HPV Infectivity and Recurring Warts

[Jon33]

In late 2010 I found I had a small clump of genital warts. I got them frozen off a month or so later and I have since undergone a dozen treatments and I've done several cycles of Aldara. I am still getting new warts and I am extremely frustrated and depressed about this. I know that the body can eventually "clear" the infection (even though the virus remains present), but I can't seem to arrive to this point, as a new wart will appear and the clock resets. Is there anything I can do, other than stay healthy to boost my immune system, that might help me in this process?

Also, I advise any new partners of my infection because I feel it is the ethically right thing to do. I assume I have HPV type 6 or 11 considering these strains are responsible for the vast majority of cases that show warts. My question is, when small (almost invisible) or no warts are present, what is the likelihood that a healthy person like a new partner will develop warts once exposed to the strain(s) I have? Is it a sure thing? Rare? 50/50?

Thanks in advance.

[Edward W Hook, MD]

Welcome to the Forum.  Your question has to do with the transmissibility of HPV, including warts and how therapy might affect them,  Before I address it however, I would suggest that you be sure these are warts.  T\It sounds like you have been well treated and there are many cutaneous processes that can mimic genital warts and on more than one occasion I have encountered patients who are been vigorously and repeatedly treated by well meaning clinicians for "warts" that are not.

Unfortunately there are few scientific data on this issue and thus my comments will be rather general.  Scientific studies of HPV transmission are difficult to perform because HPV is so very common and because it takes, on average, up to six months for warts to develop after HPV has been transmitted.  Thus, careful follow-up is a problem, in part as well because many people are multiply exposed (either to the same or other partners) and people tend to get lost to follow-up over time.  Thus there are no precise estimates of how "efficient" a single exposure to an infected partner is for transmission of HPV.

Treated warts, because of treatment, should be less transmissible to partners than untreated ones.  While you are still being treated however, I would suggest that condoms should be used to reduce transmission and that this is an area where disclosure to partners is probably appropriate.  In addition, I would use this as a reason to ask your partners if they have had the HPV vaccine which is about 99% effective for preventing HPV infections by the types of virus present in the vaccine and, if they have not had it, that they should.  It is recommended for virtually all women under the age of 26 at this time.

Sorry I cannot be more precise.  As I said, the first thing to do is to find out for sure if these are warts.  EWH  

[Edward W Hook, MD]

I do think that reviewing whether or not what is currently being treated is still HPV or not is useful.  The genital area has many normal structural "bumps" and is liable to the development of cysts, skin tags, etc.  I have seen many occasions where warts have been treated and then, partially related to increased awareness, treatment has transitioned into treating normal skin structures.  It is a mistake I have made and no one is invulnerable to.  Sometimes a dermatologist visit can be quite helpful.

As for the issue of infectivity. the fact is that if your current sexual relationship is ongoing, your partner has already been, to some degree, exposed.  whether or not she is infected is, indeed, dependent on her immunological makeup, past history, vaccination status, etc.

Please let us know what your doctor says about the possibility that what is being treated is not HPV

EWH

[Jon33]

Hello Doctor,

Thanks so much for your prompt reply. I will certainly ask the clinician about the possibility of the symptoms being something other than warts. While I am relatively certain that the initial outbreak I had was warts (they were large and textbook looking), it is very possible that that infection has since cleared and that something else has occurred since. Aside from molluscum, is there anything I should ask about/propose?

Regarding disclosure and infectivity, I will continue to practice safe sex and advise my partner on the situation. I suppose I what I was mainly curious (which as you said is difficult or impossible to answer), is whether it was likely or not that a partner would develop warts as a result of being exposed to my strain of HPV, or if that depends on the person and their history, etc.

Thanks again!