Scrotum Warts

I would like Dr. HHH to answer this question please.

I was just today diagnosed with warts on my scrotum.  The phone call came from my dermo's assistant/receptionist (!) who simply stated that Dr. xxx says it's a wart and you should come in here right away to have it removed. There are just a few (2 or 3) and they are small (tip of a pen size)  but also one other area that has a small cluster that I've been irritating myself since I first discovered it almost 2 years ago.  There are none on my penis or elsewhere.

I went to a dermatologist who previously said they were nothing but skin irritations but she did a biopsy and sure enough she now says that I have warts and should come in right away and have them burned off.

I face my new reality with relative positive outlook on future relationship but have a question.  As it has been easily 18-24 months since I first noticed SOMETHING that has now been identified as warts by biopsy, how long must I refrain from genital sex with a new partner?  I have had oral sex with a couple girls recently but no genital sex for quite a while and never unprotected since I first learned of this potential problem.  Can you please tell me how long I must wait after treatment (scheduled to be burned off tomorrow) before I confidently enter a new physical relationship with a woman?  I would really like to have a healthy relationship and sex life and progress to a family in the near future.  

Thank you for providing this very helpful information.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

There are no rigid guidelines, and certainly no reliable data, on the time it takes in this situation to be sure there is no risk of transmission.  A common guideline is that once warts are treated and resolve, and if they do not return within 6 months, that most people are cured, i.e. no longer have transmissible HPV.  However, it is not possible to be certain, especially when the warts were apparently present for as long as yours.  It is possible that your infection is less transmissible than ones that involve the penis, but that too is educated guesswork.

Oral sex apparently is low risk for HPV transmission. Warts or other HPV infections of the mouth and throat are far less common then genital HPV, even in people who regularly participate in oral sex.

I suggest you have honest conversations with women you date for the next several months, telling them you had genital warts and that since you were treated, the potential for transmission is low.  They can then decide whether to go ahead with a sexual relationship, with or without condoms to reduce the transmission risk.  Many women will understand that this does not represent a serious health risk and may not be worried about it.

You also could seek out partners who have had Gardasil, the HPV vaccine that prevents infection with the wart-causing HPV types as well as the two most common types that can lead to cervical cancer.

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

[fear911]

Thanks for your quick and helpful reply.  I have a follow up question:

My dermatologist applied cryotherapy with liquid nitrogen to the infected area today.  She really just brushed the warts with a q-tip containing the liquid.  It stung a little but nothing unbearable.  The result is essentially what appears to be slight scabbing on the 4-5 affected warts.  She said I don't really need to do anything in particular except wait 1-2 weeks for them to scab, heal and fall off but I would like a little more info.  It looks like the liquid nitro is making them bubble up a little but nothing dramatic yet.  Will they grow bigger right away?  Can I apply neosporim?  Can I wash the area with soap?  Should I refrain from touching it?  Is there any more info that you can offer to ensure maximum healing in minimal time?  She also gave me a script for aldara and said use it if I see anything else come back but I sure hope not!  I am very confident that they won't though and that this will be the last of my unfortunate experience with this very unsettling infection.   I intend to call again to follow up but meantime your assistance is very helpful in settling my nerves.

Thank you very much once again!    

[H. Hunter Handsfield, M.D.]

Freezing with liquid nitrogen and imiquimod (Aldara) are a standard treatments and the warts should clear up fine.  Beyond that, I cannot comment on treatment by another physician, and certainly would not presume to advise about a dermatologist's treatment.  You need to ask these questions of her.  Do not put neosporin or anything else on the treated area with her knowledge and approval.  In the meantime, you need to mellow out a bit about genital warts.  Nobody wants them, but it should not be such an "unsettling" situation.

[fear911]

The presence of genital warts (which the dermatologist actually wasn't really able to diagnose visually and only confirmed through a biopsy which surprises me) only proves that I have the HPV strain that causes warts.  Is there any way to confirm (by biopsy or otherwise) whether I also have the strain that causes cervical cancer?  It seems to me if I don't, and the warts are treated, then I'm not risking passing on anything really.

Thanks again.

[H. Hunter Handsfield, M.D.]

I'm also surprised by your dermatologist's comment.  It is true that many warts are sufficiently atypical that a biopsy is necessary, and perhaps that such uncertain lesions are more common on the scrotum than the penile skin.  But the large majority can be accurately diagnosed visually.

No, there is no test to know if you have (or have had) other HPV strains.  Probably you have.  At least 80% of all people catch HPV and the high-risk (cancer causing) strains are among the most common types.  But these infections generally clear up without ever causing symptoms and for that reason rarely have any important health implications.  This isn't something worth worrying about.

That will have to end this thread.  Take care.