[Question #11287] Genital Warts incubation & encounter risk

15 months ago

I am a 33 year old male (white/married). As of today, it has been nearly 13 full weeks since I had a single encounter with a sex worker (protected sex). As of right now, I have no symptoms. The country I live in offers PCR testing for HPV for men in certain clinics. Approx. 8 weeks after the encounter, I received this test performed by penile brushing (cytobrush) which came back negative for low risk strains after a few days.

1. I have read that PCR testing in men is unreliable, least of all with cytobrush compared with other methods. Is this true?

2. I have also read that most people develop warts within 2-3 months of exposure. Is this also true and to what extent or %

3. I received the first dose of Gardasil last week. Would this potentially lower my odds of showing symptoms?

Edward W. Hook M.D.

15 months ago

Welcome to the Forum. Thanks for your questions. I'll be glad to comment. As I think you know, routine genital testing for HPV in males is not recommended and not widely available. The testing you had is the sort of testing sometimes done in research settings. I'm surprised to hear that this is offered clinically where you live. If your tests had been positive, interpretation of the results would be exceedingly hard, if not impossible since HPV can remain dormant for years before becoming detectable or apparent as warts. In response to your specific questions:

1. I have read that PCR testing in men is unreliable, least of all with cytobrush compared with other methods. Is this true?

See my comment above.

2. I have also read that most people develop warts within 2-3 months of exposure. Is this also true and to what extent or %

The precise proportion of persons who develop visible warts upon exposure to low risk HPV is unknown. On average, it appears that it takes about 2-3 months for warts to become clinically apparent. These generalizations likely have exceptions but most experts would aggress that appearance of visible warts sooner than 2 months following an exposure is very, very uncommon.

3. I received the first dose of Gardasil last week. Would this potentially lower my odds of showing symptoms?

Perhaps. The HPV vaccine certainly provides excellent protection against acquistion of new HPV infections any time more than 2 weeks following receipt of the 2nd dose. There are limited data that the vaccine may also promote increased clearance of established HPV but those data are not as solid as the preventative data. Given your test results, it is most unlikely that you acquired HPV- we know that condoms substantially reduce risk for HPV acquistion (50-60%) and that most single exposures do not lead to transmission of infection. These facts, along with your negative test results are strong evidence that you were not infected by your CSW exposure mentioned.

I hope that this information is helpful. EWH

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15 months ago

Thank you for your reply, Doctor.

My biggest fear would be passing something into my wife, as such we have not had sexual contact since my experience with CSW (she does not know).

Per your comment, the country is Japan and some clinics do offer HPV PCR testing for men, although I must say there are very few to provide the service that I could find…

My follow-up to your response would be as below:

1. You mention that it would be quite difficult to interpret any meaningful results from the PCR test if it were positive, but you also mention at the end of your comment that you believe the negative result indicates an infection is unlikely. Could you kindly expound on that?

2. If I were infected with a wart-causing strand and simply currently asymptomatic, how transmissible would the virus be to my wife and how likely is it that she would become symptomatic as a result of sexual contact?

3. Since I did use protection for this encounter, my doctor said that if I had contracted the virus, then warts would only be present in areas the condom did not cover. After my negative PCR test, he could not definitely say I would not get warts in other areas (pubic area, scrotum) as the skin is too thick to reliably get samples. What are the odds then that I could develop warts in that area?

Edward W. Hook M.D.

15 months ago

I think your fears and perhaps guilt are getting the best of you. I was unaware that this sort of testing was available as part of clinical care in Japan or anywhere else, thanks for letting me know. That said, this is not standard or standardized practice and I cannot on the accuracy of the result. Irrespective, the negative test at least provides further support that you were not infected. Let me reiterate the reasons why I am, once again, urging you to not worry further and to move forward. The reasons include:

1. There is no clinical evidence (i.e. visible warts) at a time by which warts would have been expected to be apparent.

2. Most single exposures do not result in transmission of infection.

3. Your single exposure was condom-protected, a practice known to further reduce the likelihood of infection

4. You were tested in Japan and the results were negative

5. Even if your wife were found to have HPV, there is no way to prove the duration of infection and detection of infection at this time could very well reflect expsoure years ago.

In response to your specific questions:

See my comments above. While the accuracy of the testing you had cannot be assured, it appears to provide additional support to the idea that you were not infected, along with the other reasons listed above.

HPV certainly can be transmitted by persons who are asymptomatic. There are no good scientific data on the proportion of exposures which lead to infection although as stated above, most experts agree that even most single unprotected exposures do not result in infection.

Your asking a "what if" question for which there are no data.

I encourage you to take a deep breath and move on. There is no benefit to worrying about something you have no control over. In fact, to do so cannot be good for you or your relationship with your wife. EWH

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14 months ago

Thanks for your reply, Doctor.

I am now at 17 weeks and no symptoms. I understand that you would not find HPV to be cause for concern in the first place based on some of your answers here to some related questions, but it is to me and so I appreciate your candor and understanding.

Having said that, at what point (based on my circumstances) would you be able to largely rule out a genital warts appearance?

I want to be able to let this go, but from what I’ve read it’s possible up until 6 months after infection. It’s been 4 months now, so is it safe to assume it very likely would have happened by now?

Edward W. Hook M.D.

14 months ago

As you know, we provide up to 3 responses to each client's questions. Therefore this will be my final response, following which the thread will be closed.

Typically visible genital warts appear 2-3 months following an exposure. Although warts can appear at any time following infection, if warts have not appeared by 4-6 months, they most probably will not. At 4 months it is very unlikely that you are going to develop visible warts, particularly since you were tested and have initiated HPV vaccination.

I urge you to move forward without concern. EWH

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