[Question #1457] Flat warts on hands transmitted to genitals?

81 months ago
Hello and thank you for your time. If you have already addressed a similar question in another post to someone else, please feel free to direct me to it as I don't wish to waste time with questions that have already been answered. I have skimmed other posts and haven't seen this particular question, but I certainly could have missed it. 

Could you please comment on the possibility (or lack thereof!) of transmitting flat warts that are on my hands to either my own genitals (such as while washing myself in the shower) or to my husband's genitals while touching him with my hands during intimacy. I realize that the strains of HPV that generally cause flat warts or common warts are different than those that typically cause genital warts. However it doesn't seem entirely far-fetched to think that a flat wart strain, if presented to the genital area, might find it to be a hospitable enough environment to cause infection...?
Edward W. Hook M.D.
81 months ago

Welcome to our forum.  Your question is a good one and has been asked or implied indirectly by others in the past but not specifically.  I'll provide an answer.  From your question it sounds like you've searched and learned something about HPV and warts so please forgive me if some of this is repetitive.

Infections due to papilloma virus occur throughout the animal kingdom- there are rabbit infections, fish infections, and, of course human papilloma virus (HPV) infections.  Over 100 different  types  of HPV have been described and, interestingly different types have a high degree to tissue specificity such that the HPVs that cause hand and foot infections  almost never cause infection of genital infections and, conversely, genital infections do not cause infections at other sorts of human skin surfaces.  I say almost never because in medicine and science we are not able to say words like never or always ever as there are no absolutes and strange things happen.  Perhaps somewhere genital infection caused by the types of HPV that infect the hands have occurred but if so, I am unaware of it and I do look for such things.  Irrespective and perhaps relevant to your question, this is really not something to worry about or to let it impact your relationship with your relationship with loved ones.  I say this because the other important thing to remember is that virtually all humans will have HPV infections, nearly all such infections will resolve on their own, and well over 80% of adults will acquire genital HPV infections during there lives but these infections will be of no health consequence in the vast majority of such infections - visible genital warts are almost always no more than a cosmetic nuisance and only a tiny proportion of infections with so-called "high risk" will progress to cause pre-cancerous lesions, of which only a small proportion of which go on to cause cancer.  Further, we have a great system for detecting pre-cancerous changes due to HPV so that they can be treated to prevent the major important consequence of HPV- invasive genital tract cancer.  For the time being, as long as women get their regular PAP smears and reproductive health check ups, nearly all HPV related cancers are avoidable.  (As more an more women and men take the HPV vaccine, even these rather uncommon consequences will get rare and rare).

As a result of what I've said above, there is no reason to worry about transmission of HPV infections occurring at other body sites to the genitals nor any reason to worry about genital HPV infections being transmitted to others or other body sites on your hands. 

I hope these comments are helpful.  If not, please let me know and perhaps I can help.  EWH 

81 months ago
Thank you. Your explanation was GREATLY helpful. I don't consider myself a stupid person, but it is challenging (not to mention dangerous to the imagination)  to sort through all the information on the Internet, and costly to purchase access to journal articles that I may or may not be able to understand. Your answer pulled together various threads that I had been unable to put together myself.

If I could try to recap what you stated to make sure I understand, and then ask a couple follow-up questions, that would be very helpful. It sounds to me like you are saying there are two factors that make any concern about transmission of non-genital warts to a genital area (or vice versa) unfounded. First, the various strains of HPV tend to be tissue-specific, and second, even in a hypothetical situation where that sort of transmission did occur, the consequences would be extremely low.... Have I understood correctly?

Question: May I ask, out of curiosity, how scientists have come to these conclusions about tissue specificity? Is it that, when presented with a case of genital warts, it is standard practice to do some sort of typing? And there has simply never been a documented case of genital warts that has been caused by the strains that typically cause hand and foot warts? Or (and please forgive me if this is a ridiculous notion, I really have no idea if animals are used in this manner for research these days) - have researchers attempted to infect various areas of an animal's body with different strains of HPV and been unsuccessful at producing this sort of non-genital to genital transmission?

Question: May I ask about transmission of warts via inanimate objects? I read the abstracts of some journal articles in which HPV had been found on all kinds of surfaces, but I also realize that just because a virus is detectable doesn't mean it is transmissible...right? Could you help me understand whether HPV is transmitted in this way? I also tried to find whether there was some sort of agreed-upon time period that HPV "survives" on an inanimate object without a host, but I didn't have any luck. If I handled various objects a month or so ago (personal exercise equipment, clothes, etc), when I first noticed the warts, is it safe to say that nobody is going to get warts from handling those objects now, even if they haven't been washed?

Question: Could you help me understand better the idea of the body "clearing" or resolving an HPV infection? I'm confused about whether HPV is one of those infections that always remains in your body once you have it, regardless of whether you display obvious symptoms. Is it like herpes, which I believe can lie dormant for years but then can also cause periodic or even regular outbreaks? Or is it like a cold virus, that your body fights and eventually it is out of your system completely?

Once again, thank you so much. 
Edward W. Hook M.D.
81 months ago

Thank you.  I'm pleased the information I provided has been helpful.  Your understanding of what you need not worry about the transfer of hand warts to the genitals (or vis versa) is correct.

The information I made about tissue specificity is the result of biopsies and testing of literally tens of thousands of warts and HPV infections over the years as research was systematically carried out exploring the relationship between HPV and warts, HPV type and wart location, etc.  Such studies, most of which have been done over the past two decades have informed  our understanding of HPV tissue specificity. 

Research about HPV transmission, including transmission on inanimate objects is ongoing and there are elements of this process that are still not fully understood.  Most scientists believe that there are rare cases in which HPV has been transmitted through contact with inanimate objects but they also agree that such transmission is quite rare and far, far rarer than transmission through direct contact.  I know of no data on how long HPV might survive on an inanimate object - this would be difficult to do because of technical problems and the need to detect HPV by detection of DNA rather than growing the virus.  The DNA from dead virus would be detected in the same way as viable virus. 

The issue of HPV persistence is likewise a topic of ongoing research.  The immune system tends to naturally control nearly all HPV infections, making warts go away and HPV to be undetectable or detectable only by highly sensitive tests which are not used clinically.  As the immune system does its work, signs of infection go away but HPV DNA while detectable, does not seem to be transmissible or active.  Thus HPV does not periodically recur in the way that herpes infections might.

I hope these additional comments are helpful.  You are getting into the realm of complicated, ongoing research.  I urge you not to get too worried about the "what ifs".  EWH

81 months ago
Thank you once again for your thorough reply. I am very grateful. I also appreciate your advice to steer clear of the "what if" zone. I wish I had found this forum at the very beginning - I probably could have avoided a lot of unnecessary stress. Unfortunately, I already unwittingly stumbled into that what-if  zone before I found the forum, so what you see here are my efforts to walk it back to normalcy. Science and logic and facts are my 'comfort zone,' so I'm just trying to use those to squash my stirred-up imagination. My intent was to start by asking the general, scientific questions, so that I could then apply the answers to counter what I had become worried about. 

When I discovered the first wart on my hand, it was on the palm. It seemed reasonable to cover it up, and I figured I would just be careful for a few weeks while the area healed after being frozen. I avoided direct contact with that hand during intimacy with my husband. Unfortunately, other warts began to crop up, some of which I didn't even notice myself - the NP at the dermatologist's office found them when I went in for a follow-up appt. I began to be discouraged that not only was this process taking a lot longer than I had expected, I often wasn't even aware that the new warts were there. Trying to keep the warts covered and avoid direct contact with my husband began to seem burdensome and untenable. I was embarrassed to ask the NP at the dermatologist's office these questions, as she was also an acquaintance. Hence one of the reasons I was so relieved to find this forum and read your response to my questions. 

As an additional issue, I had an unfortunate encounter with a secretary at a medical office. I have NO idea why, but for some reason she just started chatting with me and told me a really awful story about a friend of hers who didn't realize she had genital warts. The friend then delivered a baby, vaginally, and the baby developed warts in his mouth, throat, etc. The baby eventually died after many surgeries to try to remove the warts. Now, I don't know if this story is even true, and I certainly think it was wildly unprofessional for that secretary to speak like that to a patient in the office. But I happen to also be pregnant, and it was a little hard not to worry after hearing that. I tried to do some research on my own, but it only ended up fueling my concerns. And so, again, I was very relieved to find this forum and read your responses to my questions. 

I hope this post gives some context to the questions I have been asking. It has been a bit miserable worrying about all this, and I already feel so much better, as if a weight has been lifted. If you could speak just a little bit to the issue of warts and pregnancy, specifically whether that means I should take any precautions regarding the warts on my hands (avoiding touching my own genitsls during pregnancy?) and whether (with regular prenatal care) it would even be possible to not realize that one had genital warts and this endanger a newborn, I would be very grateful. Based on your earlier responses, I believe your answer will be "No," but I just want to make sure my understanding is correct.  

Beyond that, there are the 3 day-to-day scenarios that I have been concerned about. Based on your thorough responses to my questions, I believe I can let go of all of these worries. But it would be most helpful if I were permitted to ask them specifically to make sure my application of your response is correct. If you would be willing:

1. I have been concerned about transmitting my hand warts to my children while changing their diapers, applying diaper cream, or bathing them. Or assisting them at the toilet during potty training. I had begun wearing a nitrile glove during these situations, but this is quite annoying and seems ridiculous. Based on your response regarding tissue specificity, it sounds like wearing a glove is excessive and unnecessary, and I should just return to doing these things with my bare hands like I normally would, even if the warts on my hands continue to persist. Correct?

2. After the secretary's story about her friend, I began to wonder if my warts could be transmitted from my hands to the dishes, while washing or setting them out, and whether my children could then end up with warts in their throats. Based on your response about the rarity of transmission via inanimate objects, it sounds like this is a ridiculous worry that I should put to bed immediately. Correct?

3. Likewise, I had begun to worry about transmission while handling the children's laundry, specifically their underwear. Again, based on your explanations, I feel great relief that this is another ridiculous concern that I can let go of. Correct?

I think that should about wrap it up - I don't expect I will have any more questions after this. Thank you. 
Edward W. Hook M.D.
81 months ago

Thanks for the additional context.  I'm pleased my comments have been helpful.  As I've already said, in the vast majority of persons warts are merely a nuisance so one might ask the question of just how much one should worry about warts that you are not even aware you have.  I would argue not at all.  As for your encounter in the waiting room, what was described was a very rare condition called recurring respiratory papillomatosis which is estimated to occur in somewhat between 2 and 5 out over every 100,000 live birth (i.e. less than 1/1000th of 1%), making many other problems far more common.  This too is something I would urge you not to worry about. 

With regard to your follow-up questions:

1.  I do not see a need for you to wear gloves while caring for/touching your children.  Better to deal with the tiny chance that they might et a wart than to deprive them of a mother's touch.

2.Simiallry, I would not worry about transmission of warts on inanimate objects.  If this occurred with any serious frequency we would all be covered with warts.

3.  Certainly no reason to worry about handling/washing your children's clothing and laundry

This is my third response to your questions.  I'm sorry you have had to worry so much about this but understand how this can happen.  I hope that with these additional assurances you will be able to move forward without concern.  If there are additional questions, you will need to stat a new question as our Forum guidelines and practicality allow us to only provide three responses per question.  Take care and please don't worry.  EWH