[Question #12718] Consumed by HPV Concerns

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5 months ago
Late 30s/Straight/Healthy/Male. Just exited a 6 year monogamous relationship. Haven’t had sex in over a year. Ex had normal paps and may be vaxxed. About 3 years ago, I noticed a single bump at the base of my shaft. Was stable for years, never spreading or changing noticeably. Two GPs examined it and each told me not a wart. Even still, major doubt/health anxiety. I used Compound W & sanded a dozen times, which caused minor changes no satellite bumps. Just went to a derm. who initially diagnosed as seb. K and excised for biopsy. I was shocked to learn it was a wart. It’s in strain testing and now I’m worried I’ll have high risk and low risk. I’m terrified of the stigma and want to ethically move forward with confidence based on objective medical facts rather than fear and uncertainty. I’m struggling. 
1. What does the long-term persistence of the wart mean?
2. Since wart never spread over 3 years, even after sanding, does that suggest high or low risk for future warts?
3. Once GW is removed, is there a risk of transmission? My doctor mentioned microscopic warts?
4. Is there a time after which I’m not a risk of transmission or recurrence? 
5. Is there a medical or ethical obligation/guidance to disclose a past, removed genital wart to future partners? What do most people do?
6. Do you have a perspective on what’s the “right” thing to do?
7. Any reason for me to tell my ex?. 
8. If strain test shows high risk type, does that mean I’m contagious? Change disclosure considerations? 

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Edward W. Hook M.D.
5 months ago
Welcome to the Forum.  Thanks for your questions and your implied confidence in our service.  I'll be happy to make some comments but I think you may be getting ahead of yourself.  Once your biopsy typing is back you'll be in a position to make somewhat more informed decisions.  Further, I can say at the outset that I think your concerns regarding stigma and the ethics of future sexual encounters are misplaced.  HPV is a "fact" of life for sexual beings.  Over 80% of persons will be infected over the course of their lives, most often with multiple HPV strains and only a tiny proportion of them will suffer serious consequences from their infections.  The "tiny" proportion falls to close to zero if persons follow regular sexual health guidelines, meaning that men get lesions checked as you have or for women, getting regular reproductive check up since both strategies allow for early intervention for the small proportion of infections which are at risk of progressing.  I'll provide preliminary responses below but would advice you to await your biopsy related typing before we use your up to 2 follow-ups as part of this thread.  

1. What does the long-term persistence of the wart mean?
unknown.  Some visible warts persist for long periods but there are no data to suggest that persistence of a visible wart is associated with cancer risk.

2. Since wart never spread over 3 years, even after sanding, does that suggest high or low risk for future warts?
No

3. Once GW is removed, is there a risk of transmission? My doctor mentioned microscopic warts?
In some persons. HPV DNA may persist despite the absence of visible lesions following excision.  This persistence may be a source of recurrence.  

4. Is there a time after which I’m not a risk of transmission or recurrence? 
With the passage of time (years) transmission risk and recurrence rates decline substantially.  Whether they go effectively to zero is unknown.

5. Is there a medical or ethical obligation/guidance to disclose a past, removed genital wart to future partners? What do most people do?
See above.  We have many discussions of the ethics of disclosure in pat threads which are available to you.  Despite thr fact that in a perfect world, disclosure is a good thing, many persons over react to an HPV diagnosis.  We do NOT feel disclosure is crucial following addressing warts.  

6. Do you have a perspective on what’s the “right” thing to do?
See above. Please look at past discussions of this topic on the Forum.  There are many.

7. Any reason for me to tell my ex?. 
No.

8. If strain test shows high risk type, does that mean I’m contagious? Change disclosure considerations? 
Let's wait for results.  The presence of a visual wart. irrespective of the type equates with potential contagiousness if partners are not vaccinated.

Hope this is helpful.  I look forward to hearing bout the typing data and addressing further questions after you have reviewed our discussions with prior clients on  the Forum.  EWH
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