HPV Warts Worry

[Lindos]

Dear Mr. Handsfield
I am feeling desperatly worried and upset about having HPV genital warts and feel I am not being given much information. I have been with my boyfriend for 11 years and have never had an STD. Both of us had 3 partners before we got together. I have not slept with anyone else during our relationship. My boyfriend has been living abroad for two years and he developed genital warts in April 2010. He swears that he has not slept with anyone else and I did believe him but now am questioning whether he has been faithful. It seems strange how he developed warts after such a long time of neither of us having any symptons (he did go through a really stressful time when the warts first developed)  I subsequently developed warts in July 2010 and they have got worse and worse. It started with one or two tiny ones which were treated straight away, and now I have about 15 of them. I have been receiving treatment the whole time, varying from freezing which is painful with so many warts, and time consuming to Aldara which causes ulceration, itchiness and soreness. Some go only to be replaced by more. I am at my wits end to know what to do as I have had these warts for 8 months now. I am a healthy person, who excercises regularly and eats well. I do sometimes get drunk and smoke but I am not a regular smoker. I am going to stop smoking, but do you also think it is advisable to go on a healthy eating diet to boost immune system? I have also been stressed over the last 8 months and I know I have to minimize stress because this does not help the immune system. Basically I feel that no-one is advising me of the best way for me to get rid of the wrarts/virus. I have not had sex for 8 months, and can’t imagine having sex whilst I have these unsightly warts and sex is something I really miss.  
Will my body eventually get rid of this virus? and do you think an immune system boosting diet is a good idea?
I very much look forward to hearing your thoughts

[Edward W Hook, MD]

As the proportion of persons available to be studied becomes smaller, the observations get a bit less precise.  Thus the precision with which we can make definitive statements about the 10% of persons whose HPV does not clear in 2 years is not great. Having said that, there is no evidence to suggest that the failure to clear warts after 2 years necessarily means that a person's immune system is week or that they are otherwise vulnerable to other problems.  There is also no evience that such lesions progress or go on to become more pressing or dangerous medical problems an if this were the case we woul know it

Sorry, I can't comment on the issue of scratching or friction-related spread.  EWH

[Lindos]

Hi Dr. Hook

Thanks very much for answering my questions. Could you maybe clarify a few things for me. I have done a lot of research on the internet and have read that 70% of people are free of warts after a year and 90% are free after two years. What about the other 10%? Whilst most people’s immune systems seem able to suppress/eradicate the virus after a certain amount of time, I do occassionally come across people who still have warts after say 4/5 years continuously, this really scares me, is this because they have weak immune systems? I have had everything checked (sexual health and normal health) over the last 8 months and I am clear of other illnesses and am considered healthy. The only thing I have been doing is drinking alcohol more than usual which I have now cut down on. I have started eating lots of fresh fruit and veg too, although I am a healthy eater. One of the reasons why the warts may have spread is that I excercise a lot which maybe causes friction? And the aldara really makes me itch and I wake up in the night to find I am itching down there! Sorry gross but this may cause a spread? Anyway I will take your advice and ensure everything is treated persistently.

[Edward W Hook, MD]

Welcome to our Forum.  Dr. Handsfield and I share the forum.  You got me and I will try to help.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

As your own experience shows, most persons acquire warts relatively soon after exposure (weeks to months, not years).  Very rarely, particularly if persons have factors which weaken their body's immune function, warts can appear after years or be particularly difficult to treat. You do not sound as though you fall into those sorts of categories.  

HPV treatment often takes persistence.  Virtually all of the current therapies are destructive in nature, being deigned to kill the tissue in which the virus is living and therefore to kill the virus at the same time.  It is a bit unusual for warts to be spreading however unless you are shaving the infected area of scraping or traumatizing the infected area in some way.  Stress is and of itself is not known to delay response of HPV to treatment, thus I doubt that there is much to be gained by trying to change your diet to boost your immune system (what's more, there is no proof that efforts to boost immunity through diet actually works).  My advice would be to work with your doctor to find the type of treatment that works best for you, both in terms of effectiveness and side effects and stick with it.  In addition to the treatments you mention some particularly hard to treat warts respond well to laser treatments which are offered by some gynecologists or dermatologists.  Perhaps this is an option.  

The topic of HPV and genital warts is a complex one.  I hope my comments have been helpful.  For additional information on this most common of STDs, I would suggest search for other HPV- and wart-related Q&A on this site, as well seeking addition information on sites such as the American Social Health Association web-site (disclosure, Dr. Handsfield and I are both on the Board of ASHA).

I hope these comments are helpful.  EWH