risk o transmission

Hello Doctor.  I was first diagnosed with genital warts (HPV) in Jan of 2002.  I have had several warts removed since then via the burning method and lazer surgery but I haven't had any for over a year which makes me think i have "cleared" the virus. Then in the beginning of this past Jan I noticed a small bump on my shaft near the base where the hair grows and decided to go to the clinic to get it checked out. The nurse at the clinic said she didn't think it was a wart but decided to remove it for my peace of mind. This was the first time I saw any wart (or at least what i thought was a wart) for more then a year. I thought I was "cleared" and actually still think i am as I really don't think that was a wart i had removed in jan.  To be honest I think I "over check" my genitals for warts and start to freak out when I see anything questionable even though it is nromal I'm sure.  
My question is what are the chances I could transmitte HPV (if in fact it was a wart) to someone else if I had sex now (4 weeks later) and wear a condom?  I had sex with a girl last weekend with a condom and now I'm kind of freaking out that I didn't mention anything to her about HPV even though I am more then likely "cleared".  The reason I didn't say anything was because the nurse said she didn't think it was a wart and since I had been wart free for more then a year before I had her remove the the little bump that was probably a hair folicale or something.   Anyway just curious what you think the chances of hpv transmision are now if it was indeed a wart i had removed in jan.  I guess I so sure it wasn't a wart and that I'm "cleared" and my doctor tells me I'm cleared that I don't want to freak this girl out by telling her and having her worry.  I would love to hear your thoughts.  Thanks for supplying this great information board.

[H. Hunter Handsfield, M.D.]

I would like to help, but it is impossible for me to predict a) whether or not the new lesion you describe is a wart or b) whether you still could transmit HPV to a sex partner.  If it was a wart, you can assume you are infectious.  If not, you may or may not be infectious; on average, it is likely that most people with genital warts cease to be highly infectious within a few months after the warts resolve, and your doctor's advice sounds like the same I would give.  But there simlply is no way for any particular person to know with certainty.

Good luck--- HHH, MD

[mullosk]

Thanks for your reply Doctor.  So to conclude, and i know this is an ethical question, but do you think i should worry about telling her I "may of had a wart but the doctor didn't think so?"  I feel like i would be worrying her for no reason.  Should i cease from having sex with her anymore unless i tell her?  Again the nurse said she didn't think it was a wart but removed it for my peace of mind.  Thanks again.

[H. Hunter Handsfield, M.D.]

Opinions vary on the ethics of informing partners about past HPV infection.  One view is that since there is some risk of transmission forever, and it cannot be predicted with certainty, that all people who know they have (or have had) genital HPV infection have an ethical obligation to inform all future partners of it.  The other side says genital HPV infection is inevitable, that most infections remain asymptomatic and are entirely harmless, and that telling a partner about a particular infection (yours) has almost no likelihood of reducing that person's risk of getting infected, especially outside monogamous settings.  Some people would modify their views based in part on HPV type--i.e., greater duty to warn if someone has been infected with a high risk type that increases the risk of genital cancer.

My personal perspective is between those two, but closer to the latter.  People with known active infection or recent infection probably should tell their partners.  But most people who have had genital warts or other HPV infections become non-infectious after a period of time, probably usually a few months.  And treatment of warts probably reduces infectivity, although this isn't proved.

In general, I tell my patients that once their warts have resolved and have not recurred after 6 months, or 6 months after the last normal pap smear, they no longer need tell potential partners.  But some users of this forum, and some very well meaning and knowledgeable STD experts, disagree with me.  There is no definite answer.

HHH, MD

[mullosk]

Thanks again Doctor, I really do appreciate your help.  Is there any statistics of how ifectious a person may be after a wart removal?  I don't think i'm going to tell this girl since my nurse who removed this suspected "bump" didn't think it was a wart. And since it had been over a year since i had a wart I would hope statisitics wouild be on myu side.  I hope i'm not making a mistake.  I just don't want her to worry and get freaked out for no reason.  I'm i thinking compeltely irrationally?

[H. Hunter Handsfield, M.D.]

No data are available, only the opinions of experts who believe transmission risk declines after treatment or after warts resolve.  Your thinking seems quite reasonable to me.  But aside from the ethics, people should consider practical issues for their sexual relationships.  The duty to warn a casual partner might be nil, partly because the odds are low of transmission for a single episode of sex.  But if someone is starting a relationship that they hope and expect to become committed and permanent, they should consider how it would go if warts indeed pop up, say a year into the relationship.  It might be better to have had a heads-up conversation beforehand, don't you think?  In other words, even without an ethical obligation to inform a partner, in some cases it might nevertheless be wise.   Whether such a conversation occurs before first sex or after the relationship is a bit more mature is a very personal decision, and I cannot guide you.

HHH,  MD

[Samsonite11]

Do you take new patients? I'm sure there are a lot of people that would travel a distance to go to you. If so, where???

:)

Thanks