[Question #1264] HPV Warts

49 months ago
About three years ago I had several small warts, I went to a local clinic in a small town and they said they should go away on their own. However, they didn't go away and grew larger.  I am now treating them with aldara and they are rapidly shrinking. My dermatologist said that they put me at an increased risk for penile cancer and my wife at risk for cervical cancer. My wife has never had an abnormal pap and I have only had two partners in my life, with my wife being the only one with in two years of when the warts developed. 

What is the risk for penile cancer from warts? Does the fact that they did not go away on their own suggest that I have a high risk strain, rather than 6 0r 11?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Welcome to the forum. Thanks for your question.

I'm afraid you have had poor medical advice, twice. First, assuming the diagnosis three years ago was correct, your warts should have been treated at that time. It is true that genital warts usually clear on their own within several months (just as hand warts do in kids), but treatment speeds clearing. That your warts persisted 3 years is unusual, but not unheard of. But certainly glad to hear they are responding rapidly to treatment now.

Second, the types of HPV that cause warts almost never cause cancer. Your dermatologist is mistaken, unless you misunderstood. People with HPV type often are infected with more than one type, and people with warts therefore sometimes have additional HPV infections, which could include a high risk (cancer causing) type. But probably not, especially 3 years after your warts first appeared. That your warts didn't clear in 3 years probably does not increase the chance they were due to a high risk HPV type, or that you are still infected with a second strain.

Even with high risk HPV types, the large majority do NOT progress to cancer. Your wife's normal pap smears also are reassuring. And for sure don't worry about penile cancer. If you ever develop another wart-like bump or an unhealing sore of your penis, of course see a doctor promptly. But penile cancer is rarely serious, almost always easily cured long before it becomes a serious problem. Truly not something to worry you. 

Finally, although you don't ask about continuing sex with your wife, I'm going to comment on it anyway. You need not change your sexual practices at this time. With unprotected sex while you had the warts, you can be sure she has already been infected with the same HPV, and her normal paps suggest it hasn't cause harm and most likely her immune system has cleared the infection. And she is now immune to cathing your infection.

At this point all you need to do is complete the Aldara as prescribed and return to the dermatologist if they don't clear up entirely within a few weeks. To be extra safe, it would be reasonable for your wife to tell her doctor about your warts the next time she has a routine visit, about then follow his or her advice about follow-up pap smears. But almost certainly nothing serious will ever come from this. Don't lose any sleep over it.

I hope this has helped. Let me know if anything isn't clear. Best wishes--  HHH, MD

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49 months ago
Doctor Handsfield, 

Thank you so much for your answer. You have provided much clarity. It is hard to sort out all the conflicting information on HPV that proliferates on the internet. 

I only have one follow up question. 
I have one wart that initially responded very well to the Aldara but now it seems to have stopped. It almost looks as if it is a scar. Is it possible that I will have scars from the Aldara treatment, or that eventually they will stop responding to the treatment?

I have a follow up with my dermatologist in a few weeks but Id thought I would get your input while I was in here. 

Thanks for your time. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Successful treatment doesn't necessarily mean skin returning to normal appearance due to scarring or simply more prominent appearing skin. Return to normal may happen over the next several months. My guess is your dermatologist will confirm your warts are gone. If not, additional treatment may be needed:  all wart treatments, including Aldara, are effective in about 70% of patients, so it's common to switch to a second treatment. In any case, this issue does not change the main point of my reply and your "take home" message:  your wart problem will be gone one of these days; and most likely there will be no other important outcomes of this problem for either you or your wife.

I'l  be interested in hearing the outcome after you have followed up with your dermatologist. Please let me know.

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48 months ago
I have a question about oral HPV and cancer. I just read an article that said that Oral cancer in men is on the rise. If I got hpv warts from my wife and we have done oral sex on occasion would I need to worry about oral cancer? Do the strains that cause warts cause oral cancer? Would oral cancer cause headaches? She has never had any abnormal paps. I hate to give into alarmist articles but it they can be hard to ignore. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Did you ask a question like this on HealthTap? I answered a very similar one. As I wrote there: The types of HPV that cause genital warts (mostly HPV6 and 11) don't cause cancer, oral or anywhere else. Among over 100 HPV types, only one (HPV16) causes almost all throat cancer. Other oral cancers rarely mostly are not due to HPV. Despite all the news reports, and even though throat cancer due to HPV16 is increasing in frequency, it remains a rare cancer. You may die of cancer someday, but it's far more likely to be prostate, lung, colon, and all the others you have heard about. Further, HPV related throat cancer remains rare even in people with oral HPV infections and thsoe who frequently perform oral sex. Headache is not a symptom of throat cancer.

That completes the two comments and answers included with each new question and so ends this thread. Do your best to move on without worry about any of this. Best wishes and stay safe.

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