Recurring Genital Warts

[BoldAsLove]

Hi Dr. Hansfield,

I am a healthy 29 year old male with dermatologist confirmed genital warts.

I have been researching every resource on this site and others and am at my wits end.  I have had recurring genital warts for 4 years now and cannot seem to get this under control.  It began in one area, spread to the other side of my penis, and I now have recurring warts in 8 different patches on my penis and testicles.

I have tried Condylox, Veregen, Cryo, and am now on Aldara.  I have one large one about2.5 cm across, and one problem patch of 5 surrounded by dozens that recur immediately after every treatment and have for years now.

I have smoked marijuana daily for about 10 years.  In my research recently I have found that certain cannabanoids prevent macrophages from performing their functions, and can inhibit cytokines and the immune system from performing their functions as well (See Cannabis and its Harmful Effects by Mary Brett)

What sort of treatment is most effective for persistent recurring genital warts?  Lazer?  I have quit smoking marijuana, but this is so far from being over. I feel like there is no hope to ever finding a solution to this problem and now wonder if I have HIV or cancer battling my immune system.

How do I differentiate penile cancer from genital warts?  Recurrences in the area where there are dozens use to involve the skin cracking and bleeding, but now just turn bright red and itch like crazy.

Please recommend something, I am an intelligent rational person but I am becoming indifferent to continuing my life with this challenge.

[Edward W Hook, MD]

I look forward to hearing about your interaction witht he 2nd dermatologist.  Please be sure to discuss the issue of shaving as the source of the spread/recurrence.  EWH

[BoldAsLove]

Thank you sir.  You are correct, I am extremely frustrated, but I do not discount your expertise none the less.  I will update once a second dermatologist has examined this.

[Edward W Hook, MD]

You are getting irritated and I am sure you are frustrated.  I'm sorry you have mis-interpreted the purpose of this Forum.  We do not diagnose or treat patients over the internet- that is for health care providers and their patient to do in person.  I have suggested that the basis of the problem is not your immune system but that shaving that you mention that is WELL KNOWN to lead to spread and inoculation of HPV infections.  This process can overwhelm normal immune function.  As far as therapy is concerned, the fact is that laser therapy is no better than other therapies and that, as I said above, which therapy is best for any individual patient will vary depending on what is seen ON EXAMINATION by a trained clinician who can assess the extent of infection as well on based on their own, preferred approach to therapy.  

Thus, I do endorse your plan to " find... someone who understands how eager I am to cure my body of this virus" - that is precisely what I advised.   Good luck.,  EWH

[BoldAsLove]

Dr. Hook,

No offense, but experts across the board (including you and Dr. Hansfield) agree that the virus is ultimately cured by the immune system, so why would you not recommend ways of bolstering it in addition to any kind of therapy?  I have also asked about the effectiveness of laser treatment with no response.

I have been dealing with this for FOUR years.  It is the most depressing thing I have ever dealt with in my life.  To pay $25 dollars for you to skim through my question, then tell me to go see another dermatologist and wait for them to start from scratch is a waste of both of our time.  This is recurring at all the original sites AND spreading.  Thanks for the advice, but now I will be finding someone who understands how eager I am to cure my body of this virus with my immune system (the ultimate determinant) and get to work so I can resume my life without waking up every day to this self-esteem crushing disease.

[Edward W Hook, MD]

As I said before, before you worry about boosting you immune system you shold stop shaving and get a plan of therapy with a dermatologist who ywill work with you on this.

Most therapies are nearly equivalent and the choice of therapies depends on what the clinican sees, what he or she feels most comfortable with and potential side effects. etc.  EWH

[BoldAsLove]

Hi Dr. Hook,

Thanks for your response.

It leads me back to my question, what sort of treatment is most effective?  Is there anything I can do to boost immune system during treatment?

[Edward W Hook, MD]

I think despite the financial problems, you need to work with a dermatologist.  I suspect that your shaving is a major contributor to the spread of your HPV, if that is what this is.  Please stop.  It sounds as though what you are having is spead and re-innoculation, not recurrence.  The process is likely to overcome any resistance to infection you are developing.  I would not entertain the idea that you have some sort of immune deficiency until you have stopped shaving and worked on this with a dermatologist.  EWH

[BoldAsLove]

Also to be fair, 2.5 cm was an overshot.  It is 1 cm across in any direction, and bright pink.

[BoldAsLove]

Hi Dr. Hook, thanks for the response.

All of the sites have been confirmed by a dermatologist.  I did not have health insurance for the first two years, and it was only at 2 sites at that point so I was ordering Condylox off the internet and self treating.  It has only begun to spread in the past 8 months or so, since which a dermatologist has confirmed my suspicion and prescribed the aldara and veregen.  Veregen seemed to be effective, then the recurrences.  It also gave me extreme contact dermatitis, causing me to switch to aldara.

I was shaving in order to treat the initial sites, which must have been the cause of re-inoculation, but I feel like a normal immune system should have controlled this after having the virus for years before the spread.

I have had 3 sexual partners during this time, none of which were long term.

What is the most effective course of action for treating the most persistent cases?  I really do fear that my immune system is compromised somehow, but normal illnesses run their course with no problem so I have no idea what to think here.

Any advice is greatly appreciated.

[Edward W Hook, MD]

Welcome to the Forum.  I think you need a second opinion.  As you probably know. most warts clear up spontaneously with therapy with 18 months of appearance.  Further to have a penile wart 2.5 cm across (1.5 inches !!!) is most unusual, as is for the infection to be showing up in different locations.  This really sounds like something other than HPV or, alternatively, you might have some other process which is going on.  A second opinion and perhaps a biopsy will be important. Then I would suggest you work with the dermatologist to deal with it, not rely upon self-administered medications.  

A number of questions occur to me related to your post-

Has all of this been confirmed by your dermatologist?  Are you still seeing the same one?  

Could you be doing something to re-inoculate yourself (such as shaving the area)?  

Have you had the same of different sex partner during the 4 years you have been going through this?

Nearly all visible warts are caused by HPV type 6 or 11.  These HPV types are very rarely associated with cancer.

Please let us know what a second dermatologist says.  I cannot believe that a dermatologist would willingly have settle for treating a patient for 4 years and not expect better results.  EWH

[danno43]

4 years ???? My God I have had warts for 4 months and am at my wits end I cant imagine dealing with them for 4 years. I feel for you !!!