[Question #1936] HPV/ Genital Warts

61 months ago
In October 2015 i noticed my first genital wart on my pubic region. I did not get this treated straight away but in early 2016 began using Aldara which ultimately didn't clear the wart. However, since Summer 2016 i have been successful treating recurring genital warts with both Warticon and Cryotherapy. However, whenever i get rid of the warts more show up a week or so later. I have lost count of the amount i have had now.  I am now continuously using warticon to treat them as they show up, but whilst they are usually gone within one week of treatment, i am concerned each time new warts reappear as to the persistence of my infection. Is there anything i can do to aid my immune system in defeating the virus into a latent state? It has been 2 years now and i am concerned that i will be living with genital warts for many years to come. I am a young male who is also taking accutane, other than that i am on no other medication.
Edward W. Hook M.D.
Edward W. Hook M.D.
61 months ago
Welcome to our Forum.  I'll be happy to comment.  I think you need to see a dermatologist of other health care provider who can carefully evaluate these lesions- I am concerned that while you may have had a wart initially, what you are now treating may be something else. Warticon is a preparation of podophyllin and Aldara is imiquimod and each both has a side effects and are not recommended for continuous use.  Each is active and recommended for wart treatment but from the sounds of things the lesions you are treating respond more quickly and certainly come back more quickly than is typical for most genital warts if they really do go away and then return in a week or so later.  Warts are very common and, as a result, many other less common genital processes are sometimes mistaken for genital warts.

I hope this makes sense.  Please follow-up if any of this is unclear.  EWH
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61 months ago
yes i am in regular contact with my doctor who looks at my warts frequently. So I am definitely experiencing new warts. They dont recur in exactly the same place that has been treated previously, i just meant that i keep getting outbreaks of warts in the penile area. My instructions were to apply warticon to any new warts as they occur, i have not continuously used it for more than the recommended time on any one area. I usually apply it to the wart, the area then becomes irritated and the wart peels/ falls off after a few days. What i am concerned about is why my warts keep recurring and have done for a period of over 18 months now. I have read most hpv infections should clear up within 3 years. Am i unlucky or is there things i can do to boost my immune system.
Edward W. Hook M.D.
Edward W. Hook M.D.
61 months ago
Thanks for the additional information.  As I mentioned before, the time course that you describe is most atypical for genital warts.  Warts typically do not respond to therapy in the manner you describe nor is it at all typical for warts to continue to appear in one location after another, even in the same area in the way you describe.  Certainly not for a period of over 19 months.  Unless your doctor is a dermatologist I would strongly recommend getting a second opinion.  This is not to cast aspersion on your doctor.  If you were a patient of mine, despite over 30 years of STI-related practice, I would do the same for you. 

As far as your immune system is concerned, unless you are taking immune modifying medications or have a chronic illness which might effect or indicate deficits in your immune system, I would not be concerned, nor would I recommend anything to boost your immune system beyond simply taking care of yourself.  The history of most (>98%) of HPV infections clearing over three years, this is a true statement but it refers to infections occurring at a single site, lesions appearing in different sites which, as I have already said, is most atypical.  EWH
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61 months ago
By coincidence, i actually saw a dermatologist this morning who again confirmed that what i am experiencing is a recurrence of warts. I have been seeing multiple doctors about this as i live in different locations. So i am reasonably sure of the diagnosis. Its very difficult to find information about how long people experience genital warts symptoms for. In regard to my description, i don't necessarily get them every week i just meant that since my original diagnosis ive had at least a few new ones each month. My diet hasnt always been great and i do drink alcohol, could these be the reasons for such an atypically persistent infection? I wasnt aware that 19 months was such a long time for it to persist and believed some people experienced symptoms for many years or even life. I should say that only since September 2016 have i made a consistent effort to freeze or treat any wart i see as they show up. is it possible i am getting reinfected?
Edward W. Hook M.D.
Edward W. Hook M.D.
61 months ago
Thanks. Several not necessarily related comments below.  I'm pleases that you saw a dermatologist although still a bit surprised at the time course and recurrence pattern that you have described.  Did the dermatologist have thoughts as to your course or suggestions for therapy?  (I presume you asked the same questions of him/her that you asked me). 

There are no data to suggest that diet or alcohol consumption impact the natural history of warts.  Reinfection is a possibility (have you had a same or different partner?.  Have your partner's been checked?).  Also, in terms of prevention of re-infection, have you been vaccinated for HPV?

19 months is not a long time for a wart to persist, it is your pattern of recurrence that surprises us.  In fact, some patients may have a visible wart stably persist for several years.  the data on warts/HPV infections clearing spontaneously in most people after three years are primarily obtained from studies of HPV infection in the female genital tract, not visible genital warts..

If you have been consistently intervening on your warts for the past 6 months (since September), it may be appropriate to continue in the fashion that you are doing.  I suspect it may be helpful to try to see the same doctor repeatedly if that is possible.

Our Guidelines call for question threads to be closed after three replies (this is the third).  I will keep this thread open a bit longer as I am interested in your replies to my questions above and because of the atypical nature of your situation.  Irrespective however, I see nothing to suggest a need to boost your immunity or anything that suggests that you are in any way immunocompromised.  EWH
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61 months ago
I dont beleive i have been reinfected as i have abstained from sexual activity during the time ive had warts. I will get the hpv vaccine though so as not to get infected with other types of hpv. Myself and my doctors plan is to use warticon as soon as new warts appear so as to treat it as quickly and effectively as possible. My doctor said it is a good sign that the warts are now so receptive to treatment but it is very frustrating that over a year and a half down the line i am still experiencing recurrences. I have read online that people in my situation have experienced similar situations for years on end and i'm becoming a bit concerned this may be true for me. My ex girlfriend, who i was with when i noticed the warts never had any symptoms. It does seem that once i began treating my warts the recurrences flared up, as for the first 6 months or so there was only 2, but since i have consistently treated them there have been at least 3/4 per month, in areas from my pubic hair to the tip of my penis and also one on my thigh,