[Question #13610] The never ending warts

5 days 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.

5 days 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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