this as background, I have to say that it is not clear that you had a wart at age 18 (many other processes can be mistaken for HPV) and, even if it was a wart, I would have told you the same thing- no recurrence in six months, you are cured.

There is a lot is mis-information out there and our knowledge about HPV infections is changing rapidly.  A small proportion of HPV infections do persist but the idea that a person who has had an HPV infection is never clear of HPV is just plain wrong.  If the bumps that are being checked turn out to be HPV they likely are a re-infection than recurrence of an infection that occurred in the distant past.

Hope this helps.  Please let me know what your biopsy shows.  EWH
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Thank you so much for the quick reply!  This is very helpful and I am sooo happy that is forum is available.  I will get my results back in 10-14 days, I will keep you posted!  
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Hi Dr.  So I got my results back today from Planned Parenthood.  It was negative for warts but positive for Herpes "Simplex".  Is it possible for a biopsy to be wrong? Two other nurse practitioners were very confident by just looking at them that they were either warts or skin tags, hence the punch biopsy.

Needless to say, I'm very, very, very, confused now.  The Nurse Practitioner that gave me my results today was confused as well, because my symptoms were not like herpes at all.  I had two flat, dry, really small, flesh-colored bumps on the outside of my vagina along my inner bikini line where my thong underwear would rub.  They did not hurt, itch, scratch, they were not pussing or oozing, and they were not sensitive to touch.  I only noticed them because I was trimming/grooming that area and noticed them.  

Next, the fact that there was a biopsy done rather than a swab test seemed odd to this NP as well.  The biopsy site is completely healed so she can't take another sample.  They are taking a blood test instead to see what kind of herpes simplex it is, either 1 or 2 or negative for both.

I'm very worried, scared, etc.  I 've been with my boyfriend for almost 2 years, and we've never had any issues like this.  He's studying for CA bar right now and will take that test in three weeks.  The NP said that we don't need to refrain from sex or need to use protection at this point since the site has healed and I've been having unprotected sex with him since the biopsy 2 weeks ago.  I think that I need to hold off on telling him until I get my final blood results, AND until after he takes the CA bar.  But I can't help but feel dirty and weird if we have sex, if it actually is herpes.  Plus, it is killing me that I can't share this with him!!  I love him so much and we don't keep secrets.  But I think this would ruin his concentration right before the bar.  Please help if you can!

  
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Indeed, this gets stranger and stranger.  I agree with the information given to you at Planned Parenthood.  Herpes is vvery rarely (as in almost never) diagnosed by biopsy and the spot you described sounded nothing like HSV.  Doing a blood test to get things sorted out is absolutely the right thing to do.  Three weeks is a bit long for blood tests to come back.  I suspect your results will be back sooner and when they are I can try to help with their interpretation when they are back.  

The topic of herpes is a complex one.  The disease is common with HSV-1 being present in over 60% of adults and HSV-2 (the virus which causes most genital herpes) being present in about 1 in 5 Americans.  For both infections, the majority of people who have the infections are not aware that they are infected, either because they either acquired it without knowing in the past or because they misidentified their herpes as something else.  I will do my best to answer your questions but in general, many of these questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).

Please let me know what your test results show. EWH
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So I just my blood work back.  The IGG showed HSV -1 at 0.16 and HSV - II at 0.17.  Which is definitely negative!  The clinician at Planned Parenthood is thinking that the initial biopsy result was somehow incorrect, mainly because "herpes simplex" is not usually a  conclusion from a tissue biopsy (punch biopsy).  

I also had a second round of blood work done at the Dr.'s office at my school clinic.  Those results came back negative for herpes as well.  This Dr. that I'm now seeing has been specializing in STD's for over 10 years.  He also thought that the biopsy conclusion was odd.  I am giving him a copy of my Planned Parenthood medical records for him to look over.  Also, contact info for the lab is on this paperwork as well.

So I feel pretty confindent that since I've been in a monogomaus relationship for 2 years and have not been recently exposed to any new sexual partners that I'm herpes free and that the biopsy was incorrect.  The Dr. at my new school clinic will hopefully be able to confirm this after I drop off my records on monday morning.  

The only thing that I was curious about, and this is probably because I watch too many episodes of "House", is that during the biopsy, the NP had another nurse grab tweezers from the exam room next door.  I couldn't tell if they were new or used, but would it be possible that the biopsy tissue was contaminated from a dirty instrument?  What is the likelihood of contracting herpes from used medical equipment?  

Thanks so much!
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I think we're all on the same page.  The earleir biopsy diagnosis was incorrect.  You do not have herpes.  

The riskl that you got herpes from the biosy is negligble.  If you had, you would have had an outbreak of more typical lesions and your blood tests would have become positive.  

I hope you can put this all behind you.  EWH
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Hi Dr. Hook,

Thank you for your help!  I have just one last question, so sorry!  I just want to get your opinion on this one last thing...

Even though both of my blood tests were completely negative on all fronts (no equivalent results), the Dr. I'm seeing wants me to re-test in 2 months again (since my biospy was in Jan., this would satisfy the 3-month window) just to make sure this is not a "new infection". I guess the current blood tests I took were to rule out if this was a possible infection from before my current 2-year relationship.  

My boyfriend is negative as well in his blood tests.  My Dr.'s justification is that he wants to rule out any possibility that there is a "new infection" that was contracted from outside of the relationship within that last couple of months, which would give false negatives.

I asked how that could be possible since I'm only kissing and sleeping with my boyfriend and vice versa, no cheating.  His repsonse: "Anything is possible, HSV-1 can be contracted through sharing drinks, sharing utensils, etc., and then transposed genitally".  Personally, I'm a big germaphobe and NEVER share drinks or utensils with anyone anyways, same with my bf.  How likely is it to contract genital herpes this way???

So really, is this just a protocol thing that my Dr. is asking me to do?  Since the blood tests ruled out an "old infection" and now they just want to rule out "new infection" of possible HSV-1.  By the way, my Dr. has told me that "all arrows point to me not have herpes" but he won't "clear me" until this one last test done.  How accurate is the IGg at 3-months?  My Dr. is saying it is 70% accurate....I've heard from other sources its 95% accurate.

Thanks again!!
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Your doctor is being quite conservative.  Your reasoning is on target. You chances that a future test will be positive are near zero.  Hard to fault him for being cautious. He's working with your best interests in mind I suspect.

HSV is just about never srpead by inanimate objects such as glasses.  this is not something to worry about.  EWH
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Great, thank you so much!  This forum is really amazing, you are doing wonderful work!
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