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Genital Warts: Treatment Worse than Virus Itself?

Male, 47, married, monogamous, unprotected sex relp for 12 years. Wife’s never had warts. She’s had Gardasil vac. I was diagnosed with warts in 1991. Treated multiple times freezing/burning, before excising. Scar remains. I scar/keloid easily. In 2011, warts diagnosed. Again, multiple rounds freezing/burning, then Aldara worked. Scars/permanent change in skin color remain.  December 2013 wart in same area treated successfully with Aldara, but with further change in skin color, likely permanent. January 2014 doc thought 4 warts present in new locations. I didn’t agree. Past warts were hardly noticeable, this time, I couldn’t even see at first what she was referring to. Looked more like very small pimples or razor burn (past warts were in the hairline on side of penis so a pre-visit shave is necessary). Within 24 hrs, these 4 bumps mostly disappeared, confirming to me a misdiagnose. During self-exams since, still doesn’t look like warts—they are all around a hair follicle and they look no different to me than other microscopic bumps not remarked upon. I’m reluctant to begin Aldara. 1) I think there’s >50% chance these aren’t warts. 2) treatment for me is worse than the virus, in that area looks better now than it will post-treatment with permanent scaring/discoloration. January 2014 issue is in new, unblemished area. 3) even if warts, my history suggests they’ll come back anyway. 4) HPV virus type causing warts (6, 11) is not type that becomes cancerous (16, 18). So why treat in my case? I always suspected the diagnosis of warts was arbitrary--various net forums confirm there’s common misdiagnose. I suspect out of 100 docs, half would say I had warts, half wouldn’t.  So 2nd opinion may not clarify things, especially with to treat first and not worry about side effects, given high rates of general population infection. I know it’s hard to diagnose without a visual exam, but even if I do have microscopic warts, why trade an immaterial, benign mark for a material scar?
1 Responses
239123 tn?1267651214
Welcome to the forum.  Thanks for a refreshing question!  Mostly questions about genital warts are from people who are freaked out and worried about how well they will respond to treatment.  Yours is the opposite -- not sure you have warts, not spooked if you do, and not necessarily even interested in treating them.  Congratulations for a level-headed, objective self analysis.

All that said, I'm not sure how much I can help.  STD experts aren't usually the best source for management advice of such atypical HPV infections or warts.  If you were my patient or in my clinic, we would refer you to a dermatologist.

However, based on all you say, I agree it seems smartest to not start treatment, at least not until you have a second professional opinion.  My guess is that you are correct:  the current lesions are not active warts. While I agree a second opinion might not change anything, usually I would expect it to make a difference in this setting.  If any doubt remains after that, a biopsy might be worth considering.  Is the doctor who diagnosed your latest possible recurrnece a dermatologist?  If not, see a dermatologist next.  And even if s/he is a dermatologist, I would go for the second opinion.

As to your ancillary questions:  Just because your warts have recurred up til now, even if the present lesions are warts, they won't necessarily recur after another round of treatment.  The purpose of genital wart treatment isn't to prevent cancer, but just to get rid of the warts themselves.  However, it's certainly optional.  If it turns out you have warts at this time, if they aren't bothering you, and given that your wife is probably immune due to her past immunization, treatment is by no means required unless they grow to a size that's botherseome.

I hope this helps.  Best wishes--  HHH, MD
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