[Question #10424] Genital warts and oral sex
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23 months ago
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Recently I was diagnosed with a few very small genital warts. These were SO small and looked like skin tags under magnification but, for better or worse, I pushed to biopsy—and it confirmed warts.Now I am trying to navigate disclosure in the near future.At the moment, here's what I was thinking. Please let me know if this seems right to you, from a medical POV.
1. In the context of my receiving ORAL sex from a new partner, once the treated warts are healed from removal: I would prefer *not* to disclose the previous warts in this scenario. Based on what I've read online, including commentary from Drs Handsfeld and Hook, genital > oral HPV transmission is rare; someone acquiring oral warts from going down on someone with genital warts rare; etc. So it seems to me like refraining from mentioning the wart diagnosis, even when receiving unprotected oral sex, would be an OK decision.
2. In the context of (protected) vaginal sex with a new partner, I WOULD disclose the genital warts diagnosis for the next 3 months or so, provided that the very tiny removed warts do not recur. I am on the fence as to whether this disclosure could or should involve the actual phrase "genital warts", since it has such a visceral reaction in many cases. I'd prefer to say something like "I was diagnosed with HPV and had it treated," unless that seems disingenous. Any help or advice appreciated!
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Edward W. Hook M.D.
23 months ago
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Welcome to our Forum. Thanks for your thoughtful questions. Thanks as well for reviewing other threads on the topic of warts/HPV. It is clear from your questions that you have a good sense on these virtually ubiquitous, mostly innocuous infections which have become a part of life for unvaccinated sexually active persons. I'll go straight to your questions:
1. This is a good summary of the advice we give, as well as it's rationale. Particularly following treatment, I see no reason for disclosure of past warts.
2. Regarding disclosure to future partners with whom you participate in vaginal sex, your position is a good one. It is truthful. Since many persons who have genital warts also have co-existent HPV infection which is not manifest as visible warts, the term "HPV infection" is probably more correct.
Two other points which you may wish to incorporate into your thinking:
1. The longer the interval since treatment of your warts, the less likely they are to recur. In addition, the small size of the warts which have been detected suggests they may be relatively recent and thus more readily treated. After all, in about 25% of persons with wart treatment, no matter what type of treatment, there is a recurrence.
2. Unless there is a reason not to, I would suggest you seek HPV vaccination. This is the "high road" in terms of future acquisition of HPV, it opens the door for a discussion of vaccination status and vaccinated partners can be assured that their risk for genital wart acquisition if very, very low, it may enhance response to treatment or resistance to recurrence, and it sets a good example for your partners.
Thanks again for your questions. Feel free to use your up to two follow-ups for clarification. EWH
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23 months ago
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Thanks so much! This makes sense. The frustrating thing is that I did INDEED have a 3-course Gardasil vaccine back in 2015. Will be curious to see the results when they do HPV typing from the biopsy, since so far I have only learned that it was a wart, not which strain.
1. Just to clarify your phrasing here: "Particularly following treatment, I see no reason for disclosure of past warts." You mean this specifically in the context of receiving unprotected *oral* sex from a new partner, correct?
2. More of a curious question here...assuming that most genital warts are from HPV 6 or 11, are there a lot of people walking around with active HPV 6 or 11 infections who just never get warts (but might be able to pass warts on to a new partner)?
3, Given that I did get the Gardasil 3 dose vaccine back in 2015--I was about 34 at the time, with many sexual partners at that point--do you think that this might in some way improve my chances of clearing this wart-causing HPV? Or, totally irrelevant?
Thank you!
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Edward W. Hook M.D.
23 months ago
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Thanks for the additional information. It's interesting to hear that you've been vaccinated yet found what are apparently new warts. Certainly the vaccine is not 100% effective but it is awfully good. The results of typing will be interesting. As for your follow-ups:
1. Not entirely. Disclosure is always a personal decision. It is an accurate generalization that irrespective of location, the longer since treatment without a recurrence, the less likely that the wart is to recur or to be transmitted.
2. Indeed, not everyone with HPV 6 or 11 develops visible warts. It is reasonable to presume these infections are transmissible.
3. Recent data do suggest, although the data are not conclusive, that vaccinated persons tend to have lower recurrence rates than persons who have not had the vaccine.
Good questions. I hope these responses are helpful. EWH
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23 months ago
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OK, so for final recap, plus one additional small Q:
1. If receiving (or giving) unprotected oral sex in near future, will not feel the need to disclose previous warts since the chance of transmission is low enough, if not necessarily zero. Fair?
2. For next 3 months or so, will disclose previous warts to partners I plan to have *vaginal* but protected sex with. Might do so by discussing "a previous HPV infection that was treated by dermatologist." After 3 months or so, if there's no recurrence, will likely NOT disclose to vaginal (protected) sex partners. Fair?
1. If receiving (or giving) unprotected oral sex in near future, will not feel the need to disclose previous warts since the chance of transmission is low enough, if not necessarily zero. Fair?
2. For next 3 months or so, will disclose previous warts to partners I plan to have *vaginal* but protected sex with. Might do so by discussing "a previous HPV infection that was treated by dermatologist." After 3 months or so, if there's no recurrence, will likely NOT disclose to vaginal (protected) sex partners. Fair?
And finally:
3. Re: the typing, which may take a few weeks! Let's say the typing comes back with one of the low-risk, wart-causing strains...plus one of the higher risk strains. Would this change any of the previous opinions? Or is the idea, as I'm guessing: that so many men are carrying various asymptomatic high risk strains at any time, and have no clue (plus few/no tests for those strains), this means previous discussion of disclosure from this thread would be the same.
Thanks for the empathy and patience, and for being a light of sane & accurate advice on the internet, which is often lacking in both sanity and accuracy :)
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Edward W. Hook M.D.
23 months ago
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1. Agree
2. Good plan
3. The typing of the biopsied lesions is of interest but would not change your approach. Occasionally the vaccine fails to protect from an type contained in the vaccine. In addition, rarely, there can be visible warts due to non-vaccine type. Neither finding would change my approach
Take care. I wish you the best. I will leave the thread open for the next 30 days in the hopes that you'll be willing to share the typing results from your biopsy. We continually learn from our patients' experiences and are interested in the outcome of your biopsy. Thanks. EWH
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22 months ago
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The typing results came back and apparently the HPV strain in question is NOT hpv 6 or 11, nor is it the high-risk HPV 16 or 18. This typing did not say which strain it WAS.
Given that I apparently have visible warts due to a strain other than 6 or 11, that seems to put me in the category of the 5-10% of people with genital warts that aren't caused by HPV 6 or 11.
My main questions here:
1. Does this mean that someone who has the Gardasil vax is likely not protected at all against whatever strain of HPV is causing my visible genital warts?
2. It seems like HPV 6 and 11 quite often turn into visible warts, at least a majority of the time. For other strains--including whichever one i might have--would it be less likely for someone who acquires this strain to unluckily end up with visible warts? Is there any data on this?
Given that I apparently have visible warts due to a strain other than 6 or 11, that seems to put me in the category of the 5-10% of people with genital warts that aren't caused by HPV 6 or 11.
My main questions here:
1. Does this mean that someone who has the Gardasil vax is likely not protected at all against whatever strain of HPV is causing my visible genital warts?
2. It seems like HPV 6 and 11 quite often turn into visible warts, at least a majority of the time. For other strains--including whichever one i might have--would it be less likely for someone who acquires this strain to unluckily end up with visible warts? Is there any data on this?
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Edward W. Hook M.D.
22 months ago
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Final response as part of this thread:
See my other response to your new question. In response to question 2. As I said earlier, in fact, while more than 90% of visible warts are due to HPV 6 or 11, many and perhaps most HPV 6 or 11 infections do not result in visible lesions. EWH
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