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Genital Warts Update

History:

In the summer of ‘04 I had unprotected sex with a girl. In January of ‘05 I noticed a 1 mm bump on the right side of my penis, located on the mid-shaft. There were also tiny red (almost irritated or inflammed) spots on the opposite side of my penis at the same location. I went to an internist who diagnosed it as genital warts. He treated me with cyrotherapy and the lesions cleared. The girl I was dating had no visible lesions. The next sexual encounter I had was in July-August of ‘09, condoms were used. In March of 2010 I developed these 0.5 mm brown spots at the base of my penis. There were 6 spots located about where I think the condoms might not cover, except one was a little further on the shaft.  The spots grew to 2-3 mm. They were diagnosed as genital warts yesterday by a family doc.  He treated them with electrocautery. I'm not immunosuppressed and I'm a healthy 25 year old male.

1. Could this be a recurrence? Expert posts on here that say recurrence is rare after being cleared for 4-6 months.  Also, the time from sex to visible lesions in both cases was about 6 months.
2. Could this possibly be an infection with another strain of HPV, or a re-infection with the same strain after I cleared it?  

I’ve noticed that "clearance" has several meanings. I've read that 2 years is a safe time frame to be considered cleared. I know that there is argument over the term "cure" and that some people think the immune system will eventually clear the HPV virus on its own but that some HPV-DNA still remains in the epithelium, albeit you are effectively "cured". The family doc I saw was adamant about being a lifelong carrier and this absolutely scares me because I will always think about it.

3. When should I feel that I've been cleared?
4. What are my obligations to future partners, given how common HPV is &how uncommon it is for people to manifest warts?
3 Responses
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300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome to our Forum. thank you for your thoughtful questions. I'll try to help.  Your history is quite complete so, rather than make general comments I'll go directly to your questions.

1.  No, this is not a recurrence. The new lesions occurred in a different location and recurrences typically occur at the site of prior infection within 3-6 months of resolution of the original lesions.  Thus, the timing is far too long.  If the lesions identified as warts were really warts on both occasions (lesions which are not due to HPV are often mis-identified as warts and the treatment is non-specific.  Therefore does not help to sort out whether the lesions you experienced were warts or something else.  It is easy for clinicians to call something a wart, make it go away with treatment and more forward but this is not always in the patient's best interest).  While most warts appear a bit sooner, it can take longer for warts to appear.  

2.  No way to tell wither this is a similar strain or a new strain.  Probably statistically more likely to be a new strain, if both lesions were warts.

This issue of how long infections persist is a complex topic with differing opinions.  Dr. Handsfield summarized things clearly a few months ago and I agree with his comments.  I've pasted them in below.

"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."

3.  See above. By a few, I use 3 months without signs of recurrence such as reappearance of the wart or warts.

4.  We do not push the issue of partner notification regarding HPV on this site.  Too complex and too misleading.  Just about everyone has warts/HPV whether they know it or not.  On the other hand, we do also encourage clients to talk with partners about past STDs and partners.  In such a conversation it would be appropriate to state that I had warts diagnosed and treated __ months ago and I understand that here is no reason to worry further about this.  

I hope these comments are helpful. There is much about HPV infections that is neither black nor white.  I'm sure you wish, as do I, that that were the case.  EWH
Helpful - 1
300980 tn?1194929400
MEDICAL PROFESSIONAL
Correct.  It is unlikely that the two events are related in any way.  EWH
Helpful - 0
Avatar universal
So you're saying if they were warts on both occasions it is unlikely that they are related to each other?  I'm not sure about the first diagnosis, but the recent lesions are likely warts (flesh-colored 2 - 3 mm papules that began as tiny brown spots)

Thanks.
Helpful - 0

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