[Question #13647] Recently diagnosed with genital warts - advice

2 months ago

I was diagnosed with genital warts 2 months ago. I had multiple clusters at the vaginal opening, tracking deeper inwards, covering a fairly large surface area. They initially responded well to 2x cryotherapy (and warticon application for the more external ones), but the internal clusters returned 2 weeks later.

I had another round of cryotherapy followed by a couple of weeks of aldara. I couldn't finish the course as I had a lot of discomfort and some blistering internally.

Now...most of the warts have gone (for now). I maybe have around five 1-2mm more internal warts which I can only really see when zoomed in with a phone camera and good lighting. The sexual health nurse said she couldn't see anything large enough with the naked eye to do cryotherapy on.

1) Is it likely that the remnant multiple tiny lesions will go away on their own now the larger ones are treated? Would leaving them untreated increase risk of recurrence, transmission or autoinnoculation?

2) My partner and I had unprotected sex for 10 months before I saw the warts. Can we still continue having sex given he has likely been exposed already or should we abstain whilst I have visible lesions? I am also particularly worried about receiving oral sex from him and causing oral or throat lesions in him?

3) I have had my first dose of the gardasil 9 vaccine. I understand the vaccine cannot treat the existing infection, but is there strong enough evidence to say it can help with recurrences or autoinnoculation?

4) I am just worried by the number of warts and surface area that was affected and whether I still have a good chance of getting rid of the infection?

Thank you so much.

Edward W. Hook M.D.

2 months ago

Welcome to the Forum. Thanks for your confidence in our service. I'll do my best to provide some useful information. It sounds like your infection was rather extensive- had you just not noted them or did they appear relatively rapidly (this would be unusual for warts, particularly a lot of them. Further, it would be unusual for warts to recur in just 2 weeks after treatment. For now I'll presume that you do have warts and organize my comments accordingly.

Let me also caution you from over examining yourself. The genital region has numerous normal irregularities and there are literally hundreds of other dermatological processes that can be mistaken for HPV. I would be skeptical that what you are seeing with photographic magnification represents a recurrence.

Regarding your specific questions:

See my comments above. If the things you have seen are warts they could be remnants from your recent treatment. My advice for now would be to simply observe them and see what happens.

Your partner has been exposed. Does he have visible warts? Irrespective, he's been exposed. I see no reason to change your sexual practices. ORal sex is less likely to lead to infection if indeed what you have are warts. Further, the HPV types that cause genital infection rarely cause oral infections- they don't seem to "like to infect" the throat. Further, cunnilingus is a biologically inefficient process which rarely results in infection when performed on an infected partner.

HPV infections are not spread through autoinoculation. I'm please to hear that you are getting vaccinated. Although unproven, there have been suggestions that the vaccine may reduce recurrences of existing infections.

4) I am just worried by the number of warts and surface area that was affected and whether I still have a good chance of getting rid of the infection?

This question circles back to the beginning of this exchange. Little more to add.

I hope this information is helpful. If anything is unclear, please use your up to 2 follow ups for clarification. EWH

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1 months ago

I do appreciate that this site will attract many people who are overly anxious or haven't sought a diagnosis. However, the diagnosis of warts has been confirmed by the sexual health clinic and I do have a healthcare background myself.

I had felt an rough patch at the introitus many months ago (possibly up to 1 year?) but thought it was due to friction from sex. It happened at a time when I was extremely stressed with other life issues. At this time I wasnt looking after myself too well in terms of sleep/diet and was vaping heavily. I only recently looked with a mirror and visualised the warts when I realised the rough patch was still there.

The "recurrence" after 2 weeks was likely more of an incomplete treatment of the warts, as looking back at the photos, I can see there was still some abnormal mucosa visible. Hence, why I am concerned about leaving any remaining small lesions unmanaged.

My partner fortunately has no visible warts.

I have also got some raised groin lymph nodes bilaterally. Is this commonly associated with genital warts?

I would appreciate your further input on questions 1 & 4 with the additional information i have provided?

Why is there so much information circulating regarding not touching the warts to avoid spread if they are not spread by autoinnoculation?

Edward W. Hook M.D.

1 months ago

Thanks for the additional information.

From the sounds of things I tend to agree than what you are seeing may be residual from limited treatment. Sometimes clinicians back off when they are treating large numbers of warts due to concerns about discomfort. If they become large enough to be seen readily re-treatment may be in order but for now I would simply observe them.

Autoinoculation is a myth. If it occurred everyone would be covered with warts.

Lymph node enlargement is not typical of HPV infections. Many people have lymph nodes which can be felt when they are looked for- this is normal as long as they are not tender or growing.

4) I am just worried by the number of warts and surface area that was affected and whether I still have a good chance of getting rid of the infection?

They are no data on how the extent of infection impacts risk of recurrence. It makes sense that this might be the case but again, my suggestion would be considering retreatment if they become readily apparent but again, I would hesitate to re-treat something that can only be seen with photographic enlargement.

EWH

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1 months ago

Unfortunately the small "remnant" warts I spoke about have already started getting bigger. I also have 2 new confirmed urethral warts as a female, which I understand is not very common.

Are urethral warts harder to clear or do they act in the same way as vulval warts whereby the body can tackle the virus on its own accord in a few years?

Do you have any recommendation for the best way of treating urethral warts with the lowest risk of recurrence?

Is it worth my partner getting vaccinated at this point if we are planning on being together long term and likely already share the infection? Is the vaccine less effective with age, as he is older?

I would like to get pregnant in the next year or so. I understand there is a risk of recurrence in pregnancy. Is there any data on how many pregnant women do have recurrences?

Edward W. Hook M.D.

1 months ago

My apologies for the delayed response. Your final follow-up was missed.

There are not good answers to your questions. The recurrence and new warts that you report is unusual. If your warts have been confirmed with a DNA test and are continuing to appear in Aldara treated areas and your persistent lesions are growing, despite both cryotherapy and Aldara you are in an unusual situation which should be dealt with by a clinician with specific experience with HPV infections.

As you point out, urethral warts are rather unusual as is the continued appearance of new lesions and resistance to therapy. This is an area where there is little experience and no clinical studies because of the rarity of your situation. The way forward will require good communication between you and your health care provider and may warrant further testing. A specialist may chose to biopsy the lesions for DNA testing or suggest evaluation for a selective immune deficiency (I am not recommending this, this is to be determined through communication with the provider who is taking care of you).

I see little benefit you vaccination for your partner. As you point out, he has been repeatedly exposed. What is done is done. Similarly, I see no reason for the two of you to modify your current sexual practices- this is almost certainly not an issue of re-infections.

You are also correct that with pregnancy warts may grow and be challenging to manage. There are no specific data on recurrence rates in pregnancy that I am aware of although it occurs enough so that many OBs have seen this occur albeit not all that regularly. No predictions, I suggest you focus on your current dilemma and deal with pregnancy-related events when and if they occur.

This completes this thread. Sorry that I can't offer more information. As I said above, I suggest that you work with an experienced clinician who can examine you and individualize your management. EWH

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