[Question #11465] Verruca Vulgaris on Perineum
14 months ago
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Hello. A couple of weeks ago I found bumps on my perineum that I thought were condyloma accuminata but the biopsy report returned as Verruca Vulgaris. The nurse said once the warts are frozen off I will no longer be contagious. Is this true just because it’s verruca? Prior to my current partner I hadn’t had sexual activity since October 2022 so am wondering if I could have gotten this through fingering. How contagious is this compared to condyloma? I got one round of cryotherapy a week ago and some warts are still there so I will go for another round in two weeks. Can I use cryotherapy in conjunction with imiquimod?
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H. Hunter Handsfield, MD
14 months ago
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Welcome to the forum. Thank you for your confidence in our services.
I'm afraid you have been misled by atypical or perhaps outdated information. "Verruca vulgaris" is the old term for common non-genital warts (hands, feet, etc). However, almost all experts use the term genital wart or (condyloma accuminatum) for warts of the genital area, including the perineum. In theory the two kinds of warts look somewhat different, which might be the reason the diagnosis of VV and not genital warts (or cond. accum.) was not made -- but anatomic location generally is considered more important than the appearance of warts. Probably you have standard genital warts due to a sexually transmitted type of HPV. Please discuss this with your doctor's office.
I'm afraid it is wrong that warts become non-contagious as soon as removed. Typically the HPV causing the infection is more widespread than the visible warts themselves. However, transmission risk probably is at least reduced once the visible warts are gone.
It rarely is possible to know when and from whom any particular genital HPV infection was caught. Warts can appear months to years after being infected. Fingering is believed to almost never transmit warts; and in any case, it is unlikely that your wart is from a common hand wart type of HPV. Such HPV types are uncommon in the genital area.
I would advise you to follow the treatment(s) prescribed by the doctor or clinic and not mix cryotherapy with imiquimod unless the clinic advises you do do so. It might increase the risk of iinflammation, soreness, etc -- and might or might not be any more effective than either treatment alone. Let the office guide you on this.
I hope this information is helpful. Best wishes and stay safe.
HHH, MD
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14 months ago
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Thank you for your response. I will most likely ask for a PCR test to know exactly what strain of HPV is causing this as I am vaccinated for strains 6 and 11 which cause the majority of genital warts. I was under the assumption that Verruca and Condyloma differ histologically under a microscope. Are you saying the biopsy could have been wrong? I was also hoping this could have been Epidermolytic Acanthoma. I heard late recurrence of HPV infection isn’t common so I was wondering if I contracted this from my current partner who does not have visible warts in his genital area. Also if what you’re saying is true, does that mean I will be contagious forever?
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H. Hunter Handsfield, MD
14 months ago
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Some dermatologists have different understandings than STI specialists on HPV and warts. I cannot judge the accuracy of the biopsy report and know nothing about "eepdermoltyic acanthoma"; I've never heard of it and it has never come up in any STD patients I have seen.
But it clearly is wrong that "late recurrence of HPV infection isn't common." It happens all the time -- discussed innumerable times on this forum. As I said above, you will never know if you contracted this from your current or a past partner and I suggest you stop trying to figure it out; it makes no difference anyway.
No the vast majority of HPV infections are not contagious forever. Typically a few months or up to a couple of years.
I don't see how knowing the HPV type will help, but feel free to seek HPV type testing if you like. With 10-15% of genital warts caused by HPV types other than HPV 6 and 11, it's not all that rare.
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14 months ago
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Ah I just thought if the lesions were caused by the strain HPV 2 it would only be mildly contagious as that is a strain that causes common warts. I did read a study from 2007 (dated I know) that stated “Of the 214/275 (78%) HPV positive vulvar lesions in adults, 6 (3%) were due to HPV 2 whereas 202/214 (94%) contained HPVs 6/11; 1 lesion contained HPV 16 and the 5 other lesions contained HPV 42, 43, or 44.”
Was hoping that at least if the lesion was caused by HPV 2, it would have less transmissibility than types 6 and 11. Please correct me if I’m wrong. My final question is if my partner came into physical contact with my warts is there a possibility his immune system will prevent the warts from forming? I have ceased sexual interaction since seeing the warts and am unsure how to proceed should he discover warts on his shaft and accuse me of giving them to him.
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H. Hunter Handsfield, MD
14 months ago
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You should not depend on reported differences in contagiousness. My understanding is the differences are not great. And even if you have HPV2 or other less transmissible strain of HPV, you still are obligated to either avoid sex or discuss and warn with potential partners. It's up to you of course, but I think you're sort of grasping at straws.
That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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