Still Occuring?

[max2025]

Doc - Fit, early 30s male.  6 years ago, treated 4x over 9 months for genital warts.  Then appeared to get to a state with no issue.  2 years ago, saw/felt a small bump in same general area, but didn't seem overly wart like.  In fact, some variation of that bump may have been there going back to when I was first treated, but for some reason it was either more noticeable or I became fixated on it.  Went to a Dermatologist, he felt it was probably just an oil gland that was more pronounced, but burned it anyway.  When you stretch the skin it would become dramatically less pronounced.  It seemed to have some effect, but on follow up he burned it again and said its nothing, didn't want to cause a scar by over treating, no further treatment needed.  I have since largely ignored it, however, every now and then it would get a bit dry and a little bit of skin would flake off.  I decided to follow up with a different Dermatologist, he felt it was a wart, said he could freeze, burn or cut off and biospy.  Said he thought it was a wart, maybe keratosis, but felt it was a wart.  I asked to remove and biopsy.

Few questions .. two years seems a long time for a wart to hang around?  Would this be contact from a different source, as I can't see how being treated in 2005/2006 would produce symptoms so many years later?  No girlfriends in the last 5 years that I am aware of have ever shown signs of warts.  I should have results next week, but I am just taken aback that I may be dealing with this all over again, it seems to go against everything I was told or researched on genital warts.  Wanted to get your thoughts.

Thanks Doc.

[H. Hunter Handsfield, M.D.]

That's the standard HPV typing test on the market.  I didn't question your previous report of HPV-16 since it seemed pretty definite.

In any case, I'm glad to hear your general health is good.  I have no further advice or other comments.  Best wishes.

[max2025]

To follow up/clarification.  My lab results were negative for low risk, positive for high risk, but the lab work didn't or couldn't differentiate which strain of HPV it was, just that it was in a class of some 13 high risk strains.  On the lab report it simply commented that 16 and 18 are of most concern, but it again it didn't state which strain.  I also followed up with my primary care physician Saturday and he did a mini physical. Results back today:  Liver, kidney, thyroid function all normal. CBC normal. Glucose normal.  Negative for HIV and syphilis.  He was basically checking that I am in good shape and no issue my immune system would have clearing anything.  I am using the Aldara now, and applying it to a slightly larger area than the treated spot, and may have brought to the surface in just two treatments two tiny spots.  My doc wants my body to clear this on its own using Aldara.  He is not a fan of burning or laser as it destroys everything and he says doesn't give the immune system the best opportunity to take care of it.

[H. Hunter Handsfield, M.D.]

The large majority of HPV infections are cleared by the immune system, at least to the extent that can be detected by the most sensitive DNA tests.  HPV DNA may persist indefinitely (how often this happens is debated among experts in HPV biology, but for practical purposes the infection is cured.  The time to clearance tends to be longer for HPV-16 and other high-risk types (12-24 months) than for low-risk types (typically 8-12 months).  (These estimates come from research in women with genital HPV; to my knowledge, comparable data for genital infection in men have not been reported.)

Normal-appearing skin is certainly a significant indicator that HPV has cleared up, but there are many exceptions.  This is something for you to address with your dermatologist, who also is in the best position to advise you about  what kinds of lesions or skin changes that should be professionally evaluated.

[max2025]

Thanks for your quick response.

So despite it being HPV 16 ... my body should clear the infection at somepoint?  The wart was removed, and area burned.  Aldara is being used to be sure to get anything missed.  If I have smooth skin in the entire area, entire groin for that matter for several months, 6 months, etc ... not just by my examination, but by close examination by my dermatologist under magnification ... that is a good sign that I have cleared the infection?

[H. Hunter Handsfield, M.D.]

Thanks for the follow-up.

As you seem to know, this is not a recurrence of the HPV infection that caused your warts several years ago.  Based on the information available, it is not possible to know how long you have had HPV-16; probably you'll never know.

Although HPV-16 is a "high risk" type with respect to development of malignancy, that doesn't happen in the large majority of infected persons.  HPV-16 is among the most common of all genital HPV types, present at any point in time in several percent of the population, few of whom ever get cancer as a result.  And penile cancer is especially rare; cervical cancer and pre-cancerous abnormalities on Pap smear are the main problems, making HPV-16 primarily a problem for women.  So I agree it is appropriate that your partner have a Pap smear, especially if she hasn't had one in the past year.

At this point, the important thing is that you follow your dermatologist's advice on treatment and follow-up, and be alert to future changes to your penile skin and be examined promptly if anything shows up.  Doing so will effectively prevent any serious outcome.  The same advice applies to your partner, should she have an abnormal Pap now or anytime in the future.

Finally, in case you are wondering, you do not need to change your sexual lifestyle and practices with your partner.  Whether or not her Pap is abnormal, you can safely assume she fas been exposed and infected with your HPV strain (and may well be the source of your infection).  So no need for condoms, for example.  Once infected, immunity prevents new infections with the same HPV type, and couples generally do not "ping pong" their shared HPV infections back and forth.

[max2025]

Given its not type 6 and 11, might explain why no partner over the last several years has shown visible warts, but I am just the lucky one to show visible signs?

[max2025]

Lab results HPV, but higher risk HPV 16.  He is giving me Rx for Aldara to apply to the area to just to make sure.  I am going to tell my current partner to get a pap test since its higher risk.  I am just shocked its an issue 7 years later, I am not sure its a new infection.  I am concerned its higher risk and I am concerned what this means overall.

[H. Hunter Handsfield, M.D.]

I won't speculate; I'll comment when the result is available.

[max2025]

Results still pending, should now be tomorrow afternoon, Friday morning.  I called the Dermatologist's office and they followed up with the lab.  They said the lab is doing "staining" which takes a little longer.  I am not sure what the additional staining would indicate or if its indicative of anything?

[H. Hunter Handsfield, M.D.]

Welcome to the forum. Thanks for your question.

It's not yet certain the lesion was a wart, since two dermatologists disagree and even the second acknowledges it might be a keratosis or something other than a wart.  The  biopsy will tell -- but in the meantime, I suggest you not make assumptions.

But assuming it is indeed a wart:  Although it isn't the norm for genital warts to recur more than a couple of years after first diagnosed and treated, it isn't all that rare. It does not generally indicate a serious long term health problem or an impaired immune system, and most such people don't have continued reappearance of warts into the future.

And you also allude to another possibility, that this is not a recurrence from your past genital warts episode but the result of a more recent HPV infection.  Unfortunatley, you'll never know; there simply is no way to distinguish new from old HPV infections.  But two HPV types (6 and 11) regularly cause warts, and several others occaionally do so.

So my advice is to await the biopsy result.  If it turns out to be a wart, just follow you dermatologist's advice about treatment and don't let this situation freak you out.  It's not all that unusual, and genital warts remain mostly an inconvenience, not a serious health threat.

Please return with a follow-up comment to let me know the biopsy result.  In the meantime, I hope these comments are helpful.

Best regards--  HHH, MD