[Question #2392] HPV

97 months ago

Hello Dr. Handsfield,

About 3 weeks ago I noticed a few small bumps on the top of my penis (Shaft). I could pick the larger one off. After discovering that, I made an appointment with my family Physician one week later. He stated due to the location that it was most likely genital warts. He prescribed Aldara/ 3 times per week/16 weeks. The prescription was filled with Imiquimod instead. So far so good. The ointment has really minimized the appearance of the warts even after just 6 treatments.

The last time that I was sexually active was between October 31, 2016- November 29^th, 2016. Roughly 7 months ago or more. So, I have a pretty good idea that my ex-girlfriend was the one that had passed HPV onto me.

I’m currently not taking this situation very well. I’m losing sleep, eating less, and really stressing out over having an STD. When I acquired HPV, I was 32 years old and only a few months shy of turning 33. So, I have a few questions regarding another problem that I’m having

1. I briefly performed oral sex on her on October 31^st to be exact. Maybe 60-90 seconds at the most. And that the was the only time performing that on her. Beforehand we were at a Halloween party drinking and smoking cigarettes. I noticed about 4 days ago, almost 8 months after the exposure that I have a minor sore on the floor of my mouth behind my bottom teeth. It looks like a small canker sore. Slightly raised, white, but it isn’t causing me any pain. I’ve been treating it with Colgate Peroxyl mouth sore rinse. I’m not sure. But I believe the lesion is a tad smaller. I am a light smoker and drink in moderation. (So obviously without seeing the lesion does this sound like it could be a mouth wart? I know reading previous questions and answers that you state they are extremely rare. Almost not existent. But I’m still worried. Also, I’m sure if this has anything to do with it but I woke up today with what seems to be the beginning symptoms of a cold sore in the middle of my top lip. Of course, though, I have suffered with cold sores since being a child. But after researching them again it states stress and even oral problems can bring some out. Could that be another indicator?

2. I’m extremely worried that having genital warts is going to haunt me for the rest of my life. I’m afraid even after they are gone, that someday, somehow, they will reappear. I was a little more relaxed after learning that over 79 million Americans carry the virus but only less than 1% show genital warts? Does that sound accurate?

3. Also, again. Do you think that possibly that that strain of HPV has entered my oral cavity, causing oral warts? If so, am I doomed to develop Cancer?

4. I’m also scared they may have spread to my rectum. I did inspect myself and noticed nothing. Could they still be yet to come?..

Thank you.

H. Hunter Handsfield, MD

97 months ago

Welcome to the forum. Thanks for your question.

I'm not convinced you have genital warts. It's possible, but there are some atypical features. First, you cannot scrape off a wart, at least not without considerable pain and bleeding. Second, a physician truly experienced and knowledgeable wouldn't be likely to hedge his bets ("likely warts because it's your penis"). There are other causes of skin bumps -- the detailed appearance of the bumps would be helpful. Improvement with imiquimod goes along with warts, but other skin bumps also might improve with such treatment. (Imiquimod and Aldara is the same; Aldara is just one brand of imiquimod.)

Genital warts probably are the best bet, but maybe not. Consider seeing a dermatologist for confirmation. But the result of my replies assume they are warts.

In any case, you're overreacting. Everybody gets HPV, and probably at least 20-25% of all people get genital warts. (We know it's that common in Scandinavia -- less good data in the US, but no reason to believe it's much different.) Warts typically appear 3-6 months after exposure, but it can take a year or more. So your current girlfriend isn't necessarily the source of this particular HPV infection. Most people infected with the main wart-causing HPV types (HPV 6 & 11) develop visible warts -- so if your gf hasn't had warts, it's a fair bet she wasn't the source. To your specific questions:

1,3) Most oral exposures to HPV don't result in infection, and oral warts are rare. Rinsing your mouth with antiseptics won't make any differennce; stop doing that. Oral cancer due to HPV remains very rare, despite media attention to it. And entirely different HPV types cause warts and cancer. The wart-causing types are the least likely to do so.

2) Delayed reappearance of warts occurs from time to time, but it isn't the norm. Once your warts have cleared, you can expect them to be gone forever.

4) Genital HPV and warts can show up in the anal area, but usually they do not. This is a problem primarily in people who are the receptive partners in anal sex -- in men, that usually means gay men.

Bottom lines: See an expert to determine whether or not you have warts. If you do, follow that person's advice about continuing treatment with imiquimod or perhaps switching to a different treatment. Several other options are available if needed. Finally, do your best to mellow out. Even if you have genital warts, it's a minor health inconvenience, not a serious health problem. Don't make it worse than it is.

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

HHH, MD

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97 months ago

Thank you, Dr. Handsfield. I feel much better now regarding my situation. But, if you could clarify a few questions for me regarding your answers I would appreciate that. After that I will consider this thread closed if that’s good with you. The skin defect that I picked off came off rather easy with minor bleeding and no pain. It did heal rather well after two weeks leaving a minor scar. I’m taking your advice and plan to visit a local dermatologist to be for sure to see if HPV is the cause of my concerns. Could you give me a general percentage on the chance that I contracted HPV into my mouth through oral sex? Would you say 3%, 10%, 20% etc. more or less? In what amount of time would you recommend me seeing my dentist if the sore hasn’t healed? It’s been 4 days. Maybe another 7 days? Do you think my newly identified cold sore has anything to do with it oral damage or just random timing? Again, thank you for your help and the help that you provide others through this great tool. Happy 4^th!

H. Hunter Handsfield, MD

97 months ago

There are no data on the risk of oral HPV from any single episode of oral sex. We do know that 100% of all people get genital HPV, given an average sexual lifestyle; and that oral infection is about one seventh as common as genital -- quite a lot, but much less than genital. And that's despite the fact that over 80% of people practice oral sex (on HPV infected partners), most of us very frequently. So it follows that the large majority of oral HPV events do not result in new HPV infections. If I had to make a numerical guess, it would be under 1 chance in a thousand for any single exposure.

HPV does not cause oral sores. You use the term "cold sore", which means oral herpes, which is by far the most common cause of periodic ulcers on the lips. Most oral herpes outbreaks heal in 7-10 days. If you would like confirmation of the diagnosis, see a health care provider (preferably a physician, not a dentist) ASAP -- the sooner the better for accurate diagnosis.

I'm keeping the thread open for one more exchange in case these comments bring up another question or two.

Thanks for the thanks about our services. Happy Fourth yourself.

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97 months ago

Hello Dr. Handsfield.

I did meet with a dermatologist and he did confirm my doctors findings. As you Did, he reinsured me that it's not a big deal and that he does constantly see and treat this problem all the time.

So.. I did notice that you state quit often in other people's threads that this issue doesn't need to be relived in your opinion after treatment with future partners afterwards due to the common fact that most people have already been exposed to it. Do you stand by your opinion? I feel once the issue has been documented and treated by a physician that the paper trail could led to possible criminal or civil suits?. If not disclosed. Which I plan to disclose anyways...

Anyway, thank you for all your help. It made a big difference in my grieving process. Hopefully, this is the first and last time you'll be assisting me..

Take care & keep doing what you're doing!

H. Hunter Handsfield, MD

97 months ago

Thanks for the follow-up, and for your understanding of my previous advice about informing partners about past HPV infections.

To my knowledge there has never been a lawsuit alleging HPV transmission, and I have even more difficulty imagining a successful one. There is simply too much uncertainty about HPV origins and details of transmission mechanism, including rare cases that seem not to have been sexually acquired at all. It is rarely possible for someone with newly diagnosed HPV to accurately judge when and from whom s/he was infected.

Your plan to disclose is fine -- I don't argue against disclosure, only that I don't see it as an ethical or legal requirement. However, many people entering new relationships, especially those with promise for long term commitment, discuss past relationships and/or STDs. More power too them -- but those who decide otherwise often have valid cases.

Glad to hear my comments helped -- but I'll point out you still refer to a "grieving process", which in my view still puts HPV and genital warts in a more important light than necessary. But very glad things are moving in the right direction.

Best wishes and stay safe.

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