[Question #1365] Genital Wart

84 months ago
Dear Doctors 
28 years old loyal maried man with a boy. I had a wart on the scrotum close to the base of the penis in 2012. It has been removed by my dermatologist informing me that it was not a GW. I get married in 2014 and we tested with my wife all stds and all came negative. My wife has begun her sexual life with me. in Sept 2015, I had the same GW as the one I had in 2014 + a small one. I had them removed and confirmed condyloma accuminata by a biopsy. Since that time I had 4-5 recurrences and they have been treated by electrocautery again. The last surgery I did was in July 2016 (after an aldara course without result) and so far nothing in this area. 
Now I have in the top of my penis shaft (below the glans) a small and hard bump and I am worried it is again a genital wart. I am worried to pass it to my wife or my baby boy by touching him. 
Please let me know what are your thoughts with regards to this recurrent episodes and how should I behave. My next appointment with the dermatologist is next week.
H. Hunter Handsfield, MD
84 months ago
Welcome and thanks for your question.

Some cases of genital warts are more durable and persistent than others, and it sounds like this might be true for you. You're doing the right thing by being in the care of a dermatologist. Not being able to see the new penile bump, I cannot common of whether it's another wart -- but I'm guessing (and hoping) not, given the entirely new location and apparent presence of only a single lesion. Several other minor skin bumps and growths can appear similar when small and new, such as a fibroma, a more prominent sebaceous skin gland, etc. The dermatologist will know.

If your wife were to be infected, it would have happened long before now. The virus is always present for long periods (e.g. months) before visible warts appear, and also involves tissues around the warts that look normal. So your wife is already exposed and probably infected and now immune to re-catching the same wart virus again. You need not change your sexual practices in any way. If she notices warts, she should get them checked out, and should follow normal pap smear guidelines. Most likely nothing will ever show up.

Finally, genital HPV is not transmitted in households or by normal personal contact with children. Your child is not at risk from this. 

If you indeed have a wart at this time, I'm sure your dermatologist will confirm all I have said. Please report back after you have seen himn or her.

Best wishes--  HHH, MD

84 months ago
Thank you Dr Handsfield for your reply 

You said exactly what my dermatologist said and I thank you for this. I have no problem of having a genital wart in the past but the fact that this comes in a loyal homogamous relation  gives headache sometimes. 

My only concern is the fact that it is recurrent and I have the following questions. 

1.Why it is more durable and persistant than others. Is the immune system involved in this? 

2.Since 2011 I have skin problems mainly psoriasis and Seboreic dermatitis. Maybe there is a link between these diseas and the immune system

3. Should I go for other testings ? 

4. Can these warts disappear for the next years of my life. I am still young and hope will not face these problems in the future

5. Should I consider these recurrent episodes as a minor problem? 

I will for sure update you on what my dermatologist will say next week. She will see the bump over this camera which makes the picture bigger 
H. Hunter Handsfield, MD
84 months ago
Glad to hear your dermatologist and I are in agreement. STD specialists don't typically handle the various skin problems you have had, including repeated wart treatment. These are more often the domains of dermatologists, and I suspect your doctor is in a better position to answer these additional questions than I am. But I'll try.

1-3) Cases of more recurrent or persistent genital warts are not the norm, but not all that rare. Presumably it's due in part to individual variations in the immune system's ability to control HPV, but this is just an educated guess; I am not aware of any research on it. I would also speculate that having other inflammatory skin problems could affect immune system control of HPV.  However, there is no evidence to suggest that these reflect a generalized immune system disorder, i.e. no reason to suspect your immune system is abnormal or that you have increased risk of other medical problems related to immune deficiency. And I see no need to be tested for other medical conditions.

4,5) Most likely you will stop having recurrent warts; I've never seen or heard of anyone who had continuing recurrent warts for more than a few years. And certainly each episode, although inconvenient, is a minor health event.

Each forum question includes two follow-up comments and replies, so best to hold off on your last one until your dermatologist has weighed in.

84 months ago
Dear Dr Handsfield 

Thank you for your advices. I am back from my dermatologist and she confirmed that the new spot is not a wart at all. It is a sebaceaous kist and she will remove it next week 

Until now, 2 months after the removal of my recurrent wart in the scrotum, she controlled and no recurrence is observed. She said that my previous dermatologist did not go deeper in the removal 

I have heard that if there is no recurrence 2 months after the removal it means that my body has cleared from HPV. Is that true? 

Thank you for your replies and I hope I will not face a genital wart episode 

83 months ago
Dr Handsfield 

As this discussion is still open, I wanted to make a quick follow up 

As informed my dermatologists confirms that I had no recurrences of my warts.  Can I have after 3 months of clearance new warts? After how many months of clearance we can say that the virus is gone? 

Thank you 
H. Hunter Handsfield, MD
83 months ago
It is never possible to be certain any HPV infection is gone forever. The longer you go without recurrent warts, the mosre confident you can be. I advise my patients that when warts have cleared up and not recurred after 6 months, they can be pretty certain they are gone forever and will not recur. But that's only an educated guess.

Sorry it isn't possible to be more certain. But happily, recurrent genital warts are a minor inconvenience, not an important health problem. It's really not something to lose any sleep over!

That completes the two follow-up questions and replies included with each thread, and so ends this discussion. I hope it has been helpful to you. Best wishes.