Thanks For Any Help I Can Get...

[ConcernedGirl504]

I was diagnosed with low risk HPV in 2002 and had one occurrence with warts (it was only one wart on the outside of the vagina that was rather large) that was treated with cryo.  Since then I have been checked every 6 months at the clinic to be sure there are no recurrences.  7 years have gone by I have not had any problems until recently I had an anal wart.  I have been in a relationship with the same guy and we only have sex with eachother.  I was diagnosed with HPV right before I started the relationship with him and we did not have sex until 6 months after my GW was treated.  He has never had any signs of HPV and only had one partner before me.  My immune system is great and I have always been healthy although I know that this has not proved to be reason for HPV clearance.  What could have caused this to happen?  I never expected them to not return, but I didn't realize they could pop up somewhere else.

Would you recommend a specialist and having a biopsy done to confirm that it is actually a wart?  I had cryo done on it 2 weeks ago but since then it has just made me irritated and feeling worse.

Do anal warts cause bright red blood in stool or on toilet paper?  

I guess I just believed that after all this time that I might be symptom free forever and now this has made me believe that it will not "go away". Could this be a recurrence from 2002 or do you believe it to be a new strain?

Thanks so much for your help!  

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.  But unfortunately, there are no clear answers to your questions.

Summarizing your questions, there are two issues on your mind:  the reappearance of genital warts after 7 years; and the location of the new wart, anal rather than genital.  I'll take the second then come back to the first.

The proper term is "anogenital" warts, even though most people -- including me -- tend to just say "genital".   In fact, most genital area HPV infections involve several specific sites and anal involvement is common.  You may well have had an anal infection from the start, regardless of not having had obvious anal warts at the time.  In women, it's easy to explain:  the anus and vaginal area are right next door to each other, so to speak.  But it's often the same for heterosexual men, whether sexually acquired or through auto-inoculation (e.g., their own fingers).  So the location of your new wart really isn't a surprise.

The other issue is the reappearance of warts anywhere.  Most HPV infections clear up entirely within a few months, and reappearnce of a new infection anywhere -- anus, labia, vaginal opening, etc -- is atypical.  However, it isn't all that rare.  Many (most? all?) HPV infections persist indefinitely -- although usually at levels that cannot be transmitted to partners or detectable with available tests.

When this happens, it does not usually mean any underlying health problems -- no immune deficiency and no explainable reason.  It just happens sometimes.  Maybe someday research will tell us a reason, but it seems to just be random.  And whether this actually is a recurrence or an entirely new HPV infection is simply impossible to say.

Any anal lesion can cause spotting or overt bleeding.  Warts themselves don't bleed, but they can easily be irritated.  Or you might have something in addition to the anal warts, such as an anal fissure.  That also is an inconvenience, not an important health threat.

Bottom line (no pun intended):  follow your provider's recomendations for treatment and follow-up.  Like your past warts, this one probably will go away after treatment and stay away (probably forever).  Don't worry about this.  It isn't an indication of anything serious or important -- just an inconvenience.

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

[ConcernedGirl504]

Do you know much about Versamune HPV?  I came across it online and just wondered if it could be helpful in the future...

Also, I am not concerned about this recurrence because I have accepted the fact that I have HPV. However, I have just recently ended my relationship and now feel like I will be contagious forever and that I should not get involved sexually for a long time.

One last thing... I am assuming since you did not mention it that a biopsy is probably not something I should look into doing.  Is this correct?

Thanks very much for your answers.  This forum is great.

[H. Hunter Handsfield, M.D.]

Thanks for the thanks about the forum.

I cannot imagine Versamune-HPV is a valid product.  I never heard of it, and in googling it, I find the company requests payment of $1.95 to get basic information, just to learn what the stuff actually is.  That's a bad sign.  Clearly it is not a proved product and most likely is quackery.  No immunity boosters of any kind are known to affect the body's response to HPV.  (Such products probably don't really boost immunity at all.)

That the lesion only got inflamed and hasn't actually gone away with cryotherapy suggests to me it might not be an anal wart at all.  But you will need to follow your own doctor's advice about a biopsy.  If s/he isn't sure the anal bump is a wart, or if s/he believes there is a chance it's actually a pre-cancerous lesion, then you should probably have a biopsy.  If all this seems uncertain, consider seeing a dermatologist.  (If you do that, stop cryotherapy for at least a couple of weeks before you are examined.)

As for being continually infectious, that is unlikely.  And even if so, your partner isn't necessarily at risk of catching HPV from you.

[ConcernedGirl504]

I recently went back to get examined only to find that there are no warts in the anal area.  I am very thankful for your answers and it made me feel so much better going back and having another exam done.

One more question and then I will be out of your hair.  I know they say that with the acid test some areas can turn white when in fact there is not viral activity going on.  I asked if she recommended Aldara just to be on the safe side and she said no.  Am I just paranoid or is this so called viral area that has always turned white going to be that way forever?  It has done that for the past seven years ever since I had the first cryo treatment but no bumps have ever came up anywhere.  Just curious to see what you would say because some of the things my Dr says do not match up to other medical opinions.  She told me that if I get pregnant I can probably count on warts coming back and that I will probably be able to spread the hpv forever.  This virus *****.  Anyway, thank you so much for any answers you can give me.

[H. Hunter Handsfield, M.D.]

I'm glad to hear you don't have anal warts, but not at all surprised.  You can believe it.  

Almost any skin tissue that is thicker than normal can turn white with acetic acid.  That includes slightly scarred tissue in areas where warts used to be.  We never use acetic acid for HPV/warts diagnosis in my STD clinic, because even in professional hands, it is just too misleading.  It definitely should never be used by nonprofessionals for self-diagnosis.

HPV DNA often persists, perhaps indefinitely.  Some scientists believe this is always the case, but other equally qualified experts are uncertain.  What is certain is that in the large majority of cases, the virus declines to a level that cannot be detected by any test and that cannot be transmitted to partners.  So for practical purpose, the infection has been cured.  Although warts or other HPV problems (e.g., abnormal pap) sometimes reappear months or years later, this doesn't happen to most people, and it certainly does not happen every time a woman with past genital warts becomes pregnant.  Either you misunderstood your gynecologist or s/he is simply wrong.

[ConcernedGirl504]

Thank you again for all your help.  I am going to just move on with my life now and stay happy and healthy!  I'm sure you have heard this many times before but I have to tell you that you are great!  

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  Take care.