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Follow Up Question
I posted a question on June 30, 2009 to which Dr. Handsfield replied. His recommendation was for me to seek treatment from a dermatologist (it is my understanding that you can review old posts - I was unable to reply to the original post). I did seek the treatment in early October. I provided him with the same information that I provided in my earlier post. He examined me through the use of a specialized magnifying glass and use of different lighting angles. He concluded that I did not have any signs of GW. Additionally, he mentioned (like Dr. Handsfield's thought) that the Primary Care Physician had likely been treating scar tissue related to my circumcision. He also stated that even if I had a GW that carried on for 5+ years that he would have suspected that the virus level would be "very low". Finally, he stated that the immune system always kicks in at some point and that condom use would be very effective.
Here are my follow up questions:
1. Even if I had a GW based on the "very low" virus level is it less likely to transmit to someone else? In other words, could I have had a GW that really only had a low level of the virus?
2. Based on the advice of the dermatologist and what I have read from the experts I intend to move forward with my sex life (while using a condom) and do not feel the need to disclose. Would you concur that this is reasonable (I would not want to infect anyone)?
3. It seems that dermatologists, urologists and infectious disease experts are all on the same page with the immune system killing this thing off (this makes sense to me). However, general practitioners/primary care physicians seem to go with the "have it for life" approach. Any thoughts as to why (I am just plain curious)?
Thanks again and this is a wonderful service that you provide.
Here are my follow up questions:
1. Even if I had a GW based on the "very low" virus level is it less likely to transmit to someone else? In other words, could I have had a GW that really only had a low level of the virus?
2. Based on the advice of the dermatologist and what I have read from the experts I intend to move forward with my sex life (while using a condom) and do not feel the need to disclose. Would you concur that this is reasonable (I would not want to infect anyone)?
3. It seems that dermatologists, urologists and infectious disease experts are all on the same page with the immune system killing this thing off (this makes sense to me). However, general practitioners/primary care physicians seem to go with the "have it for life" approach. Any thoughts as to why (I am just plain curious)?
Thanks again and this is a wonderful service that you provide.
MEDICAL PROFESSIONAL
I thought I would comment further on the "have it for life" perspective of your GP versus the other specialties.
Many HPV experts believe that most or all infections persist, in that HPV DNA persists indefinitely in formerly infected tissues. However, it is uncommon for such infections to become active again, either in causing overt warts or in becoming transmissible to sex partners. Clearly that happens sometimes, and indeed it explains many HPV infections that lead to cervical cancer in women. But for all practical purposes, the large majority of infected persons are cured by their immune systems, even if HPV DNA persists.
In other words, both your GP and your dermatologist can be considered correct on this score, depending on how they interpret the available science.
Many HPV experts believe that most or all infections persist, in that HPV DNA persists indefinitely in formerly infected tissues. However, it is uncommon for such infections to become active again, either in causing overt warts or in becoming transmissible to sex partners. Clearly that happens sometimes, and indeed it explains many HPV infections that lead to cervical cancer in women. But for all practical purposes, the large majority of infected persons are cured by their immune systems, even if HPV DNA persists.
In other words, both your GP and your dermatologist can be considered correct on this score, depending on how they interpret the available science.
MEDICAL PROFESSIONAL
Welcome back.
Your dermatologist is obviously up to speed on the natural history of genital warts and genital HPV infection. It's nice to hear that my perspectives in our discussion in June, including my guess that you no longer had active warts, were confirmed. I agree 100% with the last 3 sentences of your opening paragraph, except that "very effective" might be a bit strong as a description of condoms versus HPV. Consistent condom users have a 70% reduction in acquring new genital HPV infection compared with non-users.
1) There are no data on the efficiency of HPV transmission based on viral load. Logically, the risk is zero in your case, since you almost certainly do not have a continuing infection with the HPV that caused your presumed warts several years ago.
2) Your past warts definitely should not inhibit you from being sexually active. Condoms are always wise in non-monogamous settings, and on that basis you should use them consistently. But not because of your past genital warts. From that standpoint, there is no need for condoms. I also agree that there is no ethical obligation for you to disclose your past infection with future sex partners (whether or not you use condoms).
3) The more frequently a particular physician deals with STD issues, the more likely s/he will have sophisticated knowledge about them. (This is no different than for almost any medical condition you can name.) To that extent, I suppose the average knowledge level among GPs about the immune system and HPV is lower than that of the other specialties you mention. Beyond that, I would not speculate about GPs' knowledge level about HPV or other STDs.
Thanks for the thanks about the forum. Take care-- HHH, MD
Your dermatologist is obviously up to speed on the natural history of genital warts and genital HPV infection. It's nice to hear that my perspectives in our discussion in June, including my guess that you no longer had active warts, were confirmed. I agree 100% with the last 3 sentences of your opening paragraph, except that "very effective" might be a bit strong as a description of condoms versus HPV. Consistent condom users have a 70% reduction in acquring new genital HPV infection compared with non-users.
1) There are no data on the efficiency of HPV transmission based on viral load. Logically, the risk is zero in your case, since you almost certainly do not have a continuing infection with the HPV that caused your presumed warts several years ago.
2) Your past warts definitely should not inhibit you from being sexually active. Condoms are always wise in non-monogamous settings, and on that basis you should use them consistently. But not because of your past genital warts. From that standpoint, there is no need for condoms. I also agree that there is no ethical obligation for you to disclose your past infection with future sex partners (whether or not you use condoms).
3) The more frequently a particular physician deals with STD issues, the more likely s/he will have sophisticated knowledge about them. (This is no different than for almost any medical condition you can name.) To that extent, I suppose the average knowledge level among GPs about the immune system and HPV is lower than that of the other specialties you mention. Beyond that, I would not speculate about GPs' knowledge level about HPV or other STDs.
Thanks for the thanks about the forum. Take care-- HHH, MD
Thanks again.
You are reading content posted in the STDs Forum
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