[Question #1380] Genital Warts Concerns (LONG POST)

48 months ago
Here's my story:

I started dating a girl a couple of months ago and we decided to get checked for STDs. I took pretty much every test available, even a special HPV kit which can be used on men. The HPV test came positive for low risk types 6 and 84. After this I went to a dermatologist to analyze a suspicious little bump I had on the base of the side of my penis (which I scrubbed with the kit brush) that was also surrounded by a couple of almost flat spots of similar color. She confirmed it was genital warts so proceeded to burn them off with liquid nitrogen and also prescribed Imiquimod for the surrounding area.

My partner took a pap smear and a HPV pcr test as well and came back negative for all types, including 16, 18, 6, 11, among others. 

However, after telling her gynecologist about my wart and HPV results, her doctor scared her a lot, told her that HPV was for life, that warts in some cases can become problematic, and that the beauty of her genitals can become compromised. She told her she should get vaccinated (she took her first Gardasil shot a couple of days ago) and that we should stop having sex for 6 months. She also told her I should get antiviral treatment, but I have no idea what she means by this.

We already had unprotected sex around 12 times before having my wart treated. Do you think it's wise for us to go an additional 6 months without sex?

We really don't know where to go from here and my girl is pretty worried about it.

Thanks in advance.
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago

Welcome to our Forum.  I'll provide some information and try to help.  Let me start by congratulating the two of you on deciding to get tested for STIs early in your relationship- it is a sign of mutual respect and a great way to begin a relationship.  At the same time, I wish your testing had not included HPV testing.  Your experience is precisely the reason that experts recommend against testing for HPV.  Many studies show that when persons become sexually active they acquire HPV very rapidly and that within three years of a person's first sexual encounter over 50% of persons, even those who have had only a single partner, have HPV.  It is not conservatively estimated that over 80% of sexually active Americans have or have had HPV.  Thus it is in to way surprising that you were found to have HPV and if anything, a bit surprising that your partner did not have infection found.  At the same time the infections sometimes generates disproportionate concerns and reactions, often based on misunderstanding of the science behind the infection and often fueled by mis-information commonly found on the internet.

In addition, I would argue that your partner's gynecologist over stated things and was more alarmist than I or most experts would have been.  As mentioned above, most sexually-active persons have HPV.  It is, at most, a nuisance for nearly everyone who gets infected although in a very small proportion of persons, the infection can lead to development of genital tract (mostly cervical) cancer - it is for this reason that PAP smears are recommended as they allow early detection of pre-cancerous lesions and therapy.  Her GYN also presented one side of a controversial area related to HPV- the persistence of the virus.  In most people with HPV, even without therapy, the infection is controlled by the immune system, warts if present go away, and the virus is no longer detected.  Viral DNA may be detectable in some persons despite apparent resolution but this is typically inactive, not transmissible to others, and of no consequence.  Most experts feel that this sort of persistence is not a health hazard to individuals or their partners. 

With this as background, specific comments in response to your questions:

1.  Gardasil is recommended for all women under 26.  It is good that your partner has been vaccinated as the vaccine is highly effective at preventing new infections.  It has not effect on existing infection.

2.  If you have had sex 12 times to date, I see no reason to continue to abstain or even use condoms unless they are for birth control.  Your infection was treated, you both know each others infection status and other than the HPV apparently do not have anything to worry about.  If your partner is going to have become infected, this will have already occurred (n.b.  it may that on average, three months for infection to become apparent)

3.  With your liquid nitrogen treatment, supplemented by the imiquimod, your HPV has been treated.

I hope my comments are helpful.  EWH

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48 months ago
Thank you very much doctor. 

I have a couple of more questions if you don't mind.

1) Regarding the imiquimod, how does it work if the warts are already treated with liquid nitrogen? It was my understanding that imiquimod is used to treat visible warts, but since they are already treated I'm not exactly sure what it does. What is the benefit of supplementing liquid nitrogen with imiquimod?

2) What percentage of people infected with HPV type 6 end up developing warts? Should my partner definitely expect warts if she's already infected?

3) Can oral sex be done in the presence of warts? What are the risks? 

Thanks in advance.
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Straight to your questions.  You are asking tough questions which remain the subject of active research.:
1.  You are correct, imiquimod is recommended for treatment of visible genital warts.  It appears to work by causing a local inflammatory response which helps the infected person to clear the warts.  Use as an adjunct to therapy with liquid nitrogen is not a common approach howeve the rationale for this is that there may be infection which is not visible beyond the visible border of the wart which is being treat.  I do not know of data which suggest whether this approach has proven benefit over simply freezing the warts but there is some logic to it.

2.  Nearly all visible warts are caused by HPV 6 or 11 but there are also many patients who can be infected and not show visible warts.  I cannot give you a precise estimate of how common this is.

3.  HPV of the throat and larynx can be acquired by performing oral sex on an infected partner although it appears that transmission rates through oral sex are lower by at least half than through genital-henital contact.  These throat infections are typically a symptomatic and resolve on there own however in a very small proportion of infected persons they may lead to cancer.  Cancer risk is increased further by activities like smoking.

EWH
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48 months ago
Thanks again doctor,

Just a final question regarding oral sex before closing the thread.

You say HPV of the throat can be acquired if exposed to an infected partner, but I was wondering about my case in particular. If I give HPV to my partner and then practice oral sex on her, am I immune to acquiring HPV of the throat since I already have the virus? What about her?

Should we take any precautions regarding oral sex?

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By the way, this forum software is very glitchy and isn't working properly.

1) There are no URLs being generated for each topic, which means that people will never find these questions through Google. The forum is losing a lot of traffic and money because people will never be able to find it unless someone recommend it to them or they reach it through ASHA's website.

2) Because of the issue above, it is not possible to share a question with anyone. I cannot send this question to my partner so that she can read it. Questions cannot be linked to either. I cannot make a list of topics that I can easily refer to in the future. With time, questions will get lost in later pages and never be read again by anyone.

3) When browsing questions, the filters are reset every time I click on the next page. So if I set the forum to HPV and 50 questions per page and then click next, it goes back to no filters and 10 questions per page.

4) Navigating using the back button on the browser doesn't work since the forum doesn't generate new pages for each question. If I'm reading a question and then hit back on my browser, it suddenly quits the website instead of taking me back to the list of questions.

You should consider switching to another platform.
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago

More good questions:

Interestingly, the immunity generated by a naturally occurring infection, as measured by antibody levels is not as high as it is with the HPV vaccine.  thus there does appear to be a risk of re-infection but that risk is probably low.

Most experts suggest that, in established relationships in which partners have had sex on multiple occasions in the past, there is little benefit to use of condoms or other protected measures for sexual exposures of any sort.  I agree with this perspective and doubt that barrier methods will benefit you or your partner at this point.

As you acknowledge, this is my third reply to your questions and hence, as per site guidelines, this thread will be closed later today.  At this juncture I would not be worried further about transmission of HPV between you and your partner.  Wishing you the best.

Thanks as well for your comments on the site, I will pass it on to our web master.  EWH

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