Reoccurrence of genital warts or new infection

[concern261]

Dear Doctors,

I am a 30 year old female who was diagnosed with genital warts 5 years ago from my boyfriend.  The infection cleared though it took some about 1 year and appeared in the vaginal area.  

I also was vaccinated with GARDISIL when I was 27.

I have either had a reoccrrence or a new infection-- now in the anal area.  I had skin to skin contact with someone 6 months ago but included no intercourse.  It has been frozen twice and additionally, I am using condylox gel.

Also, I have tested positive for HSV-1 (also 5 years ago)-- though we had cold sores as children.  

My questions are as follows:
1) What caused the reoccurence/new infection?
2) HSV-1-- will I always test positive for this in blood tests?
3) Going forward, what do I tell my future partners?
4) Will this affect my ability to have children?

[Edward W Hook, MD]

Your just need to let the areas that have been treated heal.  

Now that treatment has begun, you will not be able to tell what sort of HPV was there.  Your doctor might be able to have the biopsy tested althugh I'm not sure I understand how that would be helpful to you.  EWH

[concern261]

Thank you--

Going forward-- besides having the warts frozen and using condylox gel--- what can I do to help with the healing process.  It is very uncomfortable and how might I know what HPV type I have been exposed to?

Thanks again for your time.

[Edward W Hook, MD]

Thaks for the clarification. AS far as we know from research studies on literally tens of thousands of women, the HPV vaccine is highly effective for HPV prevention.  You may have somehow gotten infected with an HPV strain that was not contained in the vaccine. While the vaccine covers the 4 most common types of HPV causing genital infections there are others which cause rare infections.  Furthermore,  in a very small number of people, warts are acquired for reasons that are not immediately obvious.  I'm sorry, but I really don't have a better answer.  Your anal warts are quite unlikely to be a recurrence of yoru infection from five years ago.

As far as disclosure is concerned,  as expalined above, we really do not feel strongly about the need to disclose past HPV infections to partners.  It is not that it cannot be done, just that the infections are so common that those who know are a minority and are disclosing infections which most people will already have or have had.  Take care. EWH

[concern261]

Thank you very much for your quick response.  Yes, the new warts on the anus have been biopsed and are consistent with genital warts.  How is this possible?

Also, I have had many different opinions and was told that it is possible my body did not take to the vaccine, I was given a new "strand" of HPV-- I am so confused.  Once this clears, should I still be concerned about giving warts to another person?

Thanks again for your help.

[Edward W Hook, MD]

Welcome to our Forum.  I will do my best to address the questions that you have asked. Before I do however, let me start by congratulate you for getting the HPV vaccine.  It is highly effective and will reduce your risk for now HIV infections and their consequences.  

There are several somewhat unusual elements to your history which make me wonder if the lesions that you are now experiencing at your anus are warts.  These include that: 1.) there are two types of HPV, types 6 and 11 which cause that vast majority of visible genital warts.  You have apparently already been infected with one of those types in the past, as indicated by your history of warts 5 years ago,.  2.), Following successful treatment of warts, as you apparently had 5 years ago, if they are going to recur they typically do so at the same location as they occurred in at first and they typically recur within 3-6 months of their treatment, not after a period of years.  3.) Finally, the HPV vaccine offers over 98% protection against new HPV infections by the HPV types contained in the vaccine. Thus I wonder if what you are being treated for are warts?  Were they biopsied?  Warts due to types other than those found in the vaccine do occur but it is rare.  If these warts have only been diagnosed visually, I would seek another opinion as to whether they are warts or not. There are many other dermatological processes which are not due to HPV but which can mimic warts.

As for questions 2-3:
2.  Yes, you will most probably always have HSV-1 antibodies detectable in your blood.
3.  Regarding HSV, your should tell partners that you have HSV-1, which causes cold sores.  With respect to HPV, we do not routinely urge disclosure.  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.
4.  No, it will not (neither your HSV-1, nor your history of warts

Hope these are helpful  EWH