Genital warts?

[MichaelP123]

Hello Doctor.

I have 2 redish bumps on the very base of my penis/shaft that kinda look like pimples. There's no itching and there's no pain. At first I thought they were pimples since I usually get a couple from time to time, but it's been 2 weeks now since they first appeared and it doesn't look like they're going anywhere. They look like 2 small genital warts.

I have a very active sexual life. In 2010 I had sex with 30 different prostitutes. I ALWAYS wear condom for vaginal sex and I have tested for HIV in November and it came up negative.

Anyway, I don't know what to do about these 2 red bumps. If there is not enough light in the room then they are very hard to notice, but when there is enough light you can clearly see them.

What should I do?

[Edward W Hook, MD]

I was referring to any of the treatments for HPV infection. Most of them have similar efficacy and outcomes of therapy (althought, as I mentioned, Aldara may be slighly better than most).  EWH

[MichaelP123]

Thank you doctor! You have been of great help.

My last question, when you say that you would recommend treatment so that I reduce the probability of infecting other partners, are you talking about Aldara or are you talking about something else in addition to Aldara?

[Edward W Hook, MD]

1. Aldara is effective an perhaps slightly better than other topical medications for HPV therapy.  It also works for a variety of other skin conditions.  

2.  If you want to be absolutely sure you are not infectious for partners we would recommend treatment.  If there is not a recurrence in 3 months following resolution of lesions, there is no further risk for transmission of infection.  

3.  Without therapy HPV does go away, meaning that the body's immune response controls the infection.  I will post a recent quote from Dr. Handsfield which provides our shared perspective on the issue of conflicting messages regarding the persistence vrs clearance of HPV infections.  "Many HPV biologists believe HPV DNA usually or always persists indefinitely.  However, even with the most sensitive tests available in research labs, the virus becomes undetectable, typically over several months to a year or two -- longer for the high-risk (cancer-associated) HPV types, shorter for low risk and wart-causing strains like HPV-6 and -11.  After that, it is uncommon for that particular infection to reactivate -- i.e. recurrent warts or newly abnormal pap smears are infrequent -- and subsequent transmission to sex partners is rare.  So for practical purposes, the infection is completely resolved and can be considered cured.  "Uncommon" doesn't mean these things never happen; they do, but infrequently.

So you can understand how some experts interpret these issues into conflicting messages:  "Most HPV infections are cured by treatment and/or the immune system" versus "HPV persists and is never really cured".  My own perspective is the first of these:  people should consider themselves cured when all signs of their HPV infection are gone and there is no recurrence within a few months."

I hope this is helpful to you.  EWH

[MichaelP123]

Hello Doctor,

I spent almost $250 with this urologist and in the end all he did was tell me to use Aldara cream (Imiquimod) or liquid nitrogen. He said the warts were not big enough to be burned. Sigh.

Anyway, here are my questions:

1) Is this Aldara (Imiquimod) cream good? Do you recommend it?

2) Can I have sex or should I remove my warts first? What can I do to reduce to the max the probability of contagiousness? I don't want to give it to my partners.

3) What do you and doctor HHH mean when you say that most HPV infections "go away" after some time? I thought there was no cure for HPV? What exactly do you mean by this?

Thank you

[Edward W Hook, MD]

Hmmm.  I'd start by asking your urologist what his next steps would be.  I will point out however that many clinicians, rather than testing would have treated you on the basis of appearance alone with one of the many treatments for HPV.  If your follow-up experience withthe urologist is not satifactory, a second opinion, this time with a dermatologist, is probably the way to go.  Part of your consideration should include just how important it is to youto have a name for these bumps.  Personally, I would not care about what they were but suspect I might want to be rid of them.  .  EWH

[MichaelP123]

Hello Doctor.

I went to the clinic and the urologist inspected me. He said "they look like warts" and then rubbed a brush over the bumps and the rest of my penis. He sent the sample to the laboratory and told me to come 4 days later for the results.

I just came back from the laboratory and the test says Hybrid Capture 2 System and it came back negative for all medium/high risk types of HPV. However, the test says nothing about the types 6 and 11 which to my understanding are the ones that cause most genital warts.

I have another appointment on Monday so that he can interpret my test results. Is there anything I should tell him? If these are not warts then I have NO IDEA what they can be.

What do you recommend?

[Edward W Hook, MD]

If the bumps are present now, why not go an get them evaluated at this time.  My guess is that waiting will not change things much.

If they are genital warts, they are easily treated using a variety of different approaches with none particularly better than the other.  Thus treatment should be discussed with your doctor.  If untreated they will likely go away over a period of months (perhaps up to 18 although most clear far earlier).  EWH

[MichaelP123]

Thank you very much doctor.

1) Should I wait a little more time before going to the dermatologist/clinic or should I go right away?

2) If what I have are genital warts, do they go away on their own or do they have to be treated?

Thanks again

[Edward W Hook, MD]

Welcome to our Forum.  Without the ability to examine you directly to see the lesions you are describing I cannot tell you whether the lesions you describe are warts or not.  On the other hand, I do note that they sound as though they are in a location which is not reliably covered with condoms and after 30 exposures to commercial sex workers, the odds are quite high that you have HPV somewhere, whether these particular lesions are warts or not.  If these are warts, it is not all that big a deal.  Over 85% of Americans have or will have HPV infections and they are easily treated when need be.  My advice would be to have a knowledgeable clinician take a look at the lesions.  In most locations regular physicians have limited experience with HPV diagnosis an management.  The best place to have your lesions would be a dermatologist or your local ST Clinic.  If they are warts, they are easily treated.

Finally, and a bit off topic. Let me congratulate you on your commitment to condom protected safe sex. HPV or not, condoms will o much to prevent STDs, including HIV, for you.

I hope this comment is helpful.  EWH
p.s.  I not herpes is included in your key words.  Nothing about these lesions is suggestive of HSV.