[Question #2340] New GW Infx

46 months ago
I am a 33 yo female, married with two kids. The last time either me or my husband has had sex with anyone else was about 6 years ago.  I recently had an outbreak of GW for the first time ever (I'm sure that's what they are based on appearance) and I'm confused and upset.
1) Does this mean my husband has cheated on me (I have not been with anyone else), or could I have gotten this 6 or more years ago and it laid dormant until now? Husband swears he hasn't cheated and of course I want to believe him. He's had no sx's.
2) I got the HPV vaccine series about 8 years ago.  So does this mean I must've already had it at the time I got the vaccine but didn't know it?
3) About 8-10 years ago I had a pap come back as ASCUS but normal upon recheck several weeks later. Would that have been the most likely reason for the ASCUS, that I had recently been infected with the GW strain of HPV?
4) I've had two kids with no sign of GW, would they have definitely appeared during one of my pregnancies, or could I have still had GW HPV but it remained dormant through both pregnancies?
PLEASE HELP such conflicting info online and my appt with gyn is still a month away.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thanks for your question.

My first response is to very strongly urge you to be examined to confirm the diagnosis. While a typical appearance is certainly suggestive, there are other potential causes of genital bumps or wart-like lesions. In addition, the pattern (exactly where located, whether several bumps are clustered together, and other things) can make a big difference. In answering your questions I'll assume your self diagnosis is correct. But you must get professional input in person. If nothing else, you'll need professional management for treatment. I suspect if you explain to your gyn's office the reason for your appointment, and your entirely reasonable anxieties about confirming the diagnosis and getting treated ASAP, they'll find a way to see you much sooner than a month. If not, I suggest finding another gyn, or visiting a dermatologist or your local health department STD clinic. A Planned Parenthood clinic would also be an excellent choice for expert evaluation.

1) This certainly could be a previously dormant infection. New appearance of warts or other evidence of HPV (e.g. an abnormal pap smear) is never sufficient, on its own, to conclude a partner has had other partners.

2) Having been vaccinated greatly reduces the chance that you have genital warts at this time. The vast majority (around 90%) of GWs are due to one of two HPV types (HPV6, HPV11), both of which are 100% prevented by the vaccine. I suppose it is conceivable you had a wart-causing HPV infection before you were vaccinated, which has now reactivated. But it's quite unlikely.

3) ASCUS means "atypical squamous cells of undetermined significance". The cause is unknown, and it isn't necessarily related to HPV. I doubt that pap result is related to your current genital bumps, even if they are warts.

4) Even with active genital HPV infection during vaginal delivery, the vast majority of infants do not become infected. (More accurately, development of visible warts or other problems is very rare. I am unaware of studies that might have documented asymptomatic HPV infections in some such infants.) That your kids didn't have any known HPV problem says nothing about the chance you were infected at the time or that the current problem is genital warts.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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46 months ago
Thank you so much for your time, just a couple of things I'm not clear on. Also some details-they are a cluster of fleshy growths just inside the opening of my vagina, and I intentionally scheduled my appt when I was off work, otherwise they would've seen me sooner.  
My questions all boil down to trying to figure out if I could've had this all along, for 6+ years and it just now making an appearance, as I'm trying to determine whether my husband had to have cheated on me within the last 6 years, or if this could be an infx I've had for 6+ years (the last time either of us had another sexual partner) that has laid dormant until now. 
1) So, could I have had this for 6+ years and it just now show sx's?
2) You said,  "I suppose it is conceivable you had a wart-causing HPV infection before you were vaccinated, which has now reactivated. But it's quite unlikely."
So then if I did not already have the GW HPV at the time I received the vaccines, this would mean I was first exposed/became infected AFTER I got the vaccines? How likely is that?
3)Let me clarify my question about GW and pregnancy, which has more to do with the likelihood of the presence of the virus during pregnancy, and not regarding my kids being infected:  Since pregnancy is a common time to have an outbreak, would I have necessarily had my initial outbreak during one of my pregnancies, or could I have had GW HPV during both pregnancies and it still not show sx's until now? (Again my question is in hopes of trying to determine if my husband has been faithful)

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
OK, understood about the medical appointment etc. But I would still recommend you find a way to be examined sooner than a month. Indeed, I find it rather peculiar that you are apparently so concerned about the implications of having GWs and yet not so eager to have the diagnosis confirmed or to start treatment. Warts can quickly grow to very large size, and early treatment while small make treatment easier, shorter, and more effective. It probably won't make any difference if you don't in fact have warts, but I still encourage you to find a way for professional evaluation diagnosis and treatment.

As for these additional questions, and your previous one, you're basically barking up a tree with no cat in it. For most persons with GWs it is not possible to be certain about when and from whom the infection was acquired, and that's especially true in situations like yours. If you have warts, most likely you will never know when and from whom you acquired that particular HPV infection.

1) Yes, this is possible.

2) Yes, you could have acquired the HPV causing your warts after being immunized. About 10% of GWs are caused by types other than HPV 6 and 11, including types not covered by the vaccine.

3) Thanks for clarifying this. However, my reply is essentially the same. Although GWs often appear (or grow larger) during pregnancy, the large majority of women with HPV, probably including infection with wart-causing types, do not develop overt warts when pregnant. The absence of warts during your pregnancies says nothing about whether or not you had already been infected with HPV.

I fully understood and still sympathize with the reasons you are hoping for these answers. However, this will never be productive. Among other things, your husband could have been the source of your HPV infection (again, assuming that you really have warts) without implying he has had other partners. Men as well as women can carry HPV for long periods, or can have reactivation of distant past infections. You could have been infected by him with no implications for him having other partners. This is among the reasons for my response to question 1 yesterday. Appearance of newly diagnosed HPV in a couple does not have the same implications as most STDs like chlamydia, gonorrhea, syphilis, etc. You must not draw any conclusions about your husband's fidelity even if the diagnosis of genital warts is confirmed.

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46 months ago
Thank you so much you have made me feel much better! I do want to explain why I haven't rushed to my gyn for diagnosis and/or treatment.  The warts first appeared several weeks ago, and it is only after tirelessly searching the internet only to find conflicting info about incubation periods etc did I resort to reaching out in this way (no offense lol). I'm a nurse, so I have very basic knowledge of disease processes, etc and I have a good friend that is a NP, whom I showed a picture of what my growths look like from a picture I found online, and she told me if my growths looked like the pic I showed her, it was most likely GW. The first day they showed up, they were much larger than they are now, and after a couple of days they shrunk a good bit, they are still there now, but much smaller, and the only way I know I have them is to feel for them just inside my vagina, so I'm not too worried about treatment as they are not bothering me nor are they visible. I hope this better explains why I strongly believe that's indeed what they are, and why I haven't rushed to the md.
Just a couple more things:
1) Since you have been adamant about me getting a diagnosis from a doctor to confirm GW, what else could they be? I know it's not herpes, not cysts, and too many to pop up at once to just be skin tags....

2) Lastly, I'm still confused about the vaccination part. If I had the vaccines, what would my chances be of having been infected AFTER vaccination with one of the few 10% of strains not covered by the vaccines? You know much more than I do by far, but to me it would seem more likely I'd already had the virus (since you told me I indeed could have had it for many years before developing warts) before I got vaccinated and therefore the vaccines did not prevent the main types (6 and 11) that cause warts because I'd already been infected.
Again thank you so much for your time and help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Thanks for the additional context.

1) Warts cannot appear in a day or two then shrink substantially within another couple of days. Complete resolution in a few weeks to a point of not being visible but only felt also is highly atypical. So I'm becoming even more convinced you do not and did not have genital warts. Presumably they were not vesicles (blister-like) and didn't evolve to open sores before they regressed. However, the time course and the appearance of several bumps in a cluster are typical for a recurrent genital herpes outbreak. Presumably you have no past history of herpes or previous blood tests, but that might be a consideration.

2) I don't understand what you don't understand about the vaccine. When you were vaccinated, the standard HPV vaccine covered 4 HPV types, which accounted for somewhere around 70-80% of all HPV infections. If you were sexually active after being immunized, you were susceptible to the other 100+ types that commonly are sexually transmitted. So why should it be a surprise that you could have acquired a new HPV infection after immunization? And indeed it is also possible you had been infected with HPV 6 or 11 before you were immunized. Vaccination has no effect on estabished HPV infection, and HPV infections can reactivate.

That completes the two follow-up comments and replies included with each question and so concludes this thread. The bottom lines are 1) you probably do not and did not have genital warts; and 2) If you decide to pursue the possibility of herpes, consider having a type-specific blood test for HSV1 and HSV2. (If you do that, make sure you have only IgG testing; tell your doctor or the lab to definitely not do IgM testing, which has a very high rate of false results and is often misleading. If you enter IgM in the forum's search window, you'll find lots of discussions about HSV IgM testing and its problems.) In the event of a positive result, especially for HSV2, feel free to ask a new question, which would be answered by moderator Terri Warren.

I hope the discussion has been helpful. Best wishes.
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