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STDs (Expert Forum)
Wart advice and questions
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which 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.
Wart advice and questions
by worriedwart07, May 12, 2007 12:00AM
I’m a 30-something year old health professional and here is my story.
About two years ago I thought that I might have a genital wart. I had been shaving my pubic region and I noticed what seemed to be a very tiny skin tag at the base of my penis shaft. I wanted to leave it alone, but it got the best of me because by then I had slept with about 11 women (mostly protected) so I went to see a dermatologist. He looked at it, told me that it was probably a skin tag, and snipped it off. I was much relieved by his news and I considered myself to be wart free.
Now, a few weeks ago (after sleeping with another 8 women, half unprotected at one time or another) I noticed that the “tag” had reappeared in what I believe is the same spot, only about 1-2 mm max in size. I vaguely remember feeling something there months ago, but didn’t really attend to it. Last week I went back to the same derm and had it removed and sent for histology (pushing my luck) and lo and behold it’s actually a . . . .wart.
Which leaves me to ponder the question of what do I do now? I’m single and I want to be responsible. I get tested for STD’s (including Herpes) and I’ve always been negative. No one that I’ve ever slept with has mentioned having warts before or after sleeping with me (and I actually keep in touch with a fair number of my partners).
So my questions are:
(1) Is it my ethical responsibility to mention my 1 mm wart to anyone I should sleep with for at least the next six months? My derm seemed to believe that after the wound healed I should be fine (and that the inflammation of healing should help clear the virus).
(2) Who is to say that six months is even long enough considering the damn thing popped back into my life two years later?
(3) Is it odd that no one I have slept with has come down with warts (as far as I know)?
(4) Whenever I think of genital warts I think of those big cauliflower warts pictures (condyloma acuminatum). Are those actually the exception rather than the rule (occurring more often in people who are immunocompromised in one way or another) and do most people get little ditzel’s like mine that they don’t even notice half the time?
Thanks for your time. I just need to get this all sorted out.
About two years ago I thought that I might have a genital wart. I had been shaving my pubic region and I noticed what seemed to be a very tiny skin tag at the base of my penis shaft. I wanted to leave it alone, but it got the best of me because by then I had slept with about 11 women (mostly protected) so I went to see a dermatologist. He looked at it, told me that it was probably a skin tag, and snipped it off. I was much relieved by his news and I considered myself to be wart free.
Now, a few weeks ago (after sleeping with another 8 women, half unprotected at one time or another) I noticed that the “tag” had reappeared in what I believe is the same spot, only about 1-2 mm max in size. I vaguely remember feeling something there months ago, but didn’t really attend to it. Last week I went back to the same derm and had it removed and sent for histology (pushing my luck) and lo and behold it’s actually a . . . .wart.
Which leaves me to ponder the question of what do I do now? I’m single and I want to be responsible. I get tested for STD’s (including Herpes) and I’ve always been negative. No one that I’ve ever slept with has mentioned having warts before or after sleeping with me (and I actually keep in touch with a fair number of my partners).
So my questions are:
(1) Is it my ethical responsibility to mention my 1 mm wart to anyone I should sleep with for at least the next six months? My derm seemed to believe that after the wound healed I should be fine (and that the inflammation of healing should help clear the virus).
(2) Who is to say that six months is even long enough considering the damn thing popped back into my life two years later?
(3) Is it odd that no one I have slept with has come down with warts (as far as I know)?
(4) Whenever I think of genital warts I think of those big cauliflower warts pictures (condyloma acuminatum). Are those actually the exception rather than the rule (occurring more often in people who are immunocompromised in one way or another) and do most people get little ditzel’s like mine that they don’t even notice half the time?
Thanks for your time. I just need to get this all sorted out.
Doctor's Answer
by H. Hunter Handsfield, M.D., May 12, 2007 12:00AM
, May 12, 2007 12:00AM
I'll go straight to your questions.
1) Most people would agree that someone with known genital warts should advise their partners for at least a few months after the last lesion has cleared up. The possible problem with your dermatologist's advice is that typically the HPV infection involves normal-appearing skin in the vicinity of the overt warts; so that removal of the wart itself definitely does not guarantee the infection is gone. But since the science is not completely clear, neither are the ethics, and you will get different advice from equaly qualifed providers. Ultimately it's up to you.
2) Six months is only a ballpark estimate. Probably it takes only a few weeks in some cases, probably more than a year in others. As I said, these are judgment calls, not fact-based advice.
3) No, not odd at all. Some of your partners may have had asymptomatic infection (at least half of all HPV 6/11 [wart virus] infections never show overt warts); others might have been immune due to previous infection; others might have had internal warts that were never diagnosed; and others might have had warts but didn't tell you.
4) Most genital warts are under 3-4 mm in size. As I said above, at least half of HPV 6/11 infections are asymptomatic, often because small warts are not noticed.
Keep your perspective: With rare exceptions, genital warts and other HPV 6/11 infections are an inconvenience, not a serious health risk.
I hope this helps. Good luck.
1) Most people would agree that someone with known genital warts should advise their partners for at least a few months after the last lesion has cleared up. The possible problem with your dermatologist's advice is that typically the HPV infection involves normal-appearing skin in the vicinity of the overt warts; so that removal of the wart itself definitely does not guarantee the infection is gone. But since the science is not completely clear, neither are the ethics, and you will get different advice from equaly qualifed providers. Ultimately it's up to you.
2) Six months is only a ballpark estimate. Probably it takes only a few weeks in some cases, probably more than a year in others. As I said, these are judgment calls, not fact-based advice.
3) No, not odd at all. Some of your partners may have had asymptomatic infection (at least half of all HPV 6/11 [wart virus] infections never show overt warts); others might have been immune due to previous infection; others might have had internal warts that were never diagnosed; and others might have had warts but didn't tell you.
4) Most genital warts are under 3-4 mm in size. As I said above, at least half of HPV 6/11 infections are asymptomatic, often because small warts are not noticed.
Keep your perspective: With rare exceptions, genital warts and other HPV 6/11 infections are an inconvenience, not a serious health risk.
I hope this helps. Good luck.
You referred to either HPV 6 or 11 as the cause of my wart, but couldn't it have been caused by any of the low risk subtypes?
Any particular things that I should do to promote virus clearance? Are there any prescription topical preparations that I can apply to my skin in that area that might promote the destruction of any lurking virus by my immune system?
Are the risk factor for 6 and 11 any different than the other HPVs or was it just my bad luck?
Or am I reading into this too much and should I just consider them to be a random HPV strain and treat them no differently?