Genital Warts Recurrence

[SomeQuestions100]

So I was diagnosed with genital warts on my scrotum by a medical professional at a STD clinic. I'm a 28 year old heterosexual male. The warts were removed by freezing and a week later were confirmed to be removed by the STD clinic.

I was researching here that if I don't get a recurrence of warts for six months, I would have cleared the virus and am not a transmission risk anymore. That's my ideal situation, so I can move on and so that nothing needs to be done or said to future partners.

My question is, do you have any hints for how to detect for a recurrence of genital warts?

When my genital warts were confirmed remove, the Nurse and Doctor did notice that I did have various skin irregularities on my scrotum, namely bumps. Should I log my pre-existing bumps with photos and notes? I can then use the photos and notes to check if I get any new skin irregularities which might be a recurrence of genital warts and have them professional checked out. I have tried to do this but have been finding it difficult to track and organize my skin irregularities. For example, depending on the angle, and if I stretch my skin I can sometimes see bumps. Also, I shave down there and have bumps where my hair follicles start.

Any suggestions on how genital warts typically look? How often should I check for recurrences? Every day, every week or every month? How long do the warts usually last for if I do get a recurrence?

Will the warts recur in the same area? I'm not very sure of the exact location, but I'm reasonably sure they occurred originally near the bottom of my scrotum. Will they recur in that area?

Is it possible for me to self spread my warts? Can they spread to other parts of my body, hands or to other parts on my genitals? For example, my underwear spreading the warts to other areas of my genital or hands spreading it to other parts of my genitals? If my genital warts cannot spread, will they likely recur in the same area original area?

My question continues

[Edward W Hook, MD]

I have not and will not read this question.  There is a word limit for posts on the site for a reason.  We can only handle so many questions per day.  If your question cannot be condensed to within the specificed workd limit the qestion will not be answered.  EWH

[SomeQuestions100]

My genital warts were removed 5 months after my last sexual contact. I was reading in another post where you stated the typical time it takes for genital warts to be cleared without treatment is 6 to 12 months. Does that mean statistically it's unlikely for me to have a recurrence?

I'm trying to sort out some issues with HPV and wish for you to comment and agree or disagree:

From what I understand, there's no way for me to know if I have any other type of HPV. There's no test for HPV. I am concerned I am infected with another strain of HPV, specifically the high risk cancer causing types. In theory, I could wait 2 years for any potential HPV infections to clear up, which still isn't a guarantee I would have cleared the virus. However, in long term relationships, sexual compatibility is important and 2 years of abstinence seems difficult.

Is my best course of action for any long term relationship is to encourage the female to get regular pap smears? Is every year appropriate? Is it true that cervical dysplasia is easily treatable and not a big deal? I was thinking for short term relationships, it is appropriate for my female partner to be responsible for her own sexual health and for me not to bring up HPV.

I am just concerned that bringing up HPV and cervical cancer would be a mood killer and more appropriate for long term relationships. That is also why I am hoping I can successfully clear my genital warts and therefore not having to mention it to future partners.

Is it true that cervical cancer is considered rare and even with a high risk HPV infection, progression to cervical dysplasia is rare and progression to cervical cancer even rarer?

My biggest concern is somehow causing my partner cervical cancer or being wrongly blamed for causing cervical cancer. Once HPV is cleared, is it true it won't cause cervical dysplasia? Is it true that if a woman does have cervical dysplasia, it's difficult to determine how it was contracted and could have easily been contracted from a previous partner? For example, if I was in a long term relationship and she gets a pap smear and has cervical dysplasia, is it possible she contracted it from a previous partner, even a previous partner from more than 2 years ago? Is it possible for a woman to have cleared the HPV virus but still have cervical dysplasia from the original infection of the virus?

My last question may seem a bit strange, but I need a bit of reassurance. What are the risks of sex or "physical intimacy". Are the only risks STIs / STDs? So if I don't have any STIs or STDs, it'll be perfectly fine to start a new relationship and be physically intimate? If I don't have any STIs or STDs then there's nothing currently that puts me or my next partner at risk if I'm STD / STI free?

Thanks!

[SomeQuestions100]

Condensed Version:

I was diagnosed with genital warts on my scrotum by a medical professional. I'm a 28 year old heterosexual male. The warts were removed by freezing.

So if I don't get a recurrence of warts for six months, I would have cleared the virus and am not a transmission risk anymore. That's my ideal situation, so I can move on and so that nothing needs to be done or said to future partners.

Do you have any hints for how to detect for a recurrence of genital warts?

When my genital warts were removed, the Doctor did notice various skin irregularities on my scrotum, namely bumps. Should I log my pre-existing bumps with photos and notes? I can then use them to check if I get any new skin irregularities which might be a recurrence of genital warts and have them professional checked out. I have tried to do this but have been finding it difficult to track and organize my skin irregularities. For example, depending on the angle, and if I stretch my skin I can sometimes see bumps. Also, I shave down there and have bumps where my hair follicles start.

Any suggestions on how genital warts typically look? How often should I check for recurrences? Every day, week or month? How long do the warts usually last for if I do get a recurrence?

Will the warts recur in the same area? I'm not very sure of the exact location, but I'm reasonably sure they occurred originally near the bottom of my scrotum. Will they recur in that area?

Is it possible for me to self spread my warts? Can they spread to other parts of my body, hands or genitals? For example, my underwear spreading the warts to other areas of my genital or hands spreading it to other parts of my genitals? If my genital warts cannot spread, will they likely recur in the same area original area?

My genital warts were removed 5 months after my last sexual contact. I was reading in another post where you stated the typical time it takes for genital warts to be cleared without treatment is 6 to 12 months. Does that mean statistically it's unlikely for me to have a recurrence?

[Edward W Hook, MD]

Welcome to the Forum and thanks for condensing your post.  it helps me to organize my comments.

I don't mean to sound uncaring and I applaud your concern about prevention of transmission to others. For better or worse however, at present HPV is a "fact of life" and most people have it or will have it at some point in the future.  Despite this fact, only a tiny minority of persons with HPV get the consequences of infection (primarily women and primarily cancer and pre-cancerous lesions).  HPV is the most commonly acquired STD.  Over 85% of sexually active women will have HPV infection at some time in their lives.  The figure for men is less well studied but similar.   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 8-24 months.  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.  For men there is far less risk of any sort.  With this as background, let's address your questions.

Detection of new warts is sometimes difficult, particularly in locations such as the scrotum where, as you are aware, there are already a great number of "bumps" and other irregularities.  If you become aware of warts in the course of normal activities I would have them taken care of but I would urge you NOT to rely upon photographs or repeated self-examination.  In the overall scheme of things the problem does not warrant it.  

Should your warts recur, they are most likely to recur in about the same area as your original infection.  HPV is not spread by scratching, hand transfer, in underwear, etc.  

Finally, the "clock" for watching for recurrent of your treated warts begins at the time of treatment, not when the warts were first noted.


The topic of HPV and genital warts is a complex one.  I hope the facts I’ve provided are helpful.  For additional 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)..Hope these comments are helpful.  EWH

[SomeQuestions100]

I just have a few follow up questions.

Do you mean that if two people get infected with the same wart causing strain of HPV, one person may develop warts but another person might not? Or is it that different strains of HPV do different things ( cause warts or cause abnormal PAP smears )

I must seem overly concerned about genital warts and HPV transmission. Definitely the reports about lawsuits against people who infected others with HPV or genital warts has me concerned as well as the general moral and ethically implications.

I've read that the HPV that causes genital warts is low risk. Does that mean it never or just rarely causes abnormal PAP smears? Or does it mean that strain of HPV does causes abnormal PAP smears but those abnormal changes never lead to cervical cancer.

Do different strains of HPV cause warts on different parts of the body and only prefer that part of the body? For example, certain HPV strains cause warts only on the hands, only on the feet and only on the genitals. I might have some warts on my hands, which I'll get my Family Doctor to inspect. Is it possible it's a genital wart strain? Should I be concerned about potentially infecting others genitally or in other places of their bodies?

In general, is the cervix the only place where HPV causes problems? Does HPV cause any health issues in other parts of the body? I've had warts on my hands and my feet before, will that cause cancer on my hand and feet? I have read that HPV can cause cancer in the penis, throat, and orally, but it's rare isn't it? Is there anything practical I can do to prevent HPV causing cancers in that area? I am more concerned about transmitting HPV to others and potentially causing cancer in those areas. Is there anything practical I can do to prevent that?

I've performed and received oral sex on the partner who probably gave me the the genital warts. My genitals have been infected already so receiving oral doesn't matter. However, is it possible that I have a HPV infection in my face or mouth or even some other part of my body? I have read that HPV 16 causes oral cancer and it's a genital HPV. Is it okay to kiss someone in the mouth, cheek, or other parts of the body? Can I transmit potential HPV infection from my mouth or from other parts of my body to someone else? Is performing oral sex with a potential oral HPV infection okay? I do have a couple of bumps around my mouth, but I think it's due to some skin irritation which I might get my Family Doctor to inspect.

In general, how risky is kissing? Are there any health risks or risks in general with kissing? This includes kissing mouth to mouth, or kissing various non-genital body parts like breasts or cheeks. I know you've mentioned innumerable times that STDs cannot be transferred via kissing but what about other maladies or viruses? I've met someone new and I want to take things very slowly while I sort things out but I do want to engage in kissing.

In terms of the detection of new warts, I wish there was some clear cut plan, but I'm trying to understand how HPV and genital warts aren't a big deal. My original genital warts were quite obvious growths different than my current scrotum bumps and irregularities. Is it prudent to be on the general lookout for those similar growths and be done with it?

[Edward W Hook, MD]

Your questions are really detailed and beyond the limited scope of what can be offered on line.  They really with deal with all of HPV biology, something that people spend their entire careers working on.  These will be the last answers.  You should talk to your own doctor about continuing concerns

1.  Different strains cause different disease manifestations.  Some types mostly cause warts, other types rarely do.  Please remember, in science there are no absolutes.
2.  REad my original response.  The legal implications that you worry about have littlefoundation in fact.  Just behave responsibly.
3.  Low risk types are not associated with cancer. They can be found in abnormal PAP smears.
4.  Different types of HPV tend to casue infections at different sites on the body. They types of HPV that casue gential infections tend to be different than the types that casue infection on the hands and feet.
5.  The associations of different HPV types with different diseases is still in evolution.  This complex topic, like most of your questions is best discussed with your own doctor.
6.  Kissing tends to be low risk.
7.  AS I said in my orginal post, I would simply see if you notice additonal warts appearing.

Clearly you have major concerns about HPV andi ti appears that they are far beyond what this Forum is designed to provide.  I presume you have looked at the web site I suggested. Beyond that, I suggest you engage your own doctor for more detailed information on this complex topic.  Take care.  EWH