STDs Expert Forum
HPV re-occurrence vs re-infection
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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HPV re-occurrence vs re-infection

Hi I'm a 26 year old female that unfortunately got genital warts back in 2006 and the infection was cleared within 8 months or so since that time I'd had yearly paps and never seen warts... till now. I had the same partner most of that time who never showed any warts but I recently have a new sexual partner. I went to my OB GYN who stated that yea there were bumps on my vulva but she was reluctant to say it was warts because they are so small. I did the vinegar test and the area showed up whiter than the surrounding tissue.  I did have unprotected sex with this new man and I tore slightly, and this is the spot where the bumps are. He did say he had quite a number of sexual partners in his past but tested clean but I know men are not tested for HPV. my question and I know there probably is no real way to know but I was hoping you could give me your best guess.

1. Is it possible after only 3 or 4 weeks of a new sexual partner to show signs of a new infection/reinfection of genital warts or is this just a re-occurrence of my previous infection from 2006?

2. If this is a re-occurrence how likely is it that he will develop warts bc of me?  Ive read a lot of different estimates anywhere from 30% to 70%

3. Do other strains of HPV show up white during the acetic test or only wart strains of HPV?

4. Do you think I should find a different OB-GYN who would look into this more than the wait and see approach? she did say she would order Aldara since I seemed so concerned. I just don't want to have the warts to get bigger because it takes longer to clear them.

Thanks
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

First, don't feel singled out or especially unlucky that you had genital warts at one time.  Up to a quarter of all people have them at one time or another (not counting others who had them but never noticed).

More important, I think it's unlikely your current genital bumps are warts.  I'm especially doubtful if there are lots of them, they're very small, almost all the same size, and if none have the typical "cauliflower" appearance of warts.  The vinegar test is poor; it often misses HPV-infected tissues, and many things that turn white aren't warts.  Further, as you seem to understand already, it isn't common for warts to recur after so many years.

To your specific questions:

1)  It takes at least 2 months and usually 3-12 months for visible warts to appear.  It is unlikely you could have new warts from your new partner.

2) 30% to 70% is a pretty good estimate for the proportion of regular sex partners of people with genital warts who develop warts themselves.  I usually advise around 50%. But of course there's no risk if your bumps aren't warts.

3) Any HPV type can cause a positive vinegar test -- but it's a lousy test for all types.  I always recommend that it never be used for self-testing .

4) I would recommend against imiquimod (Aldara) or any other treatment unless and until the diagnosis of warts is confirmed.  Treatment of any kind would risk making future diagnosis much more difficult.

A second opinion probably couldn't hurt, either from a gynecologist more familiar with warts than yours appears to be, or a dermatologist.  If there still is any doubt, a biopsy would tell for sure. But in the meantime, try not to worry; probably you don't have warts.

Best wishes--  HHH, MD
5 Comments
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I'm probably just being hyper-vigilante because I've had warts. So I will look into seeing a dermatologist but out of curiosity what else do u think would cause small bumps they are multiple on that part of the vulva small flesh colored pink not painful? i have had fordyce spots on the labia but these look to me more like mini cauliflower warts.
Thank you so much I have read many of your other posts and I don't feel alone in this but it can be inconvenient and anxiety producing nonetheless
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239123_tn?1267651214
I'm glad to hear you understand you aren't alone and seem a bit less anxious than many forum users.  Still, I suspect you're sensitized by anxiety and examining yourself to closely and are seeing normal micro-anatomy, such as mucus-secreting glands.  Can you feel them, and is it a change from the way it felt before?  If not, probably not warts.

Another clue for you to consider: warts are never symmetrical. If the appearance and pattern of the bumps is more or less the same on both sides of the affected areas, warts are very unlikely.

Also, you've had genital warts before.  A recurrence would usually look and behave pretty much the same.  Is this like your previous episode?  If not, look to another explanation.

Anyway, let me know the outcome after you've seen a dermatologist.
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Avatar_f_tn
I went to the dermatologist and the good news is that i do not have genital warts but i do have lichen sclerosus. well I am relived I'm also slightly concerned about how this will progress. She placed my on a steroid cream so hopefully it will improve. Its just odd that I've probably had this for a while according to the dermatologist and my symptoms and my OBGYN didn't see anything as abnormal.
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239123_tn?1267651214
Lichen sclerosis isn't serious.  I have no comment about treatment -- we only do STDs!  But thanks for the good news.  Best wishes.
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