[Question #12982] Genital Warts/HPV
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3 months ago
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MSM. In 2013, jelly-like anal lumps (mild and painless) and thigh lesions (painless) appeared simultaneously. I have a history of constipation. STI clinic doctor diagnosed anal lumps as warts, healed with acid. Thigh lesions were molluscum. Later, 1-2 thigh lesions appeared, saw a doctor in another STI clinic, identified as warts, cauterized. None of them looked cauliflower. Next 10 years, occasional tiny thigh lumps appeared but healed after slight picking. 1.Were they warts? (only visual inspection done) 2. Had sex with 6–7 men 1–2 months after diagnosis, unaware of HPV risks. Later informed all but one (did only oral on him). None showed symptoms, but I feel really guilty and fear my partners can unknowingly infect others. I need to test whether they carry HPV. Isn’t it possible in research and clinical settings to detect HPV if they test extensively on multiple sites or over months? Please clarify in detail.
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H. Hunter Handsfield, MD
3 months ago
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Welcome to the forum. Thank you for your confidence in our services. Directly to your questions and then some further comments.
1) The "tiny lumps" on your thighs were not warts, which are never cured or cleared by merely "picking" them. Once a true wart appears, it cannot be cleared by picking at it, scraping, etc; and warts never goe away on its own in less than several months. and if they were, probably not due to the sexually transmitted types of HPV. Could they have been continuing molluscum contatiosum? Maybe, if they appeared typical for MC (smooth, pink, often with a dimple in the center). However, MC rarely keeps recurring for as long as 10 years. Most likely you had minor folliculitis (hair follicle inflammation), which is very common in that part of the body.
2) Everybody gets genital and/or anal HPV infection, usually several times. At any point in time, at least 50% of all healthy people are carrying HPV and can transmit it to their partners. Fortunately, the vast majority of infections cause no harm. Your sex partners are no more at risk of catching HPV from you than they are from any other partners they may have; and you can never avoid additional HPV infections yourself as long as you continue to be sexually active. However, as MSM who has anal sex with other guys -- either insertive (top) or receptive (bottom) you probably are continuously and repeatedly exposed to HPV.
Testing for HPV is controversial, but often is done in MSM especially those who have had receptive anal sex (bottoming). Depending partly on the results, periodic examination by anoscopy or proctoscopy (looking inside the rectum) is a good idea. Anal Pap smears also are often done in MSM -- all this to detect possible anal cancer ore pre-cancer before it becomes serious. HPV vaccination is an important prevention. However, after several years and partly depending on your age, the HPV vaccine becomes less helpful because it is increasingly likely that you have already been infected with most or all the 9 HPV types the vaccine prevents.
All these are things you should discuss in person with a doctor or clinic experienced in anorectal health and/or STD and HPV issues in MSM. Such providers usually can be easily found in most of the US and other industrialized countries.
I might have additional thoughts with a little more information. What is your age? Can you say more about your sexual lifestyle -- regular partner, multiple partners, frequent new partners, condom use, etc? Where are you (country and maybe city, province, etc)? What is your HIV status? Have you been tested regularly for STDs, especially gonorrhea, chlamydia, syphilis and HIV?
I hope these initial comments are helpful. In the meantime, you might look at some reliable online resources about HPV. Good places to start are with CDC or its counterparts outside the US (e.g. www.cdc.gov/sti) and the sponsor of this forum (the American Sexual Health Association, www.ashasexualhealth.org). On both sites you can follow links to find detailed information about HPV.
HHH, MD
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3 months ago
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Thank you for your reply. I am 35 years old and from Sri Lanka. I kind of abstain from sex now . Im free from HIV and other STIs. Based on your response, I have certain questions;
1.Is it possible that what I had in my anus were warts?
2. You say tests are done in men. Is this functional only in cancer detection? isn't it possible to get my partners tested to detect HPV strains in the absence of symptoms at least in research clinics? if possible, do you recommend it?
3.If a general clinic offering HPV tests takes non-symptomatic swabs from different sites of the body at different times, won’t it be as reliable as research setting testing? As research tests are not often found, isn't this an apt option?
4.I did oral sex on a boy after about 3 months of detection. Should I have revealed it to him by then? I had no clue if I had it orally by then.
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H. Hunter Handsfield, MD
3 months ago
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1. The diagnosis of a doctor or clinic experienced in STIs usually is reliable, so probably they were warts. On the other hand, your description is not typical and I wonder if the anal area lesions were molluscum, like the ones on your thighs.
2. Anal area HPV testing and Pap smears are often done in men, but are not universally available. I cannot say whether these services are available in Sri Lanka.
3. There remains uncertainty on how to collect the best specimens for HPV testing. Testing multiple sites can increase the number of infections detected, but this is not necessary better (or worse) than the test methods used in research. Even those methods are widely variable from one research study to the next.
4. In my opinion you do not need to reveal your possible past warts or HPV infections to your sex partners.
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3 months ago
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I apologize if my initial symptoms were not clear to you. I got lumps which felt mild and stretchy in my anus, about 3 to 4 of them (this is what they called warts). At the same time, I got a flock of tiny lesions on my thigh close to penis. They were not as stretchy as what was on anus (this is what they identified as molluscum). I have read that visual examination alone is not usually enough. That is why I am raising this concern.
1.When you say "Anal area HPV testing and Pap smears are often done in men", does it mean detection tests are approved? 2. According to your answer for my 3rd question, do you mean methods adopted in a general non-research clinic offering HPV testing for men are as reliable as research methods? 3.If 90% of the genital warts are caused by 6 and 11 strains, can the rest of the warts be caused by other strains that cause cancer? Should I be worried if so? 4. One last question, should I really make an effort to get my partners tested for HPV?Thank you.
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H. Hunter Handsfield, MD
3 months ago
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Sorry, but I cannot say anything more about the likely causes of the anal problems you describe. I don't know what "stretchy" means.
It is not true "that visual examination is not usually enough" to accurately diagnose anogenital warts. If the clinician is highly experienced, visual assessment usually is accurate.
1) "Anal area HPV testing and Pap smears are often done in men" means only what it says. However this not a standard practice in most clinics. I do not know exactly how often it is done.
2) I do not understand this question. The methods for HPV detection in research setting are not necessarily any more reliable than those done routinely in some clinics.
3) Of the minority of genital warts caused by HPV types other than HPV6 and 11, I do not know how many are likely to cause cancer. But even with the highest risk HPV types, most infections do NOT result in cancer.
4) As I said above, I would advise you say nothing to your partner about your possible HPV problems and you should not suggest they be tested for HIV. Doing these things would be NO difference in their risk for important health problems from HPV. None at all. HPV is a normal, expected, unavoidable consequence of human sex.
That completes the two follow-up questions and replies include with each question and so ends this thread. I hope the discussion has been helpful. Best wishes, stay safe, and don't worry so much about HPV.
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