[Question #1082] Follow up to question 67

49 months ago
Drs, In June 2015, as noted in question 67, I had unprot. external genital rubbing with a young woman at a spa for a few minutes.  All tests came back negative.  Unfortunately, in June/July of this year, I noticed a growth on the underside of my penis (which is what contacted her labia) - it was about 1cm by perhaps .3 cm.  I went to a derm. two weeks ago who didn't think it was a wart, but he cut it off and cauterized the wound.  Today the biopsy came back as condyloma.  I'm nearing 60 years of age, by the way. I will of course discuss this with my wife.  My questions are these: 
1.  Given my age, what might I expect in terms of recurrence?  
2. What sort of self-examination should I perform regularly to catch any recurrence (that is - how widely might this spread)? 
3.  My wife is in her 50s.  Should she expect visible warts as well?  
4.  What is the prognosis for her?  Given the location on me, should we expect localization on her, or could the warts be almost anywhere in her genital area (internally and externally)? 
5.  What advice do you have for her? What resources should I provide? 
6.  Given her age, is she at greater or lesser risk for cancer? 
7. Finally – what steps do we need to take to make sure we don’t inadvertently transmit via our hands to family members? 
Thank you.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Welcome back to the forum.

I glanced at your two discussions with Dr. Hook last year (no. 164 as well as 67). I suppose it is possible you acquired your newly diagnosed wart during the exposure a year ago, but not necessarily. It is also possible you have had a recurrence of a long distant HPV infection. However, you'll probably never know for sure. To your questions:

1) To my knowledge, there are no data on frequency of recurrent warts at different ages. Probably around 90% of people with newly acquired warts never have a recurrence, once the warts are gone -- either spontaneously or after treatment. Of course if your wart was not newly acquired, but is itself a recurrence, perhaps the frequency would be higher than 10%. But probably not much.

2) If I were in your situation, I would not undertake any systematic self-examination. Whatever you notice naturally when showering, changing clothes or using the toilet should be sufficient.

3-5) If your wart is newly acquired, there is some chance your wife will develop warts herself. If it's a recurrence of distant infection, then probably your wife has been exposed, infected, and now immune to re-infection with the same straing (or at least highly resistant it not entirely immune). My bet is she'll never notice anything. Although warts can be internal only (e.g. in the vagina or on the cervix), mostly they are external and easily noticed. If she doesn't see anything visible, that would be very reassuring. However, it would be reasonable for her to see her doctor (preferably gynecologist), who might want to examine her two or three times over the next year or two, perhaps with pap smears -- or maybe only with visual inspection.

6) The large majority of genital warts are caused HPV types that rarely cause cancer. Her doctor might recommend pap smears, though, just to be maximally safe. But this really shouldn't be a significant concern.

7) Genital HPV and warts are never transmitted other than sexually. Look at it this way:  90% of all people get genital HPV, and probably around 20-25% have an episode of genital warts. Through your nearly 60 years, you have shaken hands, worked, eaten, and shared toilets with an uncountable number of people who had active HPV infections at the time. Did you catch it? Have you ever heard of this in anyone you know? It simply doesn't happen and should be the furthest thing from your mind.

Don't overly freak out over this. Genital warts are an unpleasant inconvenience, not an important health threat. The biggest stress here is likely to be discussing things with your wife, and I know that will be difficult. But only because of the relationship issues, not because of health issues. From that standpoint, the really isn't a big deal.

I hope these comments have been helpful. Let me know if anything isn't clear.

HHH, MD
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