I have Anal warts and high risk HPV infection. Extremely confused. Help?

[scaredofwarts]

Going on 4 months or so since my first, unprotected encounter with my parter. At the time I wasn't sure if it was actually genital HPV, although I had a pretty good idea that it was. The girl I've been sleeping with and most likely spread it to me considering the symptoms occured 2-3 weeks after sex, as described by a different topic answered by one of you experts, recently informed me that her pap, which she hadn't had done for awhile because she was always afraid of what the outcome of the pap would be, has shown positive for a HIGH RISK strain of HPV.

Since then the warts have been spreading around the anal area and nowhere else. There are now about 20-30 small warts around my anus in tight groups, and some clusters have also formed, it doesn't look like a larger wart, but rather a small cluster of warts, like one on top of the other. I am very frustrated, I've read so many articles on it and they all have different answers. I need them answered accurately.

1)Does the virus go away? Very confused on this one, some sources say it's life long in most cases, and others say your immune system clears it a rather short period of time. "Clearing" being the key word, what do you mean by clearing? Does that mean your body fights off the infection completely (killing the infection), or does it mean it just keeps it in check, the virus is always there, but your immune system has it under control.

2)I've read a lot of articles on genital warts, 6 and 11 being the highest cause of warts, but I haven't found any info on whether the high risk strains 16, 18, and a few others, being associated with warts, but rather that they are the cause of most cervical cancer causes.

3)Treatment. Option or Mandatory? Through most of my readings, HPV goes away on its own, and is usually nothing to get overworked about. I DO NOT want to get treatment at this time due to financial reasons being that the treatment is very expensive, and I do not want it on my med records.

At 2000 CL...

[Edward W Hook, MD]

tejodouro is correct.  I think you are being overly paranoid about this.  My concern is that you are not correct in your assessment.  I have nothing further to say. Good luck.  EWH

[tejodouro]

Your record is confidential.  Just go to a STD Clinic in your closest big city and don't worry about your medical record.  Do you actually think that the military department has the time to do a search of STDs at the various clinics in our country? Do you think that you are the first soldier with a STD, if it is warts?  Relax and get checked out as the doctor suggested.  If you do not want to use your real name, use a made up name.  Take good care of yourself and thank you for considering serving our country.

[scaredofwarts]

I do understand that genital warts can resemble these other conditions, and I know that there is no way to be totally sure without being checked out, but with all do respect, this picture is pretty clear, I apoligize because I know i've said that many times.

It has been several months since the first wart appeared, and since then has turned into many, and now, one large cluster. As for the contact, I did have some finger contact where the female touched my anus with her fingers a few times, but thats all, no anal sex whatsoever. Very strange to me.

I really don't want to get check out for this, I DO NOT want genital warts to pop up on my medical record when I sign up for the service.

[Edward W Hook, MD]

There are other rpecesses which can mimic warts such a skin tags, hemmorrhoids, etc.  Thus to assume that these are warts, particularly without direct contact may be misleading. Further that you now report that they seem to be resolving without therapy after just a couple of weeks is not particularly consistent with HPV.    Warts do resolve without therapy over time but the time course is typically 18 months or so, not weeks to days. EWH

[scaredofwarts]

I understand what you mean, and I also understand that it's good medical practice to tell anyone asking for medical advice to see a physician. The reason why I don't want to see one is because I am looking to join a branch of the military that is overmanned, and I don't want to have anything that can possibly disqualify me from entering the service.

Although having HPV of any type does not disqualify you from service, I would still like to keep my record clean.

About the warts, it is possible that im fooling myself, but very unlikely, this is pretty clear cut, these are warts, without a doubt, at least from my point of view. Out of curiousity, why do you think that I could be fooling myself? Is there a good reason? Such as there is no way I could have the warts in this location without some kind of contact? Or is it that good medical practice, and common sense/knowledge for that matter, that is is wrong to assume that I could be wrong about it, and that I should never self-diagnose? What other common issues could this possibily be? No disrespect, and no undermining towards your professionalism and intelect at all when I say and ask this, I'm just curious.

Also, it looks as if they are started to fade away at this point, but i'm not going to assume that just yet.

[Edward W Hook, MD]

You may well be fooling yourself.  You need to see someone who will evaluate your lesions and if appropriate biopsy them. Further, apple cider vinegar does not contain sufficient acid in it to cure warts.  You need a professional opinion.  EWH

[scaredofwarts]

The diagnosis was never made 100% official by a physician, but, to be frank, this is just one of those things that is pretty clear cut and obvious, and I can say with confidence that these are warts.

I first felt the bumps while I was wiping, I thought they were skin tags at first because I took a small mirror and looked at them, sounds gross I know, it wasn''t easy to do, but they were flesh colored, raised painless bumps. So, I manned up, pulled them off, and kept the area clean. I know removing a skin tag yourself isn't advised, but I had one before on my shoulder and I just pulled that one off, it's gone now and never caused a problem after that.

Shortly after I removed them (a week or so) they returned, thats when it occured to me that it could be genital warts, so I called ask-a-nurse to get some info on them. I explained to her exactly what they were, that I had removed them, and that I thought they were skin tags, but came back shortly after, and in larger numbers. She then told me that if the problem persists, I should see a doctor, I asked her if it could be genital warts and she couldn't say for sure over the phone because she couldn't see them herself.

I also asked if I could get warts around my anus without having direct contact with them, I know warts are contagious and can be spread rather easily, thats when she told me HPV causes genital warts, and because its a virus they can appear anywhere around the genital area. After that I started my obsessive research on the subject, I couldn't really find any ultra clear info that would satisfy me as far as answers go. So, I bit the bullet, paid the question fee, and came here to ask a true expert on the subject.

As far as the self-diagnosis goes, I know you should never self-diagnose, but as I said in the first paragraph, this is pretty obvious, im 99% sure that these are warts considering I have had warts before (on my hands) years ago when I was a child, and after looking at the genital warts pictures i've seen on medical websites. Over the passed 3-4 months, they have spread into about 20-30 small bumps and a few larger, but still small, cluster like bumps, like one wart stacked upon another, that are in almost a pattern, an example of the pattern would be to take a piece of paper, drip ink onto one half of it, and fold the two halves together, or like cutting a paper snowflake, they match up on both cheeks like they have been rubbing against eachother.

They don't really bother me physically, they arent painful and I can't even feel them. They are just kind of embarrassing, and they were driving me crazy as far as the longevity of the virus itself.

I have read on several sites that apple cider vinegar works great for them, a few people praised this remedy, and one of them was even angry that doctors don't recommend the treatment to patients. I was going to give this a shot if the warts persist and continue to spread. I have already started walking around with a paper towel between my cheeks to keep the warts from touching eachother so they don't continue to spread.

[Edward W Hook, MD]

This issue of "clearing is a confusing one.  Let me post in a recent reply that Dr. Handsfield wrote.  I agree with his perspective - "Many HPV biologists believe HPV DNA usually or always persists indefinitely.  However, even with the most sensitive tests available in research labs, the virus becomes undetectable, typically over several months to a year or two -- longer for the high-risk (cancer-associated) HPV types, shorter for low risk and wart-causing strains like HPV-6 and -11.  After that, it is uncommon for that particular infection to reactivate -- i.e. recurrent warts or newly abnormal pap smears are infrequent -- and subsequent transmission to sex partners is rare.  So for practical purposes, the infection is completely resolved and can be considered cured.  "Uncommon" doesn't mean these things never happen; they do, but infrequently.

So you can understand how some experts interpret these issues into conflicting messages:  "Most HPV infections are cured by treatment and/or the immune system" versus "HPV persists and is never really cured".  My own perspective is the first of these:  people should consider themselves cured when all signs of their HPV infection are gone and there is no recurrence within a few months."

2.  You haven't answer my question about how the diagnosis was made.  Are you sure they are warts?  If so, she may have had more than one infection. Please re-read my original response.  EWH

[scaredofwarts]

Thank you for the info, DR. I am still unclear about about a few things though...

1) Does "clearing" mean the virus is eliminated from the body? This question may sound stupid, but after all the obsessive research on the subject, I am extremely confused about the who thing.

2) If she has high risk HPV (16 or 18), has no warts, and transfered the virus over to me, how would I have 6 or 11? And why do I have them on my rectum and nowhere else (penis, scrotum) without any contact whatsoever around the rectum? We have only enganged in vaginal sex and nothing more.

[Edward W Hook, MD]

Welcome to the forum.  The topic of HPV and genital warts is a complex one.  I will try to provide some facts.  For additional information on this most common of STDs, I would suggest search for other HPV- and wart-related Q&A on this site, as well seeking addition information on sites such as the American Social health Association web-site (disclosure, Dr. Handsfield and I are both on the Board of ASHA)..

Your sex partner has been told she has HPV and you are concerned that you have warts. i presume this has been verified by a clinician who is help to manage them.  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).  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.  With this as background, let's address your questions

1.  "Clearing means that you immune system kicks in and fights the infection, making the wart go away and making you no longer infectious to sexual partners.  Treatment accelerated the clearance process.  

2.  Correct. there are over 100 different types of HPV. Some typically cause visible genital warts (6, 11) while others (16 and 18 amongst them) typically do not but are associated with the sorts of PAP smear changes which can, over years, lead to development of cancer (most often of the cervix but occasionally of the rectum as well).  Since your warts are visible, it is most likely that they are due to types 6 or 11. What type is present however is in large part, of primarily academic interest. How they should be managed does not change with the type present, particularly for men.  

3.  Optional but recommended unless there are reasons not to and the reasons you mention aren’t very good ones for not getting treated. Treatment accelerates clearance (there's that word again) and therefore shortens the time that transmission is likely to occur.  Worrying about your medical records is silly. Remember about everyone has HPV

Hope this is helpful. check out the web site I mentioned. EWH