[Question #13610] The never ending warts

2 months ago

Hello Drs,

In January 2021, I had my first bout with genital warts. My dermatologist froze them and/or gave me 5% of Imiquimod.

Within 6-12 months the warts come back.

This has been going on for close to 5 years. I did get the guardsail9 vaccine AFTER my first bout with warts.

I have HSV2 and the GW seem to come back more than the herpes.

1) is it unusual to have recurring warts for 5 years? Should I be concerned?

2) Health sites say reoccurrence happens to people with suppressed immune systems. I did have balanitis about a month ago and it cleared up. All other STD tests are negative. Is it connected to the warts or a suppressed immune system? I feel fine otherwise. I guess with the other information I just gave is there something larger going on I should be concerned about?

3) people say to tell your sexual partners. But is it more of a hindrance to tell them? (I ask because I could have HPV 16 and I’d never know. Or I can pass the wart strain even with no warts visible) From what I’ve read in previous threads here they are merely a nuisance.

4) if I do get cryotherapy again, is it safe to have sex as they are healing?

This is really messing with me.

Edward W. Hook M.D.

2 months ago

Welcome back to the Forum. Thanks for your continuing confidence in our service. I'll be happy to comment. This appears to be a continuation of an interaction you and I have nearly 5 years ago. At that time, in reviewing our interaction there appears to be some question as to whether the lesions you were experiencing were warts or some other dermatologic problem. Even before reviewing your prior posts, that was again the first question that occurred to me. It is unusual for warts to last this long- they typically go away even without treatment after a year or two. Further that you were vaccinated against HPV strengthens my concern that these might not be warts as well. The history you give is really highly unusual and is something that might be best addressed by a dermatologist. Evaluation might even include a biopsy to diagnose what is going on as there are many other dermatologic processes which can be mistaken for warts, even by dermatologists. In response to your specific questions:

1) is it unusual to have recurring warts for 5 years? Should I be concerned?

See above. The course you describe is unusual. It is for that reason that I suggest you see a dermatologist, perhaps even someone different that you originally saw who might provide a fresh perspective

2) Health sites say reoccurrence happens to people with suppressed immune systems. I did have balanitis about a month ago and it cleared up. All other STD tests are negative. Is it connected to the warts or a suppressed immune system? I feel fine otherwise. I guess with the other information I just gave is there something larger going on I should be concerned about?

It is true that persons with chronic immunosuppression may have more trouble clearing warts. It is unlikely that you have a major immunologic deficit as there would be other signs however, we are learning that some people have minor immune deficits that make them vulnerable to specific illnesses. The field of dermatologic immunology has advanced a great deal in recent years and a new perspective evaluating for a specific immunologic susceptibility might be helpful.

It is unlikely that this is HPV 16 which rarely causes visible warts. We do not feel strongly that notification of sex partners is essential as on occasion this can cause misunderstandings. Most unvaccinated sexually active persons already will have HPV and vaccinated persons should be at minimal risk.

4) if I do get cryotherapy again, is it safe to have sex as they are healing?

When cryotherapy is carried out there may be local irritation which can worsen with sex but if you are not uncomfortable, abstinence is not essential.

I hope this perspective is helpful. I'd love to hear what a new dermatologist who is told about your entire "wart history" has to say about this. EWH

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1 months ago

Hi Dr, happy holidays.

So I went to my PCP and he didn’t think it was warts, maybe one. Then I went back to my dermatologist and thought they were warts and froze them off.

I just find it odd that my warts keep coming back after 5 years. I got the HPV vaccine after year after my first breakout with warts. (I know it won’t help with a strain I got before the vaccine)

My dermatologist said more than 2 strains of HPV can cause warts and they can come back for years he said. That kind of differs from what’s said on here.

I’ve been with my same partner for over 1.5 years. I did get an HIV test because I read recurrent warts can be due to immunocompromised people with HIV ETC. is that even a concern? It was negative.

What do you make of this?

Edward W. Hook M.D.

1 months ago

Your dermatologist is correct that HPV types other than 6 And 11 which in the vaccine cause about 5% of visible warts. That could be what is causing your possible warts. Hopefully your most recent cryo episode will resolve the remaining lesions.

Not too much to add other than to stick with the dermatologist you’re seeing. Your warts are more of a nuisance than anything else. EWH

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1 months ago

Thank you for the response. If I can use my last response for something HIV related.

I was in SF in a small crowded bathroom and noticed someone press against me while I was washing my hands.

Afterwards when I left the bathroom and started walking, I felt a pain in my buttocks. It got me thinking….Maybe irrationally….which I fully admit. What if I got jabbed by a needle or pin?

1) I’m sure it’s my anxiety talking but if someone jabbed with a needle how likely is one to get HIV from that? It’ll go through my pants and underwear.

2) Then, after reading other questions on this forum, you say negative tests ALWAYS overrule symptoms from ARS.

If one got ARS Symptoms starting on Day 4 (nasal congestion) and then they ramped up on Day 9 (slight fever, aches, some congestion) and tested on Day 9, would that mean the symptoms ARE NOT from HIV ARS?

3) would a test on Day 9 rule out HIV based on Day 3 or 5 of symptoms?

4) Does ARS cause nasal congestion or slight fever?

5) anyone ever get infected with HIV that way?

Thank you for your time! And this service.

Edward W. Hook M.D.

1 months ago

We ask clients to limit their questions to one topic. I'll provide brief answers. If you have further questions, you'll need to start a new question, both because this is a different topic, was well as the fact that we provide up to 3 responses to each client - this is my 3rd response. In response to your new questions:

1) I’m sure it’s my anxiety talking but if someone jabbed with a needle how likely is one to get HIV from that? It’ll go through my pants and underwear.

We have had numerous clients who have been worried about a potential needlesticks of this sort. Despite that, we have never seen, nor heard (from colleagues, from clients, or in the medical literature) of anyone who acquired HIV or any other blood borne infections in this way. While I understand how you might be concerned, I would urge you not to worry. Further, the fact that there is no evidence of a needle stick (i.e. a visible stick or blood)add to my confidence that this incident did not put you at risk.

2) Then, after reading other questions on this forum, you say negative tests ALWAYS overrule symptoms from ARS.

Correct

Nasal congestion is not a part of the ARS. That said, a negative teston day 9 would prove that your symptoms were not due to HIV.

3) would a test on Day 9 rule out HIV based on Day 3 or 5 of symptoms?

Yes

4) Does ARS cause nasal congestion or slight fever?

No, typically the fever to the ARS is quite substantial.

5) anyone ever get infected with HIV that way?

I hope that the information we have provided has been helpful. Take care. EWH

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