Aldara and clearance

[Indy101]

Here is my situation.  30 yr old male in good health who recently had an initial outbreak of genital warts (4 weeks ago).  They are mostly located at the base of my penis.  They are very small but many clustered with a few random ones on the lower part of my penis that popped up as recently as this week. I have been using Aldara for about 4 weeks with little skin reaction at all (not even redness).  I have a two part question.
1. In your experience have you noticed Aldara be less effective depending on what part of the genital region it is applied? PI indicated 33% total clearance in males. I don't seem to be reacting to it at all.
2. Assuming I have either HPV 6 or 11 (due to the warts outbreak), I have read that the immune system will clear the infection over time.  Would this include clearance of the smaller warts as well without treatment? I am of course concerned that they are seemingly coming more than going right now.
Thx a bunch

[Edward W Hook, MD]

No, I would not expect new warts to pop up.  I continue to think your concerns would be well served with a trip to the dermatologist.  EWH

[Indy101]

Thank you for your response.  Just one follow up question...During the time it take the body to clear the virus, would you expect new warts to continue to pop up or is the initial outbreak the most severe? Would you expect the subsequent months to improve in terms of visible symptoms?

[Edward W Hook, MD]

Welcome to the Forum.  Aldara tends to work best in warts which have recently appeared and it's activity is, at least in part, correlated with the reaction that it generates.  If you have been using Aldara for 4 weeks with no effect and little local reaction, it is time to try something else such as freezing with liquid nitrogen.  

In answer to your specific questions however:
1.  No, the location has little to do with response. Warts that have appeared more recently tend to respond better.  As i said, if you wish to treat these, I would advise trying another type of therapy at this time.
2.  What you have read is correct. It typically takes 9-24 months for a person's immune system to clear HPV but over that time the majority of warts do resolve (for those that don't resolve over this period that is not a sign that something bad is going to happen however).  That you have warts continuing to appear while receiving Aldara treatment is also unusual.  If I were you, I would seek the input and care of a dermatologist at this time.  Perhaps what you are treating are not warts.  EWH