Genital Warts and Condoms.

[Sarah1567]

Hello again, doctor. I recently asked a question about a month back. I took your advice and everything came back negative.

In light of that, I went ahead and had protected sex with a close male friend of mine about 3 times. He was recently tested for everything as negative. Like I said before, I had a low risk HPV wart strain, but my doctor had said all the ones outside were gone, and she couldn't see any on the inside of my vagina.

I went back to her for a check up about two months later and during my exam, she said she noticed a few warts on my vagina, near the inner labia. I freaked out. I thought I was being safe, and had put all this behind me, and then-boom.

Basically, I want to know what his chances of infection are, given the location of the warts, and the condom use.

Thank you.

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  This time you got me.  I have read your earlier exchange with DR. Handsfield and need to start this exchange with a question.  Do you know for sure that you had warts in the past?  Were they treated?  As Dr. Handsfield said a month ago, it would be quite unusual for warts to persist.

If you do have warts, you may or may not have transmitted them to your partners.  Condoms reduce HPV transmission and reduce the occurrence of warts.  

The topic of HPV and genital warts is a complex one.  I will try to provide some facts.  HPV is the most commonly acquired STD.  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 10-24 months.  In men and women with visible genital warts, treatment with any of a variety of topical therapies will often hasten their resolution. 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.  

In addition, non-HPV skin tags and other dermatological processes can sometimes be mis-identified as warts.  Are you positive what you have at this time are warts?

By the way, as a 19 or 20 year old woman, I would recommend that you get the HPV vaccine.  The vaccine is not therapeutic but is an important means of preventing HPV infection and its complications.  It is currently recommended for all women between the ages of 11 and 26.

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 help.  EWH

[Sarah1567]

The first time I had warts was over 3 years ago. They looked like little flaps of soft pink skin all around my vulva, but I never saw any on the vagina itself. I had them for quite some time, maybe a year, before I saw a doctor. By that time, most of the small ones were gone.

The doctor said not to worry about them, they'll probably go away on their own. She told me to come back if they didn't within a few months. According to her, the treatments were harsh, and my case was mild, so she thought we should see what happened first.

Within a few months, they all fell off, except for one. I ended up tearing that one off, and it's been a few months, and it hasn't come back.

Anyways, I went back to her, she told me I was fine, not to worry, but just use condoms if I have sex. She did an exam, and everything was fine, or so it seemed. No pap smear, however.

Yesterday, I went back for a check up, and she said there was some warts near the remainder of hymen. She showed me them. They look like little white bumps right behind the hymen tissue. According to her, it's a new batch of warts cropping back up.

I'm really not sure what to do.

[Edward W Hook, MD]

It is not clear whether the prior lesions you had were warts or not.  Either way, if they are warts, they should continue to get larger.  Treatment is really not all that harsh for most persons.

Considering warts in context is important. AS I mentioned earlier, if they were warts, it is not all that big a deal - most peole have them.

Also, as I mentioned before, please take a look at the web site and please consider gettng the HPV vaccine.  EWH