Going Crazy over Wart

[anesthe1972]

Thanks for your expertise and wanting to help with these complex issues:
I had a small bump located in the circumcised area of my penis that I had biopsied which came back positive as a wart. I know that over 85% of people will get hpv so I’m not that surprised. What really concerns me is that it is from a cancer-causing strain. I knew that the bump was there for sometime, but didn’t do anything about it for a year or so. In that time frame, I had protected sex with a few different girls and now I’m scared to death that I gave them the cancer-causing strain. The condom covered the wart during sex for sure, I’m really hoping that I didn’t give them my infection. So, my questions are: 1) If the condom covered the wart, is it possible that my hpv was not transmitted? 2) Is it safe to assume that my wart is caused by a strain that doesn’t cause cervical cancer? 3) If a immunocompetent man has hpv 16 or 18 (or a cancer-related strain) are the changes to the skin on the cellular level and not visible? 4) transmission has to be from direct skin-to-skin contact and not from genital secretions? 5) I read that abnormal pap smears are caused by low-risk types almost half of the time, does that mean that the woman has non-malignant warts on the cervix and not predisposed to cancer?  As you can tell I’m very concerned about the well-being of my partners but have no way to contact them to tell them. I hope they know about hpv! If I know from the gardasil commercials, I’m sure they know about hpv. I am incredibly upset about this. Is it true that cervical cancer is totally preventable in non-immunosupressed women who get regular pap-smears and follow-up with the doctor? Thanks for helping me out here.

[H. Hunter Handsfield, M.D.]

Over 90% of external genital warts are due to HPV types 6 and 11, and most of the others also are caused by "low risk" types -- i.e., HPV strains that rarely if ever cause cancer.  Your wart virus infection does not risk malignancy in your partners.  Of course you might well have had a high risk infection at one time or another, since HPV 16, 18, and other high risk types are the most common overall types among the 85% of the poplulation that gets HPV.

Informing partners or taking special measure to prevent HPV acquisition or transmission have little role in protecting against new infections.  People with known, active HPV should inform partner and take common sense precautions like condoms for a few months, but once the infection has been treated and warts (or pap smear abnormalitiess) have cleared up, nothing more need be done and nothing need be said to partners.

To the specific questions:

1) Condoms are reasonably effective, but not perfect.  Your penile skin likely was infected with HPV 6 or 11 in areas other than the wart itself.  But within a few months of your wart being treated, if it doesn't recur, you can be reasonably certain you no longer are infected and cannot transmit it.

2) It is unlikely your wart was caused by a cancer-causing HPV type.  See above.

3) Most penile infections with HPV 16, 18, or other high risk strains are entirely asymptomatic, with no abnormal appearance to the skin, even on expert examination.  If you ever had such an infection, or if you are infected in the future, most likely you will never know it and the infection will clear up on its own.

4) Transmission is primarily skin-to-skin, but secretions probably carry some transmission potential as well.

5) True, about half of abnormal paps are caused by low-risk HPV types.  Some but not all those women have warts or other visible abnormalities of the cervix that do not lead to future cancer, even if untreated.

As implied above, there is no cause to be "incredibly upset".  It is true that regular pap smears provide nearly 100% protection against invasive cervical cancer.  The rate of cervical cancer in the US dropped 80% once pap smears became routine back in the 1960s -- long before Gardasil was even a dream.  Most remaining cases of cervical cancer occur in women who fail to get routine pap smears.

Don't let this play on your mind.  HPV isn't worh the level of concern you express.

I hope this helps.  Best wishes-- HHH, MD

[anesthe1972]

thanks for that information! So, I just want to summarize to make sure that I have everything correct.

1) I have a visible wart, so I have the hpv strain that rarely if ever causes cervical cancer. While I do know that it's possible to be co-infected with the cancer-causing strain, but, if I do carry that, it will be asymptomatic and only be seen with microscopic examination of the penile skin cells.

2) I read that oral hpv exposure is pretty common but overt warts are very rare. Do you still believe that for every person exposed orally to hpv not many more than one in a million get oral cancer.

3) HPV is harmless over 99% of the time and that for every women exposed to cancer-causing strain, about 1 in 1000 get invasive cancer.

4) is it pretty much true that as a normal sexually active person, everyone has transmitted hpv at one time or another. That really seems to be the case, yes? Whether they know it or not, pretty much everyone has transmitted hpv, correct?

[H. Hunter Handsfield, M.D.]

1 and 4, you have it right.  No. 2:  The HPV relationship applies only to HPV-16 and only to some oral cancers, notably those originating in the back of the throat.  I cannot comment on the 1 in a million rate, but it's a rare outcome, with only about 6,000 HPV-16-related throat cancer cases per year in the United States, and it is not clear that the HPV infections were sexually acquired. No. 4, I also cannot stand behind those specific figures (99% and 1 in 1,000), but the concept is correct.