[Question #10808] Hpv GW Warts
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19 months ago
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Discovered a flat GW at base of my penis 15 days ago. Went to derm, had another pin head size on my scrotum and another super small flat next to other at base. Cryo followed by Imiquimod cream. About 10 days in and things are going well with shrinking GW, look on their way to being gone. I'm a 56 y/o male, married to 51 y/o woman. Neither vaxxed. I have been frequenting sex workers, always protected sex. Any sex mentioned here with wife is unprotected.1) Wife is going to gyno in 17 days. We had one sexual encounter about 6 months ago. It was incredibly brief, less than 1 minute as I suffer from PE, so not much insertion. I'm still really freaked out that she will show positive for Hpv. She is post-menopausal, and has a dry vagina, something I read can really increase the risk. I've read stats on transmission per one time vaginal sex, but it's hard for me to tell if it's likely or not. If I was infected at the time (we don't know), how likely would transmission be as described above?2) if I can clear my GW, let's say 12-18 months clear of symptoms/no recurrence, what is likelihood that I am clear of virus? I know you have said 3-4 months at times, but you usually follow that with a statement trying to destigmatize Hpv. In my case, it would be the end of my relationship and a horrible blight on my life. I know the stats that are out there at 12 mos. (67%), but you usually have a less pessimistic outlook. Do these percentages include people who keep getting recurrent symptoms, and that's what causes them to be less optimistic than some of your statements for people who haven't had symptoms in a while? 3) I used a styptic pencil on my GW because I thought it was an abrasion when I first noticed it. I completely forgot and used it on my neck on a cut. Did I just spread Hpv to that part of my body via the cut?
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H. Hunter Handsfield, MD
19 months ago
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Welcome to the forum. Thanks for your confidence in our sevices. And thanks for reviewing other threads with similar questions, which is obvious from some of your comments and questions.
I'll start with a few general comments about genital HPV and warts, which will start to answer your quesitons. It is rarely possible to know with certainty when and where a particular HPV infection was acquired, and timing of sexual exposures usually isn't very helpful. Your warts may or may not be related to your nonmarital sexual exposures. The earliest visible warts appear is around 2 months after exposure and it can be several years after acquiring the causative HPV infection. Condoms provide incomplete protection at best; regular condom users have only slightly lower risk of having genital HPV than persons who never use condoms. So while your nonmarital sexual events could be the source, it is also possible you have been infected since you first became sexually active all those years ago, including your wife as a possible source. You'll never know for certain. As for risks for your wife, if you've had the underlying HPV infection for months or years, you can safely assume she has already been repeatedly exposed. On the other hand, given the infrequency of sex with your wife, maybe not. Here too it isn't possible to know.
I'm glad to hear the diagnosis of GWs has been confirmed by a dermatologist; otherwise that would have been my first advice. It sounds like you were appropriately treated and you can expect the woarts to resolve soon.
To your specifc questions:
1) Most likely your wife's gyn exam will not reveal visible warts. If not, I would not advise she be tested for HPV. She is beyond the usual age at which routine pap smears no longer are recommended. However, if a pap is done, it probably will include HPV testing. But otherwise I wouldn't advise HPV testing. However, this will be up to her doctor and I would not attempt to alter whatever her advice might be. Anyway, if there are no warts now, conceivably they could show up any time in the next few months or years -- or not at all. As for your recent sex with your wife, since it is likely you've been infected for a long time, and therefore that she is already sharing your HPV infection, it is likely she is immune to it by now and never will have either warts or an abnormal pap. But only time will tell. I am unaware of any data that reduced genital lubrication ("dry vagina") raises the risk of HPV. That's not a significant factor in this situation.
2) In general, it is believed that HPV is cleared if warts respond to treatment and have not recurred within a few weeks. At least the viral load and therefore transmission risk is reduced, although the risk may not be zero. But I doubt you'll still be infectious for as long as 18 months. And as already noted, if your wife has already been exposed and infected, she is immune (or at least highly resistant) to new infection with the same HPV type. For all those reasons, I disagree that this event has any serious risk of ending your relationship with your wife. Presumably your wife knows of your warts (otherwise why the planned gyn exam?). Even if she doens't and develops warts herself, this happens all the time in truly monogamous couples, even after many years of marriage, i.e. there would be no need to 'fess up about your nonmarital sexual experiences.
3) I doubt there is any risk of self transfer (auto-inoculation) of warts to your neck. It is unlikely enough virus would be carried on the styptic pencil or would survive contact with it. My understanding is that styptic pencils have antiseptic properties and I've never heard of warts or other infection being transmitted by their use.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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19 months ago
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Follow up: 1) I thought GW most often present within 3-6 months of infection? Your response seems to offer a different view that I have been infected for a long time. It's often stated that if the virus persists, that's when you get GW. But from reading your many posts, GW doesn't indicate persistent Hpv, correct? It's related to the strain right (6 or 11)? Your statement that if no recurrence in weeks (let's say 12?), virus most likely cleared, is this because if virus did NOT clear, you would keep getting GW? 2) Is it difficult to transmit with one time brief sex? When I look up transmission rate per act, it gives a range of 5%-100%! That's quite a wide range. If no warts/symptoms, is it still a high rate of transmission per sex act? Is it a fait accompli' if you have sex while still with active virus? 3) if infected with multiple strains, do the different strains tend to clear at around the same time? 4) are the time to clearance data skewed by certain strains which are tougher to clear? 5) is a quick resolution of initial wart outbreak any reason for optimism?
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H. Hunter Handsfield, MD
19 months ago
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1. As I said above, warts can show up anywhere from a couple of months to several years. That doesn't conflict with the fact that they "often present within 3-6 months". I don't understand your comments or what you think you heard before about "persistent HPV": I think you're mis-remembering or misunderstood something you read. Even if a wart-causing HPV persists, warts may or may not reappear. There's no way to predict.
2. There are no good data on the efficiency of HPV transmission, which explains the widely varied estimates you have seen. I would say that a 5% chance is too low and 100% to high. Probably it varies a lot with things like whether the exposed person previously has been exposed to that particular HPV type; and how long the infected person has had the virus (probably more transmissible soon after acquisition and less so for more prolonged infection). Whether it's a fait accompli probably is mostly related to the frequency of exposure over time: Once, probably not; 20 times, much more likely. All this is educated guesswork in the absence of scientific data.
3,4. Good questions but no good answers. Certainly some HPV infections persist longer than others, I'm not aware of careful research on this issue. Sorry.
5. I would generally consider it a good sign if warts clear promptly, likely with reduced risk of persistence or of recurrent warts. But still, no good data available.
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19 months ago
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I didn't think I would use my last follow up question on this, but I have developed a very minor burning in my tonsils/back of throat (very minor). I also have very minor hoarseness. Is this my mind playing tricks on me a bit? The hoarseness could be stress related for sure as I am stressed to the max. Is this Hpv in my throat (due to oral activities with prostitutes)? Honestly this is just really stressing me more than the GW right now. What doctor would I go to for a diagnosis? Is there even a way to check, apart from if I already have tumors/cancer? Can this go away on it's own? Or are the symptoms a sign that I already have a major problem? Or am I just completely overreacting due to the stress of the situation? No troubles chewing or swallowing yet by the way. Just a minor burning feeling in back of my throat/esophagus. Could be stress related GERD type thing?
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H. Hunter Handsfield, MD
19 months ago
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Follow-up comments are available for clarifications and follow-up questions about the original issue, not to raise entirely new issues. I will just say these symptoms sound like a minor viral infection, and of course we're at the peak time of year for such viral infections. Or maybe it's only stress, as you suggest yourself; you're a better judge of this than I can be. Any general physician would be suitable to address this problem if it persists and you decide to seek care. For sure such symptoms do not suggest HPV or any other STD.
That concludes this thread. I hope the discussion has been helpful. Best wishes.
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