Genital Warts Confusion

[Curious100]

Hi, I am male and had protected sex with a female on February 2008. On July 2008 I went to a STD clinic and was diagnosed with genital warts on my scrotum. Everything else was fine. The warts were removed by freezing on the first week of July. On my following appointment to ensure the warts were fully removed, a new Nurse and Doctor inspected me and could not detect any more genital warts. They also commented that they weren't actually sure I had genital warts but did notice that I had bumps on my skin that they said were just raised portions of skin. I unfortunately didn't study the warts that closely before they were removed, but they did seem to stick quite strikingly outside of my skin and appeared to be warts.

Reading the forums, I found that you stated that in general after 8 to 10 months, genital warts usually clear themselves up and the person is considered "cured" and "safe" without the need to disclose the HPV condition. I next had sex with a female April 2009, 14 months later. She was previously in a monogamous relationship for 3 years and before we had sex had a full std screening, which she passed. We have since separated and I've started a new relationship with a new woman.

Recently I've noticed you've changed the time for when the warts are considered cleared from up to 10 months to up to 24 months!

When is it considered safe for me to engage in guilt-free sexual relations without the risk of passing on my genital warts and without need to disclose my HPV? I've inspected my scrotum and I don't appear to have any genital warts, even though I still have the raised bumps of flesh the Doctor previously noted. What do you advise? Should I get reinspected by professionals to ensure that I don't have any genital warts? When can I engage in sexual relations without the need to disclose my HPV because I'm effectively "cured" and not a transmission risk?

thanks

[Edward W Hook, MD]

I haven't spoken with my colleague about this recently but I continue to advise my clients that if warts have not reappeared by six and certainly by 8-10 months, they can safely consider themselves to have been cured of the HPV infection that caused their warts.  Furthermore, in your specific case, it is not at all clear that the lesions you had removed from your scrotum were warts.  The scrotum is an unusual place for warts to appear and there are many other dermatologic processes such as skin tags which are common on the scrotum and can be mistaken by warts.  If you are concerned about the raised bumps you describe, you should have them looked at by an experienced clinician -either at your local STD Clinic or by a dermatologist.  Personally however, I would not worry.

As far as unprotected sex, as I implied above, if it has been over 6 months since your possible warts were removed and they have not recurred, you need not point out that you were treated for warts to partners - you are cured.

Hope this helps. EWH

[Curious100]

I think I might have scratched off one of the raised bumps this morning. I still have a couple more present on my scrotum however. Is it possible that I prematurely removed a genital wart and therefore can't accurately determine if I have fully removed the HPV from my system? Far fetched, I know.

I must have misinterpreted some of your previous forum post. For example: http://www.medhelp.org/posts/STDs/HPV-many-years-later/show/534432 . I thought after 10 months, even without any treatment, most people would be considered "cured" of HPV. For genital warts, I see now, there must be no warts present.

I'm curious about the 6 month duration. Is it that I am cured if at 6 months and over that there are no warts present at all? Or is it the situation that I'm cured only if during 6 months no warts have ever reappeared. Would that mean that I would have to consistently monitor for 6 months that no warts have reappeared? To be honest, I haven't really been consistently monitoring for the last 12 months if I had any recurrence of genital warts. My warts were removed about 12 months ago. July 18 2008 to be exact.

Are genital warts quite obvious looking? i.e. They all have the cauliflower appearance?

What do you recommend as a best way forward. Should I move on with my life and consider myself cured? Considering your comments about the unlikeliness of scrotum genital warts. Or should I visit the STD Clinic. I am a bit leery of another possible misdiagnosis, I guess I could use my conservation with you as backup.

Thanks for your time.

[Edward W Hook, MD]

Once the genital warts are gone, whether due to therapy or because they go away on their own. If they do not recur after 6 months, you should consider yourself cured.  

Genital warts can vary in appearance.

You are clearly concerned about the possibility of warts.  Go get them looked at.  I am concerned that if you do not not, you will continue to worry and that does you no good.   EWH

[Curious100]

Hi, Thank you, I will get this looked at, just some final questions for clarity please:

So after the warts are initially gone and after 6 months, if there are no warts currently present when inspected by a medical professional, the person is considered cured?

What if the warts reappear after the initial removal of warts. Is the clock reset and the patient has to wait another 6 months from when the warts reappear and the new warts are subsequently removed?

Do you inspect your patients with genital warts after 6 months to ensure that they are genital wart free and therefore indeed cured? Do you tell them to monitor themselves in case the warts reappear after the initial removal of the warts?

In my situation, when I get inspected again for warts, it will be about 12 months since my warts were officially deemed removed. If I don't have any genital warts and just random skin bumps, will I be considered cured? I have not actively monitored myself to detect if I had any genital warts recurrence. Therefore, I might have had an undetected wart recurrence without my knowledge.

Thank you for your patience. I am just a bit dismayed that there is no clear test to determine if someone is cured of HPV. I am from a developed country ( Canada ) the std clinic did not provide much post treatment information about HPV and being cured.

[Edward W Hook, MD]

I feel as though you are asking me to repeat myself again and again.  This will be the final response.

Recurrence of warts is assessed from the time they are gone. If they recur, they either need to be treated or go away to start "the clock again".  when warts appear, they can be treated, there is no reason to wait to do so.

No, no one I know does follow-up checks to see if warts are gone at six months.  If it has been twelve months since your warts were successfully treated, then you are cured.  If you do not trust yourself to make this assessment, then ask your doctor.  

the field of HPV is a rapidly changing field and thus it does not surprise me that the clinicians at your STD Clinic may not have a lot of information.  This is in part due to the fact that the field is changing so fast, in part because warts are so very common (85% percent of adults will have HPV infection at one time or another) and in part because for most people they are just not serious if managed appropriately.  Hope this is helpful to you.  EWH

[Curious100]

I apologize for forcing you to repeat yourself and sincerely hope that you'll respond to my last comment.

The main issue I am stressing about is monitoring for recurrence of genital warts for the next 6 months after the initial removal of warts. Like you said, warts can vary in appearance and there are many dermatological processes such as skin tags which are common on the scrotum and can be mistaken by warts.

So after my warts are initially confirmed gone, I would have to carefully log any pre-existing skin anomalies on my genitals and scrotum and for any new skin anomalies that crop up post treatment, I would have to get a Doctor to inspect it to ensure that it's something benign and not a wart. This is all for the next six months.

I guess that's what I have to do, otherwise I would be stuck with the ethical, legal, and moral issues of exposing someone to something I know I have. Thanks for your time and I won't ask any more questions.