HPV

[reliqtrw]

I am seeing a new girl and would like to know if I should tell her about my past exposure to HPV before we have sex (if it gets to that point). It is something that is bothering me and I want to do the right thing. We are both around 30, and I have only had one sexual  partner in the past, a long term girlfriend for 3 years. After I had been with this past girlfriend for about 8 months, I developed a small wart on the base of my penis. I removed it myself, but some more appeared a few months later, along with warts in my anus (I used a condom with the girl every single time, so I suppose it makes sense that only the parts that weren't covered developed warts). I used podofilox to treat the (very small) warts on the base of my penis, and I had the warts in my anus excised and electrocauterized. They came back a few months later, and I had to have another round of electrocauterization. This was almost 3 years ago, and as far as I know, they have not recurred since then. The last time I had sex with my previous girlfriend was 9 months ago right before she left me. I never once had unprotected sex with her.

My research indicates that HPV clears on its own in 6-24 months. However, I am paranoid that maybe I still have very small or flat warts that I cannot see. I am in good general health. In your professional opinion, do I need to tell any future partners that I have had genital warts before we have sex? I would be devastated if they contracted this from me and I did not inform them. On the other hand, I do not want to cause unnecessary worrying if there is no medical reason to do so. Would there be any benefit for me to get the Gardasil vaccine, or have I already developed immunity by having the virus?

Finally, just out of curiosity, how likely is it that my previous girlfriend cheated on me when I developed warts after 8 months of sleeping with her? She had visited a guy out of state 2-3 months prior, swearing nothing happened when I busted her.

[Edward W Hook, MD]

1.  Not all HPV infections are cleared but the vast majority are.  Once they are cleared, persons seem to be resistant to further infection with that type of HPV and transmission to others is not a concern.  Although the HPV vacccine will not be covere by insurance, if it is not a hardship for you, you limited number of partners mgiht make it worthwhile.  It cetainly would not hurt.

2.    I would discuss the management of your continuuing discomfort with a protologist. I also wonder if the irritation you are experiencing might benefit form the same sorts of meicati-ns and local therapy that help the discomfort of hemmorrhoids.  

3.  You are misinformed. Most HPV 6 an 11 infections do lead to warts.  

You can learn more about the HPV vaccine at the ASHA (American Social Health Association) web site.  EWH

[reliqtrw]

Whoops, forgot the other (and last) question: Since my body obviously responded to the HPV by developing warts (which I have read is unusual, most people don't develop warts from 6 and 11), does that mean I am more likely to develop warts if I catch another wart-causing strain? I.e., if I had type 6 HPV before, am I more likely to develop warts from type 11 if I catch it in the future simply because my cells went nuts when exposed to type 6? Is there any kind of test my doctor can do to see if the virus is persisting or cleared (such as a pap smear on the anus)? I'm going to make an appointment to discuss Gardasil and would like to be informed since I clearly wasn't the first time around, so I really appreciate your advice.

[reliqtrw]

Thanks for your response. Just a few follow-up questions.

Are you saying that it's pretty much a 100% chance that my body has cleared that 3 year old HPV infection so that there is no way I could pass it on? If so, is it possible that I could be re-infected by the same strain again in the future, or I am essentially immune to developing warts from that strain again. Or, put another way, is there any chance the same warts may come back at any point (similar to the way oral cold sores sometimes spontaneously and randomly recur for life)? The answer to these questions will be helpful in determining if I should get the Gardasil vaccine. Even though I'm 30, since I've only had one partner, I feel it may be worth it.

Secondly, ever since I had the anal warts excised with a bilateral hemroidectomy (the most painful experience of my life), I have had constant irritation and anal fissures from the resulting scars. I regret having the surgery because I was falsely informed at the time and was not told they would eventually regress on their own. My scarred and constantly irritated anus is a painful and persistent reminder of that horrible experience. Is there any medical treatment or surgery that could fix the scars and make it the way it was before all this happened? Who should I see about this? Dermatologist? Plastic surgeon? Proctologist?

Thanks again.

[Edward W Hook, MD]

Welcome to the Forum.  You are asking good questions.  Let's get straight to them.

Your experience with recurring warts is by no means unique.  Warts can be difficult to treat particularly when you are doing it yourself- health care providers tend to treat, on average, a bit longer and most intensively than patients do when they treat themselves and even so, warts require more than a single treatment 20-30% of the time.  

If your warts have now been gone for 3 years, there is no need to fear that you might still be infectious for your new partner.   Typically, if warts have not recurred within 3 months of treatment, persons can consider themselves no longer infectious.  While disclosure is always the best policy, in some relationships this is hard to accomplish and introduces unnecessary tension into the relationship.  The fact is, most people will have one type of HPV of another rather soon after they begin to have sex, thus even most people who do not know they have HPV have or have had the infection.

It can takes months for warts to appear after exposure and transmission may not occur following a single exposure. Thus that it took 8 months for your warts to develop does not mean that your ex-GF was cheating on you.

Finally, I think the HPV vaccine is a good idea for everyone.  In your own case, the fact that you have already had one type of HPV (your warts) does not mean that you cannot get others and the HPV vaccine will dramatically reduce your risk for future infection.  If not covered by insurance, it can be expensive ($300-400 for the vaccine alone) but it is highly effective.  

I hope these comments are helpful to you.  EWH