STDs Expert Forum
Update and clarification
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Update and clarification

Hello Dr.

I thought Id provide you with an update. I went to a dermatologist who said that I possible had a tiny genital wart on my penis. He said it was very small yet it could have been as there were a few things that suggested that to him.

1. Nonetheless, he scraped the wart away. Curretage I believe? Anyway, he said that he was confident that this would do the trick and get rid of it. Are these surgeries curative of a genital wart?

2 .What are the statistics that it may come back and when can I consider myself 'wart free'? He said that because the wart was so small as it could have been caught so early he felt that this minor op would do the trick.

3. I have a GF and we have been having sex with condoms for two years now, there was a time when it was unprotected by now we use condoms. He said, along with my GP, I should continue to use condoms but there is no need to inform my GF as wearing a condom and ensuring that my penis does not touch her genitals (she is very cautious of not falling pregnant so it never does) then she should be ok too. Do you agree?

4. All in all, I was very anxious about this, but I believe that HPV is a fact of life. The dermatologist said that you can pick up the wart virus easily and in fact he said many cases of children with anal warts although is suspect for abuse, in reality it turns out the their parent has a wart and transfers it to their children's skin when cleaning them, so I am not to worry about this minor inconvenience. Correct?

5. I am going to get the Gardasil vaccine. Out of interest, does the vaccine help fight off any pre-existing strains that one might have after injected?

6. Also, I know the vaccine comes in three shots. Is it only after all three shots that one gets the benefit or is there more  protection after each shot?

7. Finally, I believe the vaccination timetable, is 1 shot, then the 2nd two months after then the 3rd four months after the second. Can that timeframe be speeded up like the Hep vaccine?
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300980_tn?1194933000
Welcome back to the Forum. One thing you and I will agree upon is that you are anxious ( and I would say overly anxious) about your possible hpv infection.  Your repetitive, anxiety driven questions caused me to stop answering and delete questions earlier.  I hope I don't have to do so again but I will not get into a prolonged exchange in an effort to reduce your anxieties- you will have to do that yourself.  I will provide you with he available information related to your questions.  Further, I would also point out that we limit clients to 2 questions in any 6month period. thus, as this exchange ends, there will be no further questions permitted for until June 2012.

There remains much to be learned about HPV however to worry about it is not a good use of your time.  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.   In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears.  In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-24 months.  In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated.  For men there is far less risk of any sort.  The topic of oral HPV is still an active topic of research, as I have told you before.  With this as background, let's address your questions:

1.  First you don't know if it was a wart. if it is, curettage has about a 70-80% cure rate, as do other forms of treatment.  If your lesion (I don't know that it was a wart) does not recur in 3 months, I would not worry further and would consider yourself cured of whatever it was.  

2.  See above.  

3.  We do not emphasize disclosure to partners.  As I said above, almost everyone who has not gotten the vaccine will get HPV.   Almost 2/3 of women with a single sex partner get HPV within 2 years of the onset of sex.  

4.   I agree with the dermatologist about encouraging you not to worry about this.

5.  the data are pretty clear on this. the HPV vaccine does not help to control existing infections, it prevents new ones.

6.  there is protection for some patients after the first shot, a larger proportion after the 2nd but the entire 3 dose sequence is thought to have the best effect and to have the most durable (long acting) effect.

7.  there are no studies of an accelerated vaccine sequence. Best to do as recommended.

See my prior comments about warts. If there is no recurrence at 3 months you should not worry that your infection might be transmissible to a sex partner.

I hope this helps. EWH
12 Comments
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No space to say Thanks a lot!

and by reference to the Hep vaccine, I believe some doctors use a quickened time frame for vaccination.
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Also  Dr.

I wonder, when can one say that I would be free of the HPV virus entirely? I know that warts can grow back, but if I have no other warts now, and none grow back within three months, am I HPV free?

Perhaps you can read my earlier interchange with Dr. Hook.
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Also, I meant to ask this as well:

1. In terms of sex with my girl friend - can we partake in unprotected oral sex or a hand job? Is this safe to do?

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300980_tn?1194933000
Yes you should not worry about unprotected oral sex or masturbation with your GF.  

EWH
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Thank you Dr Hook. Thanks a lot.

Yes we agree - anxious I am indeed.

I do appreciate your comments.

1. Out of interest, because the lesion was so so tiny - The Dermatologist before he took it out actually had to find it again as it was small - does this mean it has a great chance of success. I.e. someone with overt warts, where the virus is more developed, would logically have less of a chance?

Also, I do not know if you saw this by the time you replied:

2. In terms of sex with my girl friend, can we partake in unprotected oral or a hand job? Even if we do not have oral sex, is a hand job ok -  Even if she were then to touch her genitals after?

3. I am also going to start taking a homeopathic remedy which I used when I had a verucca - it was the only thing that would help it, so I am hoping that it will help and combined with the minor op I had today do the job. Is there anything I can do to improve the chance of success?

Thanks Dr.



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300980_tn?1194933000
1.  I know of no scientific data which correlate the size of an HPV lesion with the chances of success.

2.  Answered above.  

3.  I have no experience with homeopathic medications.  Sorry

EWH

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Thank you very much Dr.

I appreciate that.

Lastly:

1.  is 3 months wart free being conservative or liberal? may they come back after that?

2. And reference to unprotected oral and masterbation (masturbation), i assume that is because the chance of infection is try minimal. oral hpv is rare and even if one has it, warts rarely do not sit well in mouth? correct?

3. and for masterbation (masturbation), have you ever seen a case where someone has got a wart on their hand following masterbation (masturbation), or is that just theoretical?

I didn't think you would know about homeopathic medicine, some say its a hoax but it has worked for me in the past. But do you know any other ways of speeding up clearing the virus? any medicine i mean?
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300980_tn?1194933000
you are at it again. This will be your last answer:

1.  Warts VERY rarely recur after 3 months but in scoence one can never say never.  

2.  Yes, correct

3.  Theoretical only.

No, I know of no way of speeding up viral clearance.  Nor do I know haw to resolve your anxieties.  I advise you to seek professional help- you anxieties are far out of proportion to your risk.  

This thread is now over.  EWH
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thank you Dr. Hook.

Appreciate your candid response.
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Dr Hook.

I meant to ask, but it completely skipped my mind, so I am hoping you will reply as I am aware I am not to post until 2012 should I have to, which I appreciate and will respect. So please can you answer this question if possible.

I cannot find the answer on the internet so thats why I ask. Out of interest, when a woman has a pap smear test, does it detect the presence of HPV, i.e. wart causing strains or types 16 and 18, or does it only say whether the results are normal or whether there are any irregularities/cell changes?

And, are all pap smear tests the same? in other words, a pap smear test done in the UK is the same as the one done in the USA i.e do some tests detect HPV,  (wart causing strains or types 16 &18) as well as any skin cell changes as opposed to others which only detect cell changes?

Hoping you will reply and thanks again. you have greatly settled my mind about a skin issue which is nothing more than an aesthetic inconvenience.

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300980_tn?1194933000
IIf you really looked, you looked in the wrong place. your question is answered on most HPV web sties.  Pap smears detect abnormal cells.  In most labs these abnormal cells can then be tested for HPV but this is not always done.

End of thread- no exceptions. EWH
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