[Question #2334] GW

45 months ago
Hello Drs,
You were such a help a few months ago after my regrettable encounter.  You calmed my nerves and of course were correct.  I had put this all out of my head months ago but now have some questions regarding genital warts.  Just a reminder, I am 35 male.  It has been about 6 months since the encounter with brief unprotected oral and brief protected vaginal with csw.  Yesterday I noticed an interesting spot high on the shaft of my penis, just below the head.  I'm going to keep an eye on it to watch for changes before getting it examined. 
Questions- 
When a condom is used and gw are acquired, do the warts appear on skin that was exposed during the encounter? or is that where the virus enters, and warts could still appear where condom covered much higher on the penis?
CSW was probably 40-45 years old.  I have seen many references to new infections at my age are rare.   Your thoughts?
I had read some previous posts on here or your past forum site that at 4 months one could feel better that gw was not acquired, but i read a more recent post where you said 6-12 months was more likely timeline for appearance.  will you clarify for me.
I have been in committed and faithful relationship prior to this for 9 years.  GW wouldn't all of a sudden appear from prior to that correct?
Overall, what is the risk of transmission of gw from my single encounter?
Thank you very much once again.  


Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome back to the Forum.  I hope that all is well with your GF- as I remember she was ill at about the time you last posted.  I'll try to help.  Your questions are about genital warts and the more general topic of HPV infections.  Before I address your specific questions, a few general comments about HPV infections.  You probably  had HPV long before the encounter of concern. 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 now conservatively estimated that over 80% of sexually active Americans have or have had HPV.  In far less than 1% of those infections, the infection will progress over a period of years to precancerous lesions which can be detected in women with routine sexual health screening and in men by having new lesions evaluated by a trained clinician (experience is important here as many physicians who have less experience will say that any genital "bump" or lesion is HPV).  Unfortunately, concerns about HPV infections sometimes generate 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.  With that let's address your questions:

When a condom is used and gw are acquired, do the warts appear on skin that was exposed during the encounter? or is that where the virus enters, and warts could still appear where condom covered much higher on the penis?
HPV is transmitted by direct exposure.  Infection is facilitated by fraction and microscopic abrasion that is a normal part of sexual activity.  It would be most unusual for a genital wart to occur at a site which had been covered by a condom.  On the other hand, with respect to the lesion you describe, there are normal penile bumps that appear, particularly around or near the head of the penis. These can vary greatly in size and appearance but are normal- one of the most common of these lesions are what are called "pearly penile papules" (you can Google them and see pictures)

CSW was probably 40-45 years old.  I have seen many references to new infections at my age are rare.   Your thoughts?
Certainly HPV infections are less common among persons over 25 or 30 years of age.

I had read some previous posts on here or your past forum site that at 4 months one could feel better that gw was not acquired, but i read a more recent post where you said 6-12 months was more likely timeline for appearance.  will you clarify for me.
The appearance of warts is highly variable but when they appear they most commonly do so between 3 and 6 months after exposure.  On the other hand, they can also appear much, much later.  Few experienced clinicians are willing to say that the appearance of a genital wart can be linked to any single sexual exposure.

I have been in committed and faithful relationship prior to this for 9 years.  GW wouldn't all of a sudden appear from prior to that correct?
See my comment above.

Overall, what is the risk of transmission of gw from my single encounter?
You used a condom for your genital exposure and HPV is very rarely acquired form oral sex, both because oral HPV infections are much less common than genital HPV and because from a biological perspective oral to genital STI transmission of any sort is "inefficient" with transmission occurring in only a small fraction of exposure to infected persons.

My advice would be for you to have a trained clinician take a look.  If this is a wart, it is easily transmitted.  I would not worry about transmission to your regular partner and can assure you that as part of her sexual health screening, she should be routinely evaluated for the consequences of HPV.  This is not something for you to worry about.  EWH
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45 months ago
Thank you for your reply.  I am seeing a dermatologist tomorrow to get checked out.  But this sure looks like some of the wart pics online.  The only thing giving me hope is that its located where the penile raphe meets the frenulum, where skin is somewhat irregular anyways.  I do understand that the health risks are not much at all.  I have tested negative for everything else twice so not concerned about my or her health.  I am in a panic that I will be found out and that my relationship is over.

If this is a wart that appeared 5 months after this exposure and she starts to show signs soon after me, its pretty clear what happened correct?  Or is this virus really that unpredictable that no dr would be that definitive with her?

Does unprotected frottage/"stripper slide" change the risk of contracting gw in your opinion?  Could that explain showing up where a condom covered during intercourse

To completely accept the diagnosis given tomorrow, I plan to ask for a biopsy.  Is that a good or bad idea?

I'll report back with the dr.'s thoughts.  Thank you again
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
You have apparently already decided that you have a wart and that you got it from the encounter you are regretting six months ago.  Warts however can appear long after an exposure, if it is even a wart.  Their appearance is unpredictable and no knowledgeable physician would tell her that the appearance of a wart was a sign of recent (even within the past six months) infidelity.

While warts could, theoretically, occur with frottage, I have not seen such a case in my over 35 years of STI focused practice.

I am not going to endorse a biopsy on a lesion I have not examined based on an on-line exchange.  See what your dermatologist says.  Be truthful with him and explain your concerns.  EWH.
 

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45 months ago
I know you are going to be really surprised at this.  He said its nothing.  I'm pretty sure I have exhausted all possible outcomes and will now be able to move past this.  Thank you for what you drs do on this site and the amount of time you must put into it.  I wish you the best and hope to never chat with you again.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Thanks for the follow-up.  I would have been surprised if this was a wart.  I hope you will now be able to move forward without concern. 

I will close this thread later today. Take care. EWH
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