genital wart/HPV

[caworrywart]

Doctor, first, your posts have been a real blessing. THANK YOU. I saw what look like genital warts just inside my vagina but my pap was fine--I'll see a gyno asap.

1) What can I do to get into that 90% that clear this virus to genetically undetectable amounts and prevent this from impacting my health in any way? Obviously, a healthy lifestyle helps, but anything else? Echinacea or immunity boosters? Pap smears every 6 months? What about pregnancy--is it enough to notify doctor of previous exposure, remove any warts, and watch out for the rare baby throat infections?  

2) How will I know if/when I'm "cured" to near zero transmission rate--clear paps and no warts for 6 months-1 yr good enough?  And how do I know if a partner is "cured"?  Same criteria?  If we use a condom and don't have sex when there are visible symptoms, how else can we protect from STDs (I know that condoms aren't 100%)?  Also, if most people clear this in a few months-1 yr, and the guy says he has never had visible warts and that I'm his first partner in a yr--either he lied or is in that 10%, right?

3) Why do only a small % of those with HPV infection develop warts? Is it because the wart strains are less common than other strains?) Or do I have an immuno-deficiency problem? When studies say that most people clear the HPV virus and that 50-75% of sex active population have had HPV infection, is that ANY strain of HPV (or just the wart strain)?

THANK YOU from the bottom of my heart.

[H. Hunter Handsfield, M.D.]

Was your self-diagnosis of warts confirmed by the provider who did your pap?  If not, before you assume you have warts, stick with your plan to see a gynecologist and get a confirmed diagnosis.  If so, they should be treated.

Your other questions have been asked and answered many times on this forum, and information is available on various websites etc.  Very quick responses, assuming you do have warts:

There are no "immunity boosters" or anything esle you can do to enhance clearance of warts or HPV.  Transmission to partners is rare after several months, if your warts clear up, and to future children even rarer; forget about it.  Unfortunately, there is no way to know for sure if you are "cured".  It is rarely possible to know for sure when and from whom someone got warts, or which person in an infected couple first was infected.  It isn't worth spending time and energy worrying about; it is never fruitful, only frustrating.  The reasons for the variable response to warts isn't known; it is not specific to particular strains of warts.  Probably just bad luck for the person who has the persistent infection.

Sorry to be so inadequte--but it would take 2 pages of writing to answer your questions completely.  See the many other posts on this forum; go to the HPV articles in the link "STD Quick Facts and Articles" at the top of the forum; and check out the CDC and Americal Social Health Association websites (www.cdc.gov/std and www.ashastd.org).  In the meantime, the main thing is to mellow out.  Everybody gets HPV--it is inevitable in every sexually active person.  You're normal.

Good luck-- HHH, MD

[MakaveliMOB]

My doctor who is a Urologist / OnCologist / Researcher told me that all strains of HPV are transmitted the same way. Skin to skin contact or skin to contaminated object contact. New research provided by  the National Institute of Health  shows this and more. I saw research that shows that babies within their first weeks of birth contract HPV (hand and feeet and genital strains), and most of them have strains that differ from their parents. So did they get  HPV (genital strain) through sex? Of course not, they got it from hospital workers and the like.

I think everyone is different, and it depends on ones immune system response, but that is not the only thing. Genetic factors and diet and other factors play a role too.

I dont see why HPV is still thought of as an STD, if they can find it in the oral cavity of 3rd graders, is this really an STD? If one can catch the chicken pox through have sex, is chicken pox an STD? If you can a cold from someone after you have sex with them, is it an STD?

Nope!

[caworrywart]

Thanks Wart or Not.  You're right--if genital warts were on any other part of the body, we'd treat them like the small nuisance that they are (while getting regular paps, of course).

Nevertheless, warts are warts and the thought of either getting or transmitting genital warts at any time 5 to 50 years down the road has really got me freaked out.  And it can't be fun to tell future partners that they can get genital warts from me.

I worry that my immune system is bad or else I probably wouldn't have developed symptomatic warts to begin with, as apparently most people don't.  If I am diagnosed with HPV warts, I would love to know that my system can "clear" it and not have to worry about getting warts or transmitting it to others--but I'm not sure if that is realistic or possible.  I'll definitely do regular Paps but I know that risk of cervical cancer is low.

It's heartening to read that HPV vaccines may be available in a few years.  This common little virus causes way too much unnecessary emotional stress and fear for everyone (myself included) and I'd love to see it eradicated--like those ugly warts!

[tamarahe]

I got warts...which cleared fairly quickly and I dont necessarily think it means I have a weak immune system.  I never get sick (EVER).

[H. Hunter Handsfield, M.D.]

Thanks for the opportunity to philosophize a bit.  (Regulars on this forum probably are learning that I enjoy doing it from time to time--maybe too often.)

The various branches of science have their own culture and attitudes.  Among STD and HIV specialists, those who are cancer-oriented and those who are STD-oriented tend to have slightly different perspectives, and your doctor's is different than mine. Some cancer-oriented persons deemphasize the sexual aspects.  My perspective, and that of most public healh experts, is that an STD is any infection that is transmitted preferentially by sex.  An epidemiologist would ask "If sex didn't exist, would the occurrence of disease, its overall frequency, etc be any different than it is now?"  If the answer is yes, it is an STD.  By contrast, even though the common cold and tuberculosis undoubtedly are more common among people who share the same bed, they are not classified as STDs; if sex were magically eliminated from human culture, TB and the common cold would carry on.  So would HIV and chlamydia.  But genital HPV infection would not.

Thus, genital HPV infection is an STD.  The exceptions are rare, if they occur at all.  (OK, maybe sharing a sex toy isn't sex.  But it's pretty darn close.)  Towels, toilet seats, and hot tubs definitely don't do it.  If you consider the entire range of HPV strains, many are not transmitted by sex, and plantar warts and common hand warts (usually due to HPV type 1) are not sexually transmitted.  But it is wrong to say that therefore HPV infections in general aren't an STD.  Do we say gonorrhea, chlamydia, and syphilis aren't STDs because babies get these infections from their moms?  Or that no chlamydial infection is an STD because some Chlamydia species are transmitted through the air and cause pneumonia?  Or that hepatitis B and HIV aren't STDs because they also are transmitted by blood?  Nonsense.

And that is why genital HPV infection "is still considered an STD".  Because it is.

Don't take it pesonally!  Best wishes--

HHH, MD

[MakaveliMOB]

Hi Doctor,

Thanks for the response. It was a nice suprise. You said...

"If sex didn't exist, would the occurrence of disease, its overall frequency, etc be any different than it is now?" If the answer is yes, it is an STD.

Okay, I see your point of view.  But let me take it a step further. You mentioned it being an STD, a disease. But what constitutes it being a disease?

1.)An outbreak of Genital skin lesions?
2.)Having HPV (Genital Strains) in/on the skin? (not limited to Genital Skin)

If you answered 2.) then we probably all have HPV STD (genital strains), by non-sexual ways, and I dont think it should be called an STD. The fact of the matter is that it is a skin virus, and that it does transmit from skin to skin, not limited to genital skin to genital skin. There is tons and tons of research that I've read from reputable sites like NIH, Medline, etc, that show that infants aquire this weeks after birth (strains which are different from parents), 3rd graders having Genital strains in their Oral Cavity, and much more. So my point is, if we are going to call it an STD based on whether or not we find the Genital HPV strains on an individual, then I think we can all say we have Genital HPV, because those strains are passed on just as easy as HPV-1 is, from hand to hand.

If you answered 1.) then I agree. Thats fine. But even so, its unfortunate that the small percentage that will get Genital Lesions, will be under the STD category, because they showed symptoms, whereas, others who also have the strains will not show symptoms.

With all respect,

Thanks for the response!

[H. Hunter Handsfield, M.D.]

That's a very insightful perspective, and the subject of a slight difference of opinion among STD and sexual health experts.  Some of us have gravitated to the term "sexually transmitted infection" (STI) instead of STD for exactly the reason you suggest; not all infections are diseases.  HPV and to some extent herpes, both of which are asymptomatic in most infected persons, often are at the center of the discussions. It's a continued evolution; 30 years ago we moved away from "venereal disease" (VD) because it was laden with negative attitudes, and adopted STD.  I don't think STD is as encumbered with attitudinal issues as VD was, and I continue to use STD rather than STI, but more out of habit than conviction.

Anyway, I'll mark you a a vote for STI rather than STD!

HHH, MD

[MakaveliMOB]

Thanks for your insight.

Your totally right, if transmitted sexually, I would definitely call it an STI instead of an STD.

But if its on the normal skin (genital or nongenital) skin of a 10 yr old virgin, without symptoms, then I'd probably just call it an HPV Infection.

There is research from NIH that shows that ppl with Genital Warts, have the Genital HPV Strains carried on their finger tips, and if they transmit this to the 10 yr old virgin, by shaking hands, is it right for us to call it an STI or STD for the 10 yr old? I don't think so.

Great Discussion. I'm sure there is a lot of controversy regarding these types of issues within the medical community. I think that if the "stigma" of it being an STD were lifted than ppl wouldnt care as much and would treat genital warts just as they would hand warts.

From what I understand of the virus and how its passed along (sex surely being 1 way), I wonder if it will 1 day be normal flora of the skin, that you get sooner or later.

Thanks Again!

[H. Hunter Handsfield, M.D.]

The vast majority of warts distant from the genital or anal area are not due to the genital types.  I would like to see the study you cite from NIH that people with genital HPV carry it on their hands; and I am even more skeptical that the virus then is transmitted with any measurable frequency to other persons.

Nobody says all HPV infections are sexually transmitted, only genital and anal infections. The exceptions are oral warts from orogenital contact and in newborns of mothers with genital infection, both of which are uncommon.

Virtually everybody with anogenital HPV acquired the infection through sex with an infected person.  Stigma and shame certainly were less when the sexual route of infection was not understood and/or was actively deemphaized by providers, which was the norm as recently as a decade ago, and still occurs from time to time.  But it is likely that more psychological and social (and relationship) damage was done because of the confusion and uncertainty when the truth came out later, as it usually did.  In general, people are not well served by fudging the truth about life's unpleasantries.

I say that because almost everybody gets HPV--it is virtually inevitable in sexually active persons (or as some people with a certain political perspective would say, "in people who choose to be sexually active")--it should not be stigmatizing, even though it is an STI.  According to a brand new research study, a whopping 30-40% of women acquire genital HPV in their very first sexual relationship.  (So much for the case that being monogamous prevents STI.)

Take care--  HHH, MD

[MakaveliMOB]

Sure Doctor,


Here are a few interesting ones:

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Sex Transm Infect. 1999 Oct;75(5):317-9. Related Articles, Links

Detection of human papillomavirus DNA on the fingers of patients with genital warts.

Sonnex C, Strauss S, Gray JJ.

Department of GU Medicine, Addenbrooke's Hospital, Cambridge.

OBJECTIVE: To determine whether patients with genital warts carry human papillomavirus (HPV) DNA on their fingers. METHODS: 14 men and eight women with genital warts had cytobrush samples taken from genital lesions, finger tips, and tips of finger nails. Samples were examined for the presence of HPV DNA by the polymerase chain reaction. RESULTS: HPV DNA was detected in all female genital samples and in 13/14 male genital samples. HPV DNA was detected in the finger brush samples of three women and nine men. The same HPV type was identified in genital and hand samples in one woman and five men. CONCLUSION: This study has identified hand carriage of genital HPV types in patients with genital warts. Although sexual intercourse is considered the usual mode of transmitting genital HPV infection, our findings raise the possibility of transmission by finger-genital contact.

PMID: 10616355 [PubMed - indexed for MEDLINE]
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Hand-genital transmission of genital warts? An analysis of prevalence data.

Fairley CK, Gay NJ, Forbes A, Abramson M, Garland SM.

Department of Social and Preventive Medicine, Monash University Alfred Hospital, Victoria, Australia.

The role of hand-genital transmission in the aetiology of genital warts is unclear. However this route is suggested by a number of observations including the relatively high proportion of genital warts in children which contain HPV types 1-4 (15% for children and 2% for adults). We compared two transmission models; one which assumes that hand-genital transmission occurs and one that it does not, and determined the conditions in which each model can reflect the available prevalence data. Hand-genital transmission provides a simple explanation of the observed differences in the proportions of genital warts containing HPV types 1-4 and 6/11 in children and adults. If hand-genital transmission does not occur, the observed difference could only be explained by an eightfold greater probability of transmission to children of types 1-4 than types 6/11, or by an eightfold greater duration of infection with types 1-4. Our findings provide support for the view that genital warts may be transmitted by hand-genital contact.

PMID: 7641831 [PubMed - indexed for MEDLINE]

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Department of Medical Microbiology, Malmo University Hospital, Lund University, Malmo, Sweden.

The human skin papillomaviruses (HPVs) represent a group of ubiquitous viruses detected at a high prevalence in the normal skin of healthy adults. In the present study, we analyzed skin swab samples from babies during their first days of life and from infants at various ages up to age 4 years. Specimens from their parents and, for the newborn babies, environmental samples were also investigated. HPV DNA was already detected on the day of birth in samples from 2 of the 16 babies, and 45% of the samples from the babies were positive for HPV in the days following birth. Seventy-seven percent of the skin samples collected from the mothers were HPV DNA positive. The prevalence of HPV DNA among children from the ages of 1 month to 4 years varied between 50 and 70%. The HPV DNA sequences detected revealed a great diversity of genotypes and putative genotypes. Among 115 samples from 38 infants and 31 parents and 7 environmental samples, a total of 73 HPV types or putative types were isolated. Of these, 26 putative HPV types have not been described before. Our data suggest that asymptomatic HPV infections of normal skin are acquired very early in infancy and are caused by a great multiplicity of HPV types.

PMID: 12791874 [PubMed - indexed for MEDLINE]
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Urethral condyloma acuminata following urethral instrumentation in an elderly man.

Sumino Y, Mimata H, Nomura Y.

Department of Oncological Science (Urology), Oita University, Idaigaoka 1-1, Hasama-cho, Oita 879-5593, Japan. ***@****-u.ac.jp

A 70-year-old man had undergone urethral dilatation with bougie for 8 months following transurethral resection of the prostate and complained papillary masses at the urethral meatus. Physical and endoscopic examination revealed multiple tumors from the urethral meatus to the bulbous urethra. These tumors were resected transurethrally and 5-FU cream was instilled into urethra. Microscopic examination revealed urethral condyloma acuminata. Human papillomavirus types 6/11 were detected in the condylomas. As high prevalence rate of genital human papillomavirus was reported in penile skin of healthy men, urethral instrumentation including transurethral surgery might cause dissemination of penile skin human papillomavirus into the urethral lumen.

Publication Types:
Case Reports

PMID: 15479306 [PubMed - indexed for MEDLINE]

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Zhonghua Kou Qiang Yi Xue Za Zhi. 2003 Nov;38(6):426-8. Related Articles, Links

[Infection of human papillomavirus in oral benign epithelial proliferation in children]

[Article in Chinese]

Liu LK, He ZX, Li YN, Yi XZ.

Department of Pathology, West China School of Stomatology, Sichuan University, Chengdu 610041, China.

OBJECTIVE: To investigate the presence of HPV infection of oral mucosa proliferative lesions in children and determine the associations of HPV types with oral mucosa lesions in children. METHODS: Immunohistochemical method and in situ hybridization techniques were applied to detect human papillomavirus (HPV) infection in biopsies taken from clinical lesions in oral mucosa of 30 children. RESULTS: The most frequent lesions detected were SCP (66.7%), followed by CA and FEH. The HPV viral antigen was present in 73.3% (22/30) of the oral benign epithelial proliferative lesions in children. A high frequency HPV was found in CA (6/6) and SCP (15/20) by means of IHC. In the ISH positive case, high risk HPV 16/18 was observed in 77.3% (17/22). CONCLUSION: This study demonstrates a high prevalence of HPV infection in children's oral mucosa proliferative lesions, and high-risk HPV16/18 are predominant in children's oral mucosa proliferative lesions.

PMID: 14703474 [PubMed - indexed for MEDLINE]

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Sorry, I thought you might want to see a few others.

From what I have read, and understood from my doctor, who says he has attended conferences with World Experts on HPV, I do not think that Genital Warts will grow on areas outside the Genital region. I am not arguing that. I do know that the Genital HPV strains (6,11, etc) can be found on the body outside the Genital Area. And since this is true, then it is transmitted just as HPV-1 is, skin-to-skin. Not restricted to genital-to-genital skin transmission.

Thanks for the interesting discussion!

[MakaveliMOB]

My last words are, Thanks for your time and the interesting discussion!

Your a very sincere person.

Thanks again.

[H. Hunter Handsfield, M.D.]

Thanks for enlightening me.  But as you likely appreciate, the most that can be said of those abstracts is that they raise the possibility of nonsexual transmission of HPV; they say nothing about how frequently it occurs.  I disagree with the reasoning of your concluding paragraph.  You can't conclude that because HPV 6/11 occasionally can be found on non-genital skin, nonsexual transmission occurs with any regularity.  As I said couple of messages ago, the occurrence of nonsexual transmission does not declassify an infection as an STD (or STI, if you like the term better).  The weight of evidence of sexual transmission is great, and the occasional exception does not disprove the rule.

But it's also true that in such a rapidly evolving and complex field, nobody can (or should) be rigid in their conclusions.  But for now, I feel very confident in the messages I convey on this board about transmission risks for genital HPV.

I'm not sure it's helpful to most readers to continue an online debate, although I have enjoyed it.  Feel free to have the last word.

Regards--  HHH, MD