Questioning where my genital warts most likely came from

[vitorious]

Hello, doc. About 10 days ago a bump formed right near the shaft of my penis. I thought it was a pimple, but it wouldn't pop. I scratched it off, it bled, and then it grew back in similar form a week later. Then, I noticed I had developed another bump on the upper part of my scrotum right next to the penis about an inch away from the original one. This first one is a bit reddish and the second one is more fleshy colored. I went to go see a doctor and he told me they're warts. I got a blood test for other diseases as well.

In the last month I had protected sex with two different women. However, about 6-7 weeks ago I received an unprotected ******** from a prostitute (I know, it was an awful decision).

I have read your past posts on HPV and I understand that the experts on this forum claim that HPV cannot be spread orally, or it is very rare. Does my situation raise the chances significantly? Is it possible that the warts came from the prostitute who gave me oral sex? The worst scenario I can think of is that she had given oral sex to a guy before me who had HPV and then transferred the virus to me. Is this possible?

The wart popped up about 3 days after I had protected sex with one of the women. She bled during intercourse because she was on her period. Is it possible for it to show that quickly? Does the blood make it much easier to spread?

The other woman I had sex with was about 4 weeks ago. Is this the most likely origin?

Do you recommend I get a 2nd opinion before I freeze it off? The doctor was a local Vietnamese doctor since there were no Western doctors on duty.

How can I move on with my life and not have such a hard time with the dating game?

Please respond whenever you can. I really appreciate it.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  Reacting first to the title "Questioning where my genital warts most likely came from":  Usually it is uncertain unless the infected person has had only a single sex partner in the previous few months, and even then some cases go back several years.

Now I have read the question itself.  Despite your doctor's diagnosis of genital warts, your description sounds more like molluscum contagiosum, based on:  "reddish", quick regrowth after (partial) removal, brisk bleeding when removed, and scattered lesions from base of penis to scrotum.  Other clues to look for:  MC often shiny pink, and often with a dimple in the center of the lesion.)

Whether you have warts of MC, the source remains unclear.  For either one, one of your genital sex partners -- even if condom protected -- is a more likely source than the oral sex episode.  Condom protection has never been researched for MC, but most lesions occur in the pubic area, labia major in women, sometimes upper/inner thighs -- and condoms would not protect against lesions in those locations.  Neither warts nor MC can show up in 3 days; 2-3 weeks is the minimum for both.

Your self-suggestion for a second opinion is exactly right.  MC is often mistaken for warts by providers not highly experienced in recognizing genital skin lesions.  I recommend you discuss this possibility with your doctor, or perhaps get a second opinion from a dermatologist or your local health department STD clinic.  Do it before using any treatment, and avoid the temptation to handle the lesions.

Please return with a follow-up comment and let us know the outcome after the second opinion.  Once you have a definite diagnosis, you'll need to speak to both your recent genital intercourse partners so they can see their own health care providers.  My bet is that one or the other will turn out to have MC.

Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

Re-read the opening of my initial response.  You're never going to know when and from whom you were infected and I suggest you just stop thinking about it.  Almost certainly it was not the oral sex event.

You are correct about the length of this thread.  Time to end it.  My final advice is that you not make more of this than it is -- an inconvenient but non-serious health problem.

Take care.

[vitorious]

The woman I had a one night stand with had a pap smear taken and showed up negative. What would you consider is the most likely scenario;

The woman I had sex with has HPV but is showing no symptoms?

or...

I'm one of the rare cases of orally transmitted HPV?

If I'm getting too comfortable with asking too many questions I'll stop. You have just been very quick and reliable with every question that I've had. Sorry, this is just tough for me to accept right now.

[H. Hunter Handsfield, M.D.]

Nobody knows for sure how long after the warts are gone to be confident the transmission risk is low enough to be disregarded.  Therefore, there are no rigid guidelines.  Some would say a month, others a year.  My own advice to patients is 6 months, but it is admittedly somewhat arbitrary.

[vitorious]

I know you said that will be all for this thread, but I was wondering how many months is several? Should I remain abstinent for at least 3 months?

Sorry if I'm pushing my limit. It's the last question I have.

[vitorious]

Thanks again. You've been very helpful and supportive. Take care.

[H. Hunter Handsfield, M.D.]

Once genital warts have cleared with treatment, and no new warts have appeared within several months, they rarely recur and the virus is rarely transmitted to subsequent sex partners.  After that, in my opinion there is no need to inform future sex partners about your past infection.

And your wart virus infection poses no risk for cancer in your partners.  The HPV strains that cause warts do not cause cancer.

That will be all for this thread.  You might consider participating in MedHelp's HPV community forum.  You'll find forum participants with experiences like yours as well as expert moderators.

[vitorious]

Dear Dr. Handsfield,

I want to thank you for all of your help and professional advice. I also would like to apologize for overwhelming this discussion with numerous questions. Hopefully I didn't frustrate you.

I went to a dermatologist for a second opinion. He confirmed that they are in fact genital warts. I suggested the possibility of MC and he said no, MC looks different. He applied liquid nitrogen to them and I was given Povidine, a substance that I need to apply to the warts once every day. I actually developed a third wart.

So, now to move on with life after HPV. Every professional, including you, makes HPV sound like something that doesn't warrant any concern. I understand this is mostly because almost every adult has contracted HPV at some point in their life. I guess I'm just concerned about the moral factor of informing the next person I sleep with that I have HPV. It seems like the majority of the population is completely ignorant to this disease and will automatically back off once someone brings it to their attention. Do you think that I NEED to inform anyone that I'm going to have sex with about my HPV history? Should I just let the warts disappear and move on as if nothing happened? And do these warts pose any cervix cancer risks to women I may be intimate with? Thanks again.

[H. Hunter Handsfield, M.D.]

I have never hear of MC being auto-inoculated to the eyelids.  I suppose it is could happen, but "symmetrical small whitehead looking bumps" doesn't sound like MC, more like normal appearance of the skin in that area.  You're probably just examining yourself too closely and seeing things that have always been there.  See the dermatologist as you are planning to do.  In the meantime, stop being so alarmed about all this.  Both MC and genital warts are minor inconveniences, not important health problems.

Feel free to let me know the dermatologist's poinino.  Until then no more comments of any kind, please.

[vitorious]

I acquired my health test results which were all negative. :)

I also showed my bumps to a different doctor at the same clinic and she could not give me a definitive answer. She suggested that I wait a week before I see a dermatologist to see if the bumps subside, grow or increase in numbers.

I've been browsing on the web about MC. I'm overly concerned because I feel like I now see symmetrical small whitehead looking bumps right next to my eye lids. Can MC transfer from genitals to eyes easily?

[H. Hunter Handsfield, M.D.]

No you may not post a picture.  In our view on this forum, that comes too close to practicing medicine from a distance.  See a health care provider.  Don't post any more comments or questions until you have done so.

[vitorious]

Also, is MC easily contracted orally?

Sorry for the parade of questions. Just trying to get my $15 worth I suppose. ;)

[vitorious]

And, is MC similar to HPV in that it remains with you for the rest of your life?

[vitorious]

Can I send you a picture? Is that too much?

I'm going to a dermatologist regardless, but I have to wait until I get paid. Can I provide a photo for you to see in the meantime?

Also, I'm aware that there is no blood test for HPV. Is there a way to make a definite diagnosis of MC?

[H. Hunter Handsfield, M.D.]

I saw these comments before I replied above.  Avoid sex entirely until the diagnosis is clear, then we can discuss transmission risks for either infection.

[vitorious]

Sorry, one more bit of info. Before all of these sexual acts I didn't have sex for 4 months. Before then I had two serious girlfriends. That is all.

[vitorious]

Also:

After the warts are removed, if a woman gives me oral sex, is she at high risk for anything?

After the warts are removed, is HPV still very contagious?

Is it bad if I don't tell anyone about it after the wart is removed? Should I be completely honest?

I'm so down about this. Please help.