Genital Warts

[Cam_77]

Dear Doctor Handsfield,

I found out I had genital warts about a year and a half ago. I originally was prescribed Veragen, but that didn’t do much. In December I finally got laser surgery done. In January when they healed I thought I saw two small warts growing back so I got prescription of Aldara. I used the cream, and so far everything is looking good. I’ve been wart free for two months now. Here are my questions:
1.I have a weird red dot on my upper thigh that just appeared about two weeks ago. Normally I wouldn’t think much of it, but when I got the laser surgery done, the doctor had removed something in my upper inner thigh close to my testicles. I have also read that genital warts can appear on the upper thighs. Could this be a papilloma or an indication of genital warts?
2.Is it worth getting a PCR test done here? I’m not familiar with PCR or HPV prevalence. The only quote I found regarding it was from Wikipedia. Here it is:
“Traditional theories postulated that the virus remained in the body for a lifetime. However, new studies using sensitive DNA techniques have shown that through immunological response the virus can either be cleared or suppressed to levels below what polymerase chain reaction (PCR)tests can measure. One study testing genital skin for subclinical HPV using PCR found a prevalence of 10%”.
Yes, I know this is from Wikipedia, and I actually couldn’t find this quote in the source. But current tests today actually say that the PCR is below 0% for HPV when you are assumed to be “cured.” At least that’s what I have taken from when you say that current tests can’t detect the HPV anymore. Sorry Doc, I wasn’t a science major, this stuff is a little confusing to me. :)

[seefour]

A related discussion, hpv warts and time between out breaks was started.

[Edward W Hook, MD]

The answer to your question about is it worthwhile to get a PCR test is that their are NO tests recommended for detection of HPV in men, including PCR.  I agree with this.  If it was positive, what would you do about it?  

The term "below limits of detection" is a hedge meant to cover the fact that with very low level infection, there may still be small amounts of HPV DNA there that might be detected if you were tested again.  EWH

[Cam_77]

This will be my last post. My original question was never really answered.

Is the PCR test the most scientifically advanced test there is today to test for HPV DNA? And am I correct in saying that HPV is "below detectable levels" means that the PCR rating for HPV DNA is 0%?

The quote I put in my first post was talking about 10% prevalence. Like I said it's just one study and I couldn’t find the actual quote in the citied source.

Thanks,
Cam

[Edward W Hook, MD]

Your follow-up is longer than your question.  I will provide brief follow-up answers:

1.  I agree with your GP.  Had you gotten HPV in the past you would have gotten over it by now.

2.  No change to my answers.  Please remember that the HPV vaccine covers the 4 most common types of genital HPV but that there are over 30 different types that cause genital infection.  Further, that she may have had an infection does not necessarily mean it came from you.

Take care.  EWH

[Cam_77]

Doctor Hook,

So below detectable levels mean a PCR rating of 0%? That means it's not detectable in DNA anymore? I'm trying to get my head around this scientifically.

Thanks for the reply btw. I'm 23 year old male currently teaching in a distant city in South Korea. I would have to have a co-worker translate if I visited the doctor about this which would be presumably awkward. My Dad has shipped two more prescriptions of Aldara over. Do you recommend using the cream again/or on the spot just to be safe? I have a lot of scar tissue from the surgery and I can’t really tell if there are any warts. If there are any, I can’t see them. I had two other questions which I couldn’t write because of the character limit. Here they are:

1. I know your stance on informing people about genital warts and the six month advice. This advice has been a godsend to me because I was having a moral issue with it. Do you have any advice on how to reconcile if you are a carrier of a “High Risk” strain? I know there is no way to really know. I've had past girlfriends who have gotten abnormal paps, but who knows if I gave them a high risk strain or not. Foolishly I had a lot of unprotected sex in college. So there is a fair chance that I have had a "high risk" strain. Thankfully one thing I have learned from this HPV episode is the importance of protected sex. I asked my GP about this a while ago and he said, “Being afraid of having sex because of this is like being afraid of getting in your car because you might kill someone.” Would you agree with this? I got the Gardasil shot last year to prevent future infection.

2. My ex-girlfriend had the Garadsil shot a long time ago. About a month ago she told me that her gynecologist found an abnormal pap smear and “lesions.” She wouldn’t go into any more specifics (we are on bad terms now). Is it possible I gave her a different strain of genital warts then the common ones? And if I did, does this change any of the usual information that you provide on the subject. If you need more info about this, I can contact her.

Lastly, I would like to extend a deep gratitude to you and Dr. Handsfield for all the hard work you have done. It's a blessing to have people like you in this field doing it proper justice. As you probably already know, there is a lot of scare tactics out there involving HPV. It's refreshing to find clear and concise information on this subject. So again, thank you.

Cam

[Edward W Hook, MD]

Welcome to the Forum.  You have a right to be confused, it is a confusing topic.  Let me use an answer that Dr. Handsfield provided a prior client on this topic as a beginning to my reply to you.

"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 agree with this perspective and recommend that in the absence of evidence of new infection, if your warts have not recurred after 3 months (as I understand it, you have a month to go), you should not worry further.  With respect to the red spot that you noted, I would add that it may be a wart but is also likely not to be. It is common for hair follicles on the thigh to be apparent and to appear as red spots. Obviously however, for a more definitive opinion, you should have your doctor take a look.  

I hope these comments are helpful.  EWH