HPV Lip Wart Transmission

[paul1252]

Doctor,

I was diagnosed with genital warts last week.  This week I noticed what appear to my untrained eye as the beginnings of a wart(s) on my lower lip.  I have made an appointment with my doctor for Monday morning.

Subsequent to my my diagnosis of  genital HPV warts and prior to my inital concern re: possible HPV warts on my lip (i.e., prior to any visible hint that they might be in the  offing) I gave my daughter and wife several kisses on the lips upon parting their company or as part of the usual morning greetings.  All kisses have been closed-mouth.

1) IF I do have genital warts rising on my lips, what is the likelihood that I have trasmitted the infection to them?

2) IF I have communicated the HPV infection, when can my wife and child  anticipate seeing visible symptoms?

2) How soon in advance of their appearance, are HPV warts on the lips communicable?

Thank you.

[Edward W Hook, MD]

The reason for doing tests is to guide decison making.  At th is time, my adivce is to discuss these problems with your doctor or get a second opinion.  

If this were MC the biospy would have shown it.

I still do not think this sounds at all like HPV.  EWH

[paul1252]

Doctor -

If I must start another string to address the following question, please let me know.

My biopsy showed no signs of viral activity.  The Doctor is concerned that  that the results may not be accurate since one session of cryotherapy was performed before the biopsy. For this reason he has decided to keep me on Aldara for the balance of the 16-week regimen.  I have a follow-up with him on Friday of this week.

Since my biopsy last week, I have developed a one small, raised, dome-shaped yellow pimple on the lower groin surrounded my a outer circle of red inflammation.  I've had it for three days now.  It is not flesh-colored or pearly in appearance and does not have the characteristic dimple at its apex, all of which are typical of the photographs of molluscum contagiosum that I have referenced.  My questions:

1. Could it be a reaction to the Aldara?

2. Is it likely Molluscum Contagiosum?

3. If it is Molluscum Contagiosum, what must I do to ensure that I do not spread it to family members?

4. If it is Molluscum, I shall ask my doctor to freeze it.  Is this the preferred method of treatment or would Aldara be more effective?

Thank you.


  

[Edward W Hook, MD]

1.  Warts do not typically appear this quickly.  That you had new lesions appear like this in 2 days makes it most unlikely that you are dealing with HPV.  

2.  See number 1 above.  Aldara is highly effective therapy.  If it is not working it this is further evidence that this is not HPV.

3.  When they have eliminated the wart, there is about a 20-30% chance that the wart willl recur.  If it does not in 3-4 months, there is no reason to be concerned about recurrence or transmission to others.

4.  See no. 1 above

EWH

[paul1252]

Doctor,

With respect to my concern re: lip warts, I must admit that I let my anxiety get the better of me.  Every bump on my lips , in my mouth or on my throat (real or imagined) has  caused me anxiety since my diagnosis of genital warts.

To answer your questions:

a) I have been test for other STD's.  I tested negative on all, except Herpes Simplex 1.

b) I contracted this infection from a foolish indiscretion while traveling.

c) A biopsy was performed earlier this week to verify the initial diagnosis of genital warts.  Two plugs were removed from what was at the time a single point of visible infection.  Results will be shared with me next week.

d) Treatment to date has involved Aldara.

Questions for you, please:

1. Two days subsequent to the biopsy, additonal warts appeared as pink/white bumps to either side of the biopsy site.  Is it possible that the biopsy spread the infection?

2. My next appointment is a week-and-a-half away.  My concern is that the new warts that have shown up will grow and spread without immediate, aggressive treatment.  I have little faith in the Aldara to keep the warts in check given all that I have read.  Do I need to urgently move up my appointment with my Doctor to, say, tomorrow or Friday of this week?

3. Can you give me any idea how long Aldara and/or cryotherapy will take to suppress the visible warts?

4.  Do you have an educated estimate as to how long the current outbreak will continue to generate new warts?

Thanks for your response.

[Edward W Hook, MD]

Welcome to the Forum.  Your question starts with the assumption that the lesion you have noted on your lip is a genital wart.  I would urge you not to over think this until you know what it is that is on your lip.  I hope your appointment is with a dermatologist as well since there are many cutaneous processes which can mimic warts.  

In addition, let me provide some additional thought and then as a question or two.  Warts are caused by HPV.  Not all warts are genital warts.  There are over 100 different HPV types of which most do not typically cause genital warts but instead cause warts and/or infection in other locations (a scientifically interesting thing about HPV is the fact that some types of HPV seem to “favor” different sites to cause infection .  That may have a wart does not mean it was acquired through sexual contact.  HPV is transmitted by direct contact of an infected site (like a wart) with an uninfected site.  Transmission is enhanced by friction or other processes which may make it easier for the HPV virus to get beneath the skin surface.  Thus in answer to your questions:
1.  Hard to say.  Warts on the lip are quite unusual and not something I deal with on a regular basis.  Direct contact is the mechanism of transmission for all HPV so, IF this is a wart, it MAY have been transmitted.  If so, they could develop warts at the sites where you kissed them although as I have said, this would be rather unusual in my experience.
2.  The only way one would know they have a wart on the skin or lip would be by seeing it.  I would by no means suggest or endorse other sorts of testing.
3.  When the lesion is present, so is the virus.  

Finally, might I ask a few questions of you to help understand this situation better. How did you get genital warts?  Are you sure of the diagnosis.  Are your genital warts being treated?  If you have genital warts were you tested for other STDs as well?

EWH