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Avatar universal

HPV Questions...

Hello, Dr.

First, I have to say, in all the reading/research/google-ing I've done on HPV and genital warts, yours is the freshest and most reassuring I've ever read. The usual attitude is far heavier and, while not "dooms day", does not instill much peace-of-mind.

1. First, the point-of-view question (I have tried searching the threads and haven't seen this addressed). In other areas I've asked this question or have seen it asked, including other forums similar to this where answers are provided by a doctor/dermatologist, they have advised to avoid sexual activity at all costs while a wart outbreak is present and then to practice extreme caution when the warts are gone because the virus is still contagious.

Your point-of-view seems much more a "don't really matter" one. Even with warts present, you can't get it twice (my next question) and so there's no point in abstaining whether there are warts or not. When the predominant mentality seems to be so much more on the side of caution, I'm curious what brings you to have such a "lighter" view of it?

2. HPV is systemic, is localized to the area the virus contacted, and basically cannot spread throughout the body other than by  contact with an infected portion of exposed skin to another, correct? If that's the case and you've already got warts present, couldn't any contact with neighboring unaffected skin cause the virus to spread there, too, causing a sort of localized epidemic over time? It's maybe not a big deal, but honestly, warts are unsightly and aggravating. They're not supposed to be there ya know? That in mind, is unfettered continued sexual activity even with warts present really so trivial? Are you risking the spreading of the virus to other unaffected skin, making an already ugly situation potentially uglier? Or, does your body learn to "fight it" from the first outbreak, making local spreading more unlikely? I hope I'm explaining this well.. :-).

3. I've tried several different things now to treat my wart out-break. I want them gone. I want to treat the virus and the wart both and have the lowest chance of reoccurance. So far nothing I've used seems to be doing anything to them. I want them gone, if only for peace-of-mind. What would you suggest to a patient as a regimen to use? Are you a stickler for prescribed methods, are you a proponent of herbal/natural remedies? Do you promote a certain supplement regime of vitamins/diet and such to help build the immune system against it to help fight the HPV off? A combination of all of the above perhaps? If so, what would you most recommend to someone?

And, in your experience - not asking for a personal prognosis or exact figures because those would be impossible to give - but in your personal professional practice, what has been the average "recovery" rate for your patients when using a regime you've recommended? I have no idea how long I'm supposed to continue on a treatment before deciding it's not working.

Thank You.

8 Responses
239123 tn?1267651214
Thanks for the thanks about the forum.

1) I'm not sure I go quite as far as "it really doesn't matter".  It matters, and all things considered it is better if people don't catch genital HPV infections.  But it's basically unavoidable at anything approaching normal patterns of sexual behavior, and the vast majority of infections do not lead to serious health outcomes.  We all face risks in life, such as a decision to drive on the freeways.  We use seatbelts and avoid drugs and alcohol before we go on the road, but we still drive and accept the remaining risk of injury and death.  So with HPV (and other STDs):  reasonable, common sense approaches to safety make sense, but not to the point of completely giving up on sexual rewards.

2 and 3) You've got it right (with the correction "not" systemic).  Warts can be spread locally by autoinoculation; for example, no shaving around warts.  Otherwise they don't spread body-wide.  There are no known dietary or other manipulations known to affect the response to warts or other HPV infections.  My recommendation is to just have visible warts treated under the care of a knowledgeable professional, knowing that eventually--within a few months--in most people they will cease to be a problem.

There is a lot of individual variation in response to particular treatments.  If not responding to, say, Condylox or Aldara, trying the other makes sense; or see a provider skilled in freezing or laser surgery (e.g., most dermatologists).  Any particular treatment should start to show clear benefit within 2 weeks (longer for Aldara, up to 4 weeks); otherwise tell your provider you want to try something else.

Best wishes--  HHH, MD
Avatar universal
A correction..In question #2.. I meant to say "HPV is not systemic...". Forgot a word.

Thanks again.
239123 tn?1267651214
What you say about transferrence of warts may seem to make sense, and I knew exactly what you meant. But it just doesn't happen; in 30+ years in this business, I have never seen a patient who had transferred his or her genital warts outside the immediate genital and anal area.  The genital HPV strains just don't grow well, if at all, in other body areas.

But to the extent there is some small risk of that, it is greatly enhanced by not getting warts treated, and I fail to understand why you didn't take the prescribed therapy.  Not smart.  Do it now.  But I haven't a clue how long you prescription is valid; call your doc's office, or just go to a pharmacy and see if they honor it.

Avatar universal
"2 and 3) You've got it right (with the correction "not" systemic). Warts can be spread locally by autoinoculation; for example, no shaving around warts. Otherwise they don't spread body-wide. There are no known dietary or other manipulations known to affect the response to warts or other HPV infections. My recommendation is to just have visible warts treated under the care of a knowledgeable professional, knowing that eventually--within a few months--in most people they will cease to be a problem."

First, thank you for your responses.

I think I get your gist, now, about the "not worrying" part. It's a concern, but - especially in the face of being a stigma - its bark is pretty much worse than its bite.

In the case of treatment. I went to a dermatologist some time ago and had them examined.. that's how I know for sure they're warts. He gave me a prescription for Aldara, and a couple starter packs. I haven't started on it yet because I didn't have money for a prescription, nor insurance to cover it.. I didn't want to start with the starter packs, stop when I ran out, and then start again. As a related question.. I still have that prescription, originally written out on 3/15/06 (yes, I know, it's a while back - life kinda got in the way for a while). Do you know if that prescription would still be valid, or do they have an inherent "expiration" after a period of time, etc? Can I still go in and retrieve the Aldara? That would be most convenient if I can without having to see another Dermatologist, pay another office visit, etc. My financial situation being better now, I could afford to fill it and I would like to.

Other than that, I don't think I asked one of the questions as well as I should have - regarding the whole "local epidemic" idea. How I should have asked it is.. I've got a wart outbreak and they are of course contagious. Let's say they come in contact with someone and that part of their skin becomes infected... Then, the warts touch another part of the skin, nearby... that spot, too, becomes infected.. Next thing you know, you've got infections spreading to three, five, eight spots, etc. from the same "source" wart. Think of it as a wart being a rubber stamper being stamped all over a clean piece of paper - where the rubber stamper will eventually run out of ink, the wart is not going to stop being contagious so long as it's hitting uninfected skin. Of course, every contact is not necessarily going to result in a new infection, but it still seems (with my completely unschooled understanding of it) that it could cause a large area to be affected on someone.

Avatar universal
Usually prescriptions are good for 6 months, but as Dr. HHH said, just go and see if they'll still fill it.
79258 tn?1190634010
I agree that it's probably still okay. However, if it's been too long and your pharmacy won't fill it, just call the dermatologist's office and ask him/her to call it in for you. You shouldn't have to pay for another office visit.
Avatar universal
I did check into it and I can still fill the prescription.

The reason I didn't fill it at the time are that I was in-between jobs with not enough money to spend $200+ ($250 according to someone at a local Eckerd Drugs) on a prescription. And, I didn't have medical coverage to make the cost any cheaper. I'd paid for the office visit/examination out-of-pocket already as it was just to find out what was going on. Believe me, I would have liked to get the prescription right then, but it just wasn't feasible.

However, my financial situation is a bit better now so even with the price-tag, I'm going to go and fill it in the near future.

Thank you again for the info.
Avatar universal
If you can't afford the prescription, go to your local health department/family planning.  If you don't have the means, they will give you the Aldara free after you have a visual inspection from their doctor.

Best of luck.
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