HPV - Specific Questions

[Nick191]

I have been to the clinic and been diagnosed with HPV in Nov. '11. So I have a couple of questions on this:

1) I have had some warts which had appeared on the shaft of the penis and frozen off (twice) which was effective, however, there are some smaller warts which the clinic wont treat as too many and v. small. (the clinic had said they aren't warts but bc they appeared at the same time, I am sure they are warts too). I tried Warticon on the small ones which works so so. I also tried some herbal stuff and immune boosters which didn't do anything. How do I best treat this now? Any kind of non-corrosive creams that can be applied on larger areas without causing scarring?

2) I have a new partner, and I would have given it to her now as Im now getting new warts every couple of days after we have unprotected sex. What is the correct course of action for all of this?

I am told that after 2 years the body clears it itself. Should I have protected sex for the next 2 years? If we continued to have unprotect sex would we pass it back and forth?

4) I have a couple of dark spots which occurred at the same time as the warts, except they are not raised and larger. The edge of the spots (of which there are maybe 3) are slightly shiny identical to the warts. The colour on the inside of the spots looks as dark as a lightly coloured mole. These spots started the same as the warts, very small and white, but then grew over the course of a few weeks and now remain static (the clinic didn't say anything about this and thought the spots were where they had previously done the freezing due to the similarity in darkish colour). Is this dangerous in any way? Public health websites say that cancer of the penis is a possible (if rare) outcome of HPV. Chance would suggest thats not what I have, but should someone take a sample?

Thank you kindly for your help. I need advice on what should be done and what behavioural rules I should follow.

[Edward W Hook, MD]

Typically it takes months, up to six months on average for genital warts to appear after acquistion of infection.  The virus is quite slow growing.  

As for genital tract cancer, in women PAP smeas are outstanding for detection of cancer precursors which are readily treated.  For men, penile cancer is far less common but the major sign would be a persist abnormal skin lesion.  EWH

[Nick191]

Dear Dr. Hook,

Thanks for your response. I will see a dermatologist. I found a picture and it is kind of exactly what it looks like except it is on the shaft for me. The doctor in the article calls it Lichen planus.

http://www.pulsetoday.co.uk/main-content/-/article_display_list/10985479/snapshot-diagnosis-what-s-this-annular-rash-on-the-glans

My only concern is around cancer. I suppose as HPV can cause that we know. What would you say are definite warning signs?

The other thing that confuses me is the timeframe. So when you are exposed to HPV, how long do you suppose it takes for symptoms to show. If it is not days, would a two week timeframe be more realistic?

Thanks.

[Edward W Hook, MD]

Welcome back to our Forum.  I'll try to address your questions.  For better or worse, 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).  As you probably know, 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.  At present, when one has sex with a new partner, it is likely that, if they have been sexually active ever before, they already have HPV.  As a result, other than recommending the HPV vaccine for both men and women, we typically do not worry too much about the transmission issues.  It's all too common a problem and al too easy to get over wrought about.  Let's deal with your specific questions in order:

1.  If these are warts (and just because you noted them following your earlier diagnosis does not mean that they are- there are many other, normal irregularities and bumps to both male and female genitalia), the best approach to management would be to see an experienced  dermatologist (not all are).  Sometimes laser, liquid nitrogen or Imiquimod can be helpful in these situations.

2.  Warts do not appear within days of contact or develop in days so I suspect what you are describing is something else.  If you are seeing new lesions over a period of a few days they are likely something else and represent another good reason to discuss this with a dermatologist.  If you have HPV and she does not, it is likely that she will.  As I said above however, there is a good chance she already does, whether she knows it or not.  The HPV vaccine is far and away the best preventative measure.

3.  Again, despite your careful description I cannot and would not make a diagnosis over the internet. To do so would be improper.  This is another reason to see a dermatologist.  Warts are not typically pigmented.

I hope these comments are helpful, at least in providing a direction to go. There is excellent information on the web at the American Social Health (ASHA) web site which you might also wish to take a look at.  EWH