[Question #1533] Follow-up - possible bump

47 months ago
Hello to the experts,

I recently posted a question regarding HPV transmission risk from a one-time protected exposure with some hand-genital contact with a CSW. Dr Hook's comments were very reassuring and I was able to relax for a while. 

This was an awful mistake on my part, and I have been on the alert for symptoms ever since. It is now 22 days after the exposure, so I know that I am in the clear for herpes, but I have been worried about HPV due to its commonality and the fact that my partner and I had only had sex with one another until my mistake. 

This morning while using the bathroom, I noticed a small red discoloration near the base of my penis. The location is worrisome, as it was close to where the condom would have ended, although I believe it would have still been covered. The discoloration is a bit red, not terribly so but noticeably a bit different from the rest of the skin. Upon close inspection, there is a very small white outline of skin (could be something else but doesn't really go away upon gentle rubbing or scratching) around this discoloration. 
The discoloration is shiny compared to the rest of the skin. There is no bump of any kind, if you simply touched the skin around it, you would not be able to determine its location. It is also not painful or itchy or sensitive. 

From reading the Medhelp forum, it seems that warts do not appear earlier than 2 months, and I am just barely past 3 weeks, but could this simply be the signs of a wart in its very early stages of growth? 

I suppose I would like to ask the broader corollary question: do these warts appear overnight? It doesn't seem likely, but wouldn't that allow for the possibility that they begin to grow well before being noticeable at 2 months? 

Thank you Drs, I apologize for the repeat question but I am afraid my mistake will haunt me forever and ruin a great relationship 

Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

I'm pleased that my earlier replies were helpful but disappointed that you are still worrying about this very, very low risk exposure.  The worst thing you can be doing is closely scrutinize your genitals daily or multiple times daily.  In doing so you are almost certain to notice abnormalities that have always been present and are part of normal anatomy.  You need to address your guilt and get over it. 

As you point out, HPV-related changes take months to appear and DO NOT appear overnight.  The discoloration you have noted is likely normal variation or, possibly the sort of common, non-STD genital fungal infection that people get on a regular basis. 

Your error SHOULD NOT haunt you forever.  You made an error in judgment. I urge you to move forward without concern. EWH

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47 months ago
Dr. Hook,
Thank you again for your prompt reply. 
I am doing my best to move forward and was making great progress until I noticed this discoloration. I am 95% sure it was not there a few days ago, and your comment regarding the time to appearance of a wart is reassuring. I return to your comments whenever I feel anxious, and this has helped immensely, despite my current episode regarding this discoloration. I should add that I think you and the ASHA are providing a fantastic public service. So much of sexual health education in the US seems to be based upon fearmongering, and I think my anxiety is a manifestation of that and I doubt I am unique in this regard. Your scientific, measured approach to sexual health is commendable and much-needed.

I had some follow-up questions:

1. On some of your earlier Medhelp forum posts, both you and Dr. Handsfield seemed to indicate that warts could appear within a matter of weeks. However in the past couple of years, the advice you have given is that warts do not appear sooner than 2 months. Is this the earliest possible time of appearance? I understand that nothing in science or medicine is absolute, so in other words, it is extremely rare for any warts to appear before 2 months? 

2. When genital warts do appear, how rare is it for there to only be one wart? Is it usually the case that multiple warts are present?

3. Somewhat related to the above question, do these warts appear one by one? For example, 4 months after exposure one might develop a single wart, and then a month later develop another wart etc? Or do they all pop up at once?

4. Are there any data on how quickly warts are cleared by the body? Are these strains like the high-risk strains in that they are usually cleared by the immune system within a year or 2? Or do they normally require treatment to be cleared?

5. Are there any data on how many infections with HPV 6 or 11 remain asymptomatic? That is, people who do have those wart-causing strains but never develop warts. 

Thank you again
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Straight to your continuing questions:

1.  I believe you are incorrect regarding out statements related to the appearance of genital warts.  Irrespective however, there are now clear data to indicate that wasrt so no become apparent until several months after acquisition of infection.  It would be most unusual for warts to appear earlier than 2 months after and exposure, or for them to manifest their presence in the manner that you describe. 

2.  As you mention above there are no rules but typically when warts appear there will be more than one although they may be close together.

3.  Over time additional wars may appear. 

4.  The best available data are that even without treatment most warts would resolve over the passage of a year or two.  On occasion they may persist longer.

5.  This is a difficult question to answer for men. In women cervical infections with HPV 6 or 111 can certainly occur without visible warts.

You are continuing to overthink this in a way that I suspect is not good for your mental health.  EWH

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47 months ago
Thank you again Dr. Hook,

I understand the forum has a policy against repeated anxiety-driven questions. I will not post on this forum again for at least a year.
Only one final question:

I can continue unprotected sex with my current partner with no fear of infecting her with any kind of HPV, and move on with my life without giving this exposure event another thought? 

Thank you Dr. Hook. Sorry again for the repetitive and perhaps childish nature of my questions. Happy holidays to you and yours. 
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Thanks for your acknowledgment of our policy.  I will not repeat it.  This thread will be closed later today.

I see no reason related to the exposure that you reported for you to worry or hesitate to have unprotected sex with your regular partner.  there is no realistic reason to fear this.  EWH

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