Reccurences & Picking

[david1234]

Dear Sir,

Firstly a quick history. I am a 24 year old male with genital herpes an a history of eczma (eczema). I first noticed that I had genital warts in April 2006. Due to working hard and treatments not eradicating all of the warts I did not manage to clear them all until May 2007. Since then I have had constant reccurences. The warts however, according to health care providers are 'small.'

I have seen recently that the frequency of reccurances and that number of warts have begun to slowdown.

I am now treating any warts with Aldara.

My question is two parted.

1. I have been told by my specialist that ALL wart infections eventually die down. Is this true and if so how long might I expect to continue having reccureces?

2. Today, after a rush of blood to my head, I 'picked' off a smallish wart on my pubic region. It was relitavely easy to pick off, not causing much if any irritation to the surrounding skin, and bled but not for very long. Will this wart certainly come back? How detrimental might this be to my overall goal of ceasing to have recurances?

Thank you very much.

David

P.S I have stopped smoking ciggarettes and marijuana and stopped drinking alcohol. I eat right and excersise. Is there anything else I can do to stop having reccurances? How about rubbing a thin layer of Aldara over cleared-up areas to stimulate my immune system?

[H. Hunter Handsfield, M.D.]

First, I'm not convinced from your description that you still have gential warts.  "Constant recurrence" is unusual; and although you don't describe the actual size, multiple small (tiny? hard to see?) lesions also are atypical.  If you are under the care of a dermatologist who has confirmed the diagnosis, undoubtedly it is correct.  If not, I suggest you stop using the Aldara, wait a couple of weeks, then see a dermatologist. Molluscum contagiosum sounds like a possible alternate diagnosis (see below).

Going to your questions:

1) Yes, all wart infections eventually clear up. I suppose there might be rare exceptions, but I have never seen one.  the average duration until resolution probably is 4-6 months and I have never seen a case that kept recurring more than 2 years.  But that might happen and I cannot give any definite time limit.

2) Genital warts are uncommon in the pubic region; in men, mostly they are on the penis, less commonly the scrotum, least common in the pubic area.  Also, I do not think it is possible to pick off a wart.  I wonder whether your current problem is molluscum contagiosum.  That's a minor viral infection, common in the pubic area, causes pink, somewhat shiny bumps, often with a dimple in the center.  Unlike warts, MC lesions are easily scraped off, followed by brisk bleeding.

If you indeed have warts, there is no known thing to do that influences recurrence or persistence.  Diet and smoking have no known effect.  However, it's interesting to speculate about smoking.  In women with asymptomatic HPV infection, the virus clears up more slowly in smokers than non-smokers, and smoking is statistically associated with pre-cancerous cervical lesions due to HPV.  So it seems plausible that stopping smoking might help fight off a wart virus infection.  But there are no data to know for sure.  Certainly it's a good idea to not smoke, but don't count on it to work magic on your warts.

It is unknown whether continued use of Aldara after the warts clear up prevents future recurrence.  I don't recommend that unless your own provider suggests it.

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

[david1234]

Firstly, if you would like me to post a new question please advise. Another $15 is cheap for good advice. My specialist charges me $400 per session!

Thank you very much for your quick response. Most importantly it is great to hear that 'all wart infections eventually clear up.' I am in a loving relationship waiting to get married but will not sleep with my girlfriend until my warts have cleared up.

The warts are small as in probably 2/3 mm in diameter. By constant reccurances I mean that i used to get a new wart every third week or so and a cluster of warts near the head of my penis have always recurred a week or so after clearing. My STD specialist, who i saw last week, prescribed Aldara for these warts near the head of my penis. He was in a hurry and did not look at them for too long but used a vinigar solution. I DID notice that there were small indentations in them, but as outlined above these bumps were on the exact site of previous wart outbreaks (confirmed by a number of health care providers), that had only cleared up a week or so before this new outbreak  and cleared up with the use of Aldara.

The day after I visited my specialist, to confirm that the warts near the head of my penis had cleared up, I discovered another wart/cluster of two warts on the base of my penis. I visited my local GP he confirmed they were warts and and prescribed me more Aldara.

Today I found the bump on my pubic region. It was dark purple in colour, and I think it was quite smooth. After being picked off it left a fairly straight abresion on the skin. I have managed to pick off confirmed warts before. If this was a wart then how detrimental might this be to my overall goal of ceasing to have recurances?

Again please advise if I should post a seperate question. All I want is for these warts to clear and to marry my girl,

Many thanks

[david1234]

Just as an afterthough - this purple bump was on the pubic region but very close to the base of my penis,

Thanks again

[H. Hunter Handsfield, M.D.]

The additional information doesn't change my opinion or advice.  I won't any further comments.  Don't post a new thread.

[jda123]

Doctor Handsfield,

I'm not sure how much heed you give to comments such as these, but I can say that my HPV warts, as confirmed by a dermatologist and a biopsy, can be picked off.  I stopped doing so once they were diagnosed as warts for fear of spreading them, but it's quite painless and only leaves a small cut with minimal bleeding.  It also seems like the inside of the wart is an off-white, blackhead-type piece.  Unlike what I've read about molluscum, they don't appear to have dimples and the center can't be popped or forced out with pressure.