[Question #16] HPV / WARTS

41 months ago
My daughter received her Gardasil vaccine just as required. She is a type-1 diabetic and twenty. She was just diagnosed with vaginal warts. I have read conflicting information on birth control and menstrual cycles. She is on the implanon implant , does not have a cycle and has not had on for three years now.  Does a menstrual cycle help clear the virus?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome to Ask the Expert.  Thanks for your question. However, it would be best to know that your daughter is seeing the question and my replies. It can cause confusion when asking questions on someone else's behalf and then conveying the answers back and forth.

Congratulations on your daughter's decision (and perhaps yours on her behalf) to be immunized against HPV. Every young person should do it! Even though she probably had her wart-causing HPV infection before she got the second dose of vaccine, she is protected against any of the vaccine types to which she hasn't been exposed. But it has no effect on HPV infections already acquired before completing at least two of the 3 Gardasil shots. The most important benefit is a much lower chance of cervical cancer and pre-cancerous Pap smear abnormalities. Did she get the original Gardasil vaccine, which covers 4 HPV types? Or the newer Gardasil-9? G-9 protects against the same 4 types plus 5 more, and is quite a bit more effective in preventing cancer and pre-cancer of the cervix.

Finally to your main question:  Menstruation has no effect on clearance of HPV. Her diabetes also won't have any significant effec on this. Your daughter's immune system will clear her wart-causing HPV infection over the next few months, regardless of having a regular menstrual cycle. Of course, the warts themselves should be treated as well. Presumably that's being done, right? Either with treatments in the doctor's office or prescription medication at home. Treatment usually gets rid of visible warts quite quickly, typically within 2-4 weeks.

I hope this has helped. Best wishes--  HHH, MD
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41 months ago
Thank you for your response.  Yes, she will see this and knows that I am researching so we can ask the correct questions with her doctor. The information online can be very confusing. My daughter just turned 20. She received her HPV in 2010/11. Correctly and within the suggested dosage periods. I do not know which Gardasil she received.  She is getting treatments for the warts via her OBGYN and at this point it looks like surgery will be the best option. Can you receive all or part of the newer vaccine? Thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Thanks for the follow-up. Gardasil-9 approved 5 months ago, so your daughter had the original. But double check with the doctor that she received Gardasil® and not Cervarix®, another avaiable HPV vaccine. It only covers 2 HPV types, not including the two that cause most genital warts.

Although Gardasil-9 was approved in January, it was expected to take a few months to become routinely available. When it is, your daughter definitely can and should receive its expanded protection, with at least 2 doses and maybe three. It won't improve prevention of the 4 original HPV types, but it's not at all harmful -- in effect it will count as booster doeses for those types.

It sounds like your daughter may have fairly extensive, large, or treatment-resistant warts. If they indeed are very large (any lesions over an inch or so) or extensive, surgery may be the best option. However, if she has only seen her ObG so far, consider consultation with a dermatologist before making a final decision. In general, dermatologists have the greatest experience in wart treatment and might have suggestions for other approaches short of surgery. They also are often best at judging whether especially large warts might have pre-cancerous components -- not common at your daughter's age, but better safe than sorry if they indeed are large.
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41 months ago
Thank you so much. She will do the follow up and see dermatologist for 2nd opinion.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
You're welcome. I'm glad to have helped.---