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Genital Warts - from outside to inside?

Dear Doctors,

First of all I would like to thank you both for your support of this forum. The information you've given here proves invaluable to me.  

I am a 27 year old female. I only have one partner in my life and we have been together for 3 years but currently living apart. I was infected in late Nov when I last saw my boyfriend. I developed the symptoms in Jan but diagnosed with GW in March and had electrocautery performed right away.Because of this my boyfriend later confessed that he had a one night stand with a stranger back in September. However, he has not developed any symptoms of genital warts. Needless to say I was devastated but I know that I have to be strong.
From then I still develop a few small warts around the anus and on the perineum right the vagina opening. I was prescribed aldara about 4 weeks ago but was not able to use it continuously because I also get the doctor to put podophilin on the warts when they are visible and that sometimes cause the irritation of the area, hence, I had to stop aldara for a few times already when that happened. I had my Pap Smear done 2 weeks ago and the test result was negative. I also had Gardasil vaccination last week.

My questions are:

1. My gyno confirms that I don't have any warts inside my vagina. I read Dr. Hansfield's Q&A about HPV and warts and realised that a couple do not reinfect each other but would it be possible for him to give me visible warts inside my vagina if we have unprotected sex?
2. In the skin on the vagina opening (right in front where the urine comes out) suitable for the use of aldara? I had the wart there removed by podophilin once and thought aldara could help prevent it from coming back.
3. Would it help to stop a weekly podo treatment and let the warts develop then get electrocautery performed again? Perhaps last time was too early in the infectious stage.
4.What's the average time between infection and warts start clearing up?

Thank you for your time.
3 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the STD forum.  Sorry to hear your difficulties and uncertainties about your genital warts.  Try not to let it get you down; this won't go on indefinitely and all will be well.  And congratulations on starting Gardasil.

Warts are not especially common in the vagina, except on the cervix.  If visible warts haven't appeared in those locations by now, most likely they will not.  Any additional warts that you develop will not be from re-catching the virus from your partner.  All HPV infections are more widespread than meets the eye -- if new lesions do appear, it will be because you are already infected at those spots.

Not being able to use Aldara doesn't much matter; don't worry about it.  No treatment, including imiquimod (Aldara), is more than about 60-70% effective.  In theory, Aldara might be better at preventing recurrent warts, but in the real world there is no obvious difference in cure rate or recurrence rate between Aldara and any other treatment.  If one method isn't working well, trying another makes sense.  Aside from podophyllin and Aldara, other options are freezing, repeated laser- or electrocautery, and trichloroacetic acid.  

1) Any warts that continue to appear probably will be from the infection you already have, not re-catching the virus from your partner.

2) You can use Aldara anywhere in the genital area. Aldara causes more inflammation as a side effect than some other treatments, in which case there might be some uncomfortable urination.  But no serious side effects are likely.

3) I can't get into such specific treatment recommendations.  Each case and each patient are different.  This is something to discuss with the doctor who is treating you with podophyllin and prescribing Aldara.  (In general, I avoid using more than one treatment at a time.)

4) Genital warts, and the underlying HPV infection, generally stop recurring within a few months and pretty much always clear up within a year or so.

Dermatologists generally have the greatest experience with persistent or recurrent warts and the broadest range of experience with multiple treatment options.  If new warts continue to appear and/or existing ones aren't clearing up promptly, consider asking for referral to a dermatologist.

I hope this helps. Best wishes--  HHH, MD
Avatar universal
Dear Dr. Handsfield,

Thank you for your quick response. Your answers are thorough and complete. Thank you very much.
239123 tn?1267651214
MEDICAL PROFESSIONAL
Thanks for the thanks.  I'm glad to have helped.  Take care.
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