HPV Questions

[bob41]

Hi-
I have a few questions regarding HPV.  I was diagnosed with genital warts about a month ago.  I had 2 tiny warts (one in the public hair line and directly below) and promptly had them frozen off.  My skin is currently healing up and am using Aldara on those areas.
Is the fact that I had a relatively small outbreak (I’m assuming only 2 is a small outbreak) a good sign ?  Does it mean that there is a stronger chance of no reoccurrence ?
I also have had plantar warts on my feet and am having trouble getting rid off them (left them untreated for years, just started to treat them, seem to responding slowly), will this affect my possibility of clearance of the genital warts ?
Am I morally obligated to tell future partners ?
I have heard some news on vaccines.  Do you know when one will be available and if it will help one who is already infected ?
Is there anything I can do to help prevent future outbreaks ?
Any statistics on the people who have just one outbreak  ?
After realizing I had warts, I thoroughly checked my penis.  I noticed a small bump that hasn’t grown in the last month, seems to change color with the surrounding skin, and stretches with the skin.  It is located on the skin of my circumcision scar.  Could this be a wart or am I just being paranoid ?
I tried to make sure while looking through the posts that you haven’t answered these questions before.  I thank you in advance for answering these questions and commend you on your site. It is a great service to those in distress (such as myself).

[H. Hunter Handsfield, M.D.]

Was your health care provider certain about the diagnosis?  I'm what you mean by "pubic hair line and directly below".  If the upper pubic hair line (lower abdomen), maybe not warts at all; they rarely occur in the pubic area.  Maybe molluscum contagiosum?  Many non-expert docs confuse the two.  If you mean lower pubic hair, i.e. base of the penis, warts are possible.  Anyway, the rest of my replies assume the diagnosis is correect.

As far as I know, the number of warts doesn't predict future recurrence.  You might be at lower risk for recurrence than someone with, say, 20 warts--but I wouldn't assume that.

I am unaware of any research showing that slower resolution of HPV type 1 infections (the cause of most plantar and hand warts) predicts more problems with HPV-6, -11, and other causes of genital warts.  My guess is it probably doesn't correlate.

There are differing opinions on the ethical obligation to tell future partners of past HPV infections; the very fact that it's a moral question predicts that there won't be complete agreement.  My personal judgment is that you should inform partners in the next 3-4 months, but if after then you have had no recurrences, you can safely assume your immune system has cleared the HPV infection and no longer need inform partners.  But there is a non-moral dimension to your question, one of simple pragmatics:  How will you feel if you don't tell and a partner comes back to you 6 weeks later and say "You gave me warts."  Wouldn't it be better to take the risk up front rather than deal with such a situation later?

Research on HPV vaccines is very promising, and one or more vaccines may be on the market in 2-3 years.  One vaccine will protect only against the common "high-risk" types that often cause cancer and pre-cancerous changes in the cervix; the other company's product will also protect against the most common wart-causing types.  These vaccines will not treat existing infection.

There isn't anything you can do to prevent future outbreaks, but the risk is low after a few weeks or months.  Very few infected people keep having outbreaks for years.

I can't say anything about the bump on your penis--but it doesn't sound like a wart.  If it doesn't change or grow, forget about it.

Returning to my first point, go back and search out the forum messages and my responses on molluscum contagiosum.  See if that infection matches your symptoms.

Good luck--  HHH, MD

[bob41]

Thank you for quick reply.
I have had molluscum in that area before about a year and a half ago. Didn't look like it.
The first wart was at the base of my penis. It was biopsed and came back as a wart.  The second growth was about an inch above the base of my penis in my lower pubic hair line.  It started as a yellowish flat discoloration on my skin and over the course of a week, became dark colored and raised. My doctor assumed it was a wart also and froze it off.  Does this sound like a wart to you ?
I can't tell you how much your frank answers to these questions help me and everyone else.

[H. Hunter Handsfield, M.D.]

Thanks for the kind comments.

Given your description and your doctor's apparent certainty, I think you had warts.  But if there is persistence or recurrence after Aldara, get it checked out again.

HHH, MD

[ChristianZane]

First of all I would like to say you have literally been a life saver regarding HPV, thank you.  I've been trying to post here for two weeks but never seem to make it so I'll give it a go here.

I have read every single post on this forum, and I am a little confused about some of the things you have stated about HPV disappearing for good and when it’s safe to have sex again.  Here are two examples:

“Certainly after 6 months, you don't need to inform future sex partners”

“The immune system usually eradicates HPV (in over 90% of infected persons) within 6-12 months”.


1. If I don’t have anymore occurrences of warts, do I wait 4, 6 months or 12 months before having sex again?  

2. After that period of time, is it pretty much a sure thing that I will NOT pass on HPV to my partner, even without wearing a condom? (I got my genital warts WEARING a condom).

3. I’ve read many posts, in this forum, where people have said “my warts came back all of a sudden after 10 years”, and I’ve read this kind of thing on other HPV sites.  Do these people represent the 10% of those whose bodies don’t cleanse it out?  Or is this a different strain of the HPV virus that they recently acquired?

[H. Hunter Handsfield, M.D.]

Thanks for your kind comments.

On one of the many replies I have made to questions about HPV, I tried to make it clear that some of my responses are generalizations, including my comments about duration of HPV, cure vs suppression, etc.  So the following information is a repeat--but you might have missed it.

General principle:  All that follows is based on recent research, plus my interpretation of the studies.  Some other experts may have somewhat different interpretations, but most HPV experts will agree with my perspectives.  In any case, knowledge continues to evolve--and some of the following may turn out to be wrong.  Persons interested in HPV issues need to keep their antennae up for new information.

What we know for sure is that the most sensitive tests available, genetic tests for HPV DNA, usually become negative after 6-12 months; and that people in whom they become negative then are resistant to catching the same HPV type.  These facts suggest, but do not prove, that the immune system has eradicated the virus.  However, it is possible that HPV DNA remains in small amount, ready to start up a newly active infection somewhere down the line.  That almost certainly happens, e.g. when someone gets immune deficiency in the future, like HIV infection or cancer chemotherapy.  It probably occurs in immunologically normal people too, but uncommonly.

So my practical take-home message is that after several months with no wart recurrence normal pap, the person can consider him/herself cured; this is practically true if not always biologically true.  Such persons probably transmit HIV to future partners rarely, if ever.  Accordingly, I do not consider it ethically mandatory, or even recommended, that every person who ever has had HIV must henceforth and forever tell future partners they once were infected.

So to answer your specific messages:

1) If you have a regular partner before the warts appeared, you don't need to stop having sex at all, except to avoid irritation if the wart areas are sore from treatment; s/he is already exposed and likely infected, too late to make any difference.  (Some experts would say stop having sex until the warts clear up, then resume.)  For a new partner, you probably can start having sex as soon as the warts clear up.  That soon, you SHOULD tell your partner, because there is still some chance of transmission.  If s/he is aware of the low risk of an adverse outcome and feels OK with proceeding, don't let HPV stand in your way.  If it has been longer than 6 months, I don't think you need say anything.  Some people would endorse 3 months, 4 months, or a year; the science doesn't allow any more precision than this.  I say 6 months.

2) This was answered above:  yes, after a few months, the chance you will transmit HPV is very low, probably close to zero.

BTW, how do you "know" you acquired warts while wearing a condom?  If you had no sex for 6 months before that particular exposure and then no sex until the warts appeared 4-12 weeks later, I'll buy it.  Otherwise, you might have acquired your infection sometime other than the encounter you're thinking about.

3) Good question, no good answer.  Long-delayed recurrence of warts probably occurs both because an old infection reactivates and by acquisition of new HPV.  My guess is that it's more often the latter.  In any case, don't ever assume that any health problem is as common as implied by web postings--squeaky wheels and all that.

Regards--  HHH, MD

[HHH,MD]

Important typo in paragraph 5 of the above comment:  HPV, not HIV.

HHH, MD

[ChristianZane]

Dr. Handsfield thank you for the follow-up, I hope you aware that the time you spend answering these questions and sharing your medical expertise truly makes dramatic differences in our lives, including mine, I can't thank you enough.  The amount of unreliable, misinformed and confusing information disseminated  on the internet is astounding.  Do you take donations or recommend a charity I might donate to show my appreciation?  

I have had the same sex partner for 2 1/2 years, and we use a condom because she doesn't like taking the pill.  Before that, I had not had sex for 4 years, and before that, I always wore a condom.  I have never had intercourse without a condom, so that's why I believe it was skin to skin contact and most of my warts are concentrated under the pubic hair above the shaft of my penis, we also did a lot of "grinding" as that stimulated her clitoris.  So that's my (***)umption.

So 6 months after my warts disappear, I won't think about or mention HPV to anyone or a future partner again, of course unless I see a visual recurrence of warts, I went out today and bought a magnifying glass too, but I promise not to obssess about it :)  THANKS AGAIN!

[Elise_2]

I appreciated this thread as well.  The idea that HPV is eradicated from the system after a period of time has not been conveyed to me anywhere. I am sure that this is a transmitted infection that doctors are not as worried about (as other genital infections), but this has not been properly conveyed to me by a doctor.  This thread has calmed me. I was worried that I would be threatened with cervical cancer for the rest of my life.

[ChristianZane]

Well I guess it's a much different situation for those of us with Y-chromsomes, the warts are just a nuisance really.  You girls have all the fun with all that child-bearing stuff going on up there.

I have found that most of the misleading or 'scare tactic' type information has been on sites supported by religious groups with an agenda for abstinence (no offense to anyone) and public web support forums/blogs where anyone can say anything they want, usually bogus info perpetuated by stereotypes about sexually acquired viruses.

[bob41]

Doctor -
So the chances go down drastically of reoccurrence as time goes by ?
When does one consider oneself cleared ?  The skin has healed completely over and looks normal from where my first wart was and my second wart was frozen off and now the skin is red there where it was frozen.  Will I be clear when that skin becomes normal again and it doesn't look like there is a wart growing there or can I consider myself cleared now ?
Secondly, it is taking a long time for that red patch of skin to heal.  Could it be because I am still putting the Aldara on it ?  Should I discontinue the Aldara until the skin heals and then continue ? I think the Aldara is slowing the process of healing.
Thanks again for your help.

[H. Hunter Handsfield, M.D.]

Yes, the chance of recurrence declines with time and is quite low after a year.  See my replies above about when to "consider oneself cured" and my advice about when one can stop telling a definitely can't consider yourself cured just because the warts have responded to treatment; you need to wait a few months to assure that warts don't recur.

Redness and irritation go along with all wart treatments but especially with Aldara.  Aldara should be used 2-3 times after the wart appears to be gone, then you can stop; the redness and soreness should then clear up over the next 1-2 weeks.

Good luck--  HHH, MD

[Aliascorreo]

Here is my concern.  I have small white areas (not necessarily bumps) on the shaft and head of my penis, but there is a scaring type of feeling when I rub my finger across them.  When I say areas, I mean small circular areas no bigger than a millimeter.  The affected area on the head of my penis is in a cluster type of formation.  I am not in any pain and I do not have any secretion from my penis.  I have been aware of the white areas for two months or so.  There has not been any change in the appearance or size of the white areas.

Two weeks ago I went to my primary care physician to get tested for STD’s.  I supplied a urine sample for a culture test and I had a RPR w/reflex (DX) test.  Both tests came back negative.

I am a sexually active male.  I have lived with a woman since September 2004 we have unprotected sex.  I found some medication for Bacterial Vaginosis prescribed to my current roommate.  I have two questions:

1. Is it possible that I have genital warts or some other STD?
2. Could my room Bacterial Vaginosis affect me in any manner?

Please provide any addition insight you may have.

[jonthomps]

I was diagnosed with HPV about a week ago.  I had one moderately sized wart on the right part of my shaft.  The doc froze this one and he also froze a few other tiny spots that he thought might be warts also.  They are currently scabbing over right now.  I have had sex with the same person regularily for 6 months now.  I was a virgin and she had a few partners.  Of those partners one of them wasn't a virgin so she suspects him of infecting her.  She has been checked for other STD's and all of which are negative.  
   Anyway, the wart appeared 6 months after we started having sex.  My partner has had no symptoms. I have read many threads about HPV on this forum and would like you to clarify a few things for me.

1.) Could you clarify the severity of visible warts compared to the strain that gives no simptoms.

2.) Is Vitamin E a good thing to put on warts?

3.) It seams like I have been having diarreaha more often, is this usual

[sexyartbeast]

A related discussion, confused was started.