HPV Nightmares

[aaa2006]

Dear Dr. Hook/Dr. Handsfield.

I am a 26 year old male - lost my virginity over a couple of months ago to a commercial sex worker. I had both protected oral and protected vaginal sex. About 2-3 days after the incident, I noticed 3-4 extremely tiny bumps that were next to a bigger skin tag that I had before the incident. My dermatologist thought nothing of it and was reluctant to do a biopsy. After much convincing, he finally agreed. Yesterday he called me and gave me the bad news - the biopsy did in fact confirm that it was HPV. The report however did not say which strain of HPV - but I am guessing that it's either 6 or 11, right? He told me to come back so that we can freeze those suckers.

1. How long after freezing would the infection have resolved? Can I still transmit this virus after this period?
2. What are the chances that I also caught the high-risk strains? Would these infections also resolve in the same time period? How do researchers know that a high-risk infection has resolved if there are no symptoms - i.e. warts?
3. What is the moral obligation for disclosing this infection 2-3 years from now?

Thanks

[Edward W Hook, MD]

Welcome to the Forum.  You can discuss my comments with a your dermatologist and should but, in my experience, for warts to appear in 2-3 days is most unusual, in fact it is virtually unheard of.  These may have arisen from something else or some other kind of contact.  Whether they were related to your recent exposure or not is not relevant to my answers however so let's address your questions:

1.  The reason freezing works for treatment of warts is that it kills the infected skin which then falls off and is replaced by normal, uninfected skin.  Once the warts are gone, in theory, you should be cured. the problem however is that because there may be HPV below the surface of normal skin adjacent to your warts, they may recur. In fact this happens in 20-30% of treated warts, not matter what the treatment.  Once your warts are gone, if they do not recur in 3-4 months, you should not worry further about the possibility of recurrence or transmission to others.

2.  Low.  Nearly all visible warts are caused by types 6 and 11, the low risk types.  Some people do get infected with more than one strain so there is a chance but it is rather low and if present in the same area the infection will likely be cured with your therapy.  Researchers use biopsies and scrapings to follow the course of HPV infections in research studies.  these specimens are easier to get from women than men, hence most of what we know is from women.  When compared, most of what is described for women holds for men as well.

3.  We get this questions often. Personally I see no need to disclose 3 years from now. On the other hand I do recommend that persons talk with their partners about their pasts, thus in the course of a discussion I also see no downside to saying I had warts and was treated.   After all, estimates are that at least 85% of adults will have HPV infection at some time.

Hope these comments are helpful.  EWH

[Edward W Hook, MD]

That your warts have recurred following your intial therapy does not mean that they will not.  I would suggest you have them frozen again.   EWH

[aaa2006]

Dr. Hook. You were absolutely right. The warts did in fact re-appear after I had frozen them more than a month ago. Even though my warts are really tiny, but the recurrence is extremely frustrating.

What is the best treatment for warts? Should I continue with the freezing treatment (with liquid Nitrogen) or should I try something else?