HPV transmission to others and advice for surgery

[ncusa]

Recently I was diagnosed with having HPV and genital warts inside my anus.  I first noticed the bumps in my anus around September of 08.  I went to a clinic in January of 09 and tested negative for all other stds.  They referred me to a surgical clinic where a PA diagnosed me with genital warts.  He told me that I should have them surgically removed.  I havent been able to save enough money for the surgery but I am considering putting it on my credit card.  I also have been taking Clear Natural in hopes that they will go away.  Would u suggest I have surgery to remove the warts?  I have been told that they could clear your system after 6 months but it doesnt seem like they are going away.  They assured me at the surgical clinic that they would not go away on their own.

The PA also told me that I could not pass HPV through my penis or testicles or by kissing.  He told me that the only way I could pass this is if someone had touched the warts with one of their sex organs.  I believed this to be true and have had several encounters of oral sex and kissing.  I recently called the cdc and they informed me that I could pass it to my partner even if  they didnt come in contact with my anus.  Could u clarify this?  Also whats the percent chance that I did pass it to him through oral sex or kissing?

Finally last weekend I had an oral sex encounter with somone I had recently been dating.  A couple days after I felt a small bump on the roof of my mouth.  Its white in color.  It isnt painful and doesnt seem like it has grown or changed much since last wednesday when I first noticed it.  Is it possible that the HPV is in my mouth also?  If it is can I have the bump removed and how easy would it be to pass to a partner?

[H. Hunter Handsfield, M.D.]

Anal warts are a complex problem and not very well studied and there are not good answers to some of your questions.

Apparently you are male, but you don't say whether you have sex with men or women.  Anal warts aren't rare in heterosexual men without any obvious anal sexual exposure, but they are most common in MSM as a consequence of anal sex.  However, this probably doesn't make a major difference in management.  HIV status is important, however.  Are you HIV positive?

I am unfamiliar with "Clear Natural" and can't find much about it on the web, but it appears to be some sort of over-the-counter wart treatment.  I can't advise on its use, but I doubt it is effective.

The natural course of anal warts, as with other genital warts, is that they eventually go away.  However, it can take a long time and surgery often is recommended.  Other standard treatments -- freezing, podophyllin, condylox, aldara -- aren't very effective, in part because it is difficult to identify and treat individual warts inside the rectum.  The best treatment and need for surgery varies from one person to another.  You will have to rely on your own provider's advice and/or that of a proctologist or colon and rectal surgeon.  (If uncertain, get opinions from at least two such specialists.)

You cannot pass HPV inside your rectum or on the anus through your penis, mouth, etc.  However, many men with anorectal warts probably are infected on the penis with the same HPV, in which case they could transmit the virus to partners through sexual practices not involving their own rectums.

As for the spot inside your mouth, I haven't a clue as to the cause.  Oral warts are rare, even in people exposed orally to partner's genital HPV infections.  They are more common in HIV infected persons.  But warts take a few weeks to show up, so if your oral bump is a wart, you didn't catch it during the exposure 2 days earlier.

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

[ncusa]

Thanks for your answers.  I am a gay male.  I was just tested a month ago and tested negative for HIV.  Clear NAtural is a herbal supplement that is supposed to boost your immunes system.  I also have started taking vitamin e and euchenecia to try to boost my immune system.  

I had another appointment at a surgical clinic today and they suggested that I not have the surgery becasue it could lead to other problems.  They told me to continue to use podophyliin and that I could insert it inside my rectim but only one cenimeter in.  They also told me a bout a cream taht costs 500 dollars but is 70 to 80% effective but I cant treat my internal warts with it.  I guess I will need to see another professional to see what they say about the surgery?


Is there a way to be tested to see if the virus is on my penis?  My biggest fear is that I spread it to my new partner.  He has performed oral sex on me and I also performed on him.  What are the chances that he got it on his mouth or penis?  If he did catch it what are the chances he will develop warts?  Am I putting him at risk for oral cancer?  I heard that you cant get cancer for hpv 6 and 11.


The two doctors that looked at me said that they didnt think the bumb on the roof of my mouth was anything.  They basically said to ignore it.  I originally thought it was white in color but they said it is flesh colored.  


Im sorry for so many questions.  Im just really confused on what I should do and I really would like to persue a relationship with my new friend.


Thanks again

[H. Hunter Handsfield, M.D.]

In my opinion, there is no scientific basis for any general "immune system booster" and certainly there is no evidence that having a "stronger" immune system (other than avoiding things like HIV or chemotherapy) has any effect on clearance of HPV or any other viral infection.  So I doubt Clear Natural, vitamin E, or euchanacia will make any difference -- but I also imagine they won't be harmful except perhaps to your wallet.

There is no readily available test to determine whether asymptomatic HPV infection is present on the penis or anywhere else.  The only test that comes close is the kind used to test pap smear specimens in women, and they are not approved by the Food and Drug Administration for use in men; even if you were to be tested, I would not rely on the result.

You heard wrong about HPV-6 and -11 with respect to cancer orally or anywhere else.  The oral cancer story is limited to HPV-16, one of the types most prone to cause cervical and anal cancers.  But hundreds of thousands of people in the US (maybe millions) are exposed orally to HPV-16 each year, yet despite all the hype HPV-related oral cancer remains rare, with only around 6,000 cases per year in the country.  And it isn't certain that those HPV-16 infections were acquired by oral sex anyway.  This isn't an issue worth any worry.

You're going to have to rely on your own providers at this point.  I have no additional advice about the best treatments for your anorectal warts.  But in the long run, eventually they should cease to be a problem, with or without surgery or other treatments.  However, MSM are at significant risk for anal cancer, and that risk may be highest in men who have had overt anal warts.  Please be sure you follow your doctors' advice about follow-up examinations.