[Question #2397] HPV/Genital Warts - Male

45 months ago
Hello Drs, 

Firstly - thank you for this service. It helps to have expert advice in one place. 

As background, I'm a 29yo male who was diagnosed with tiny but multiple genital warts about three weeks ago. 
I underwent cryotherapy, which appears to have removed the ones treated, but was also given Aldara which I am now using on others not seen during the examination - I'm heading back to the clinic this week to make sure they are, indeed, warts, but they look the same, so I suspect as much. 

My questions to you are: 

1) Based on recent studies I've read in your latest responses about the HPV infection eventually being controlled and not eradicated, should I expect to have a recurrence of warts years down the track after (hopefully) my immune system manages to "clear" the infection. Or is re-activation more likely in high-risk, cancer-causing, types?

2) For this reason, was the clinician who treated me now wrong to suggest patients don't need to tell a future partner (I plan to, regardless), since they'd be at risk of infection should the HPV re-activate?

3) Can genital warts be grey/black in colour? A couple of my bumps appear to be. 

4) To me, the talk surrounding the recurrence of genital warts is almost identical to that of herpes. For all intents and purposes, do the viruses remain "dormant" in (effectively) the same way? Or does your immune system fight off HPV to a greater extent?

5) Can "persistent" HPV still be eventually cleared by your immune system?

Sorry for the multiple questions. And thank you very much in advance..
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thanks for your confidence in our services. Directly to your questions:

1,5) You may have misunderstood something you read on this forum or elsewhere. Probably HPV usually is completely eradicated by the immune system, or at least suppressed to a point where only DNA remains (and not always even that), overt infection does not recur, and the infection is not transmissible to partners. In other words, the immune system does indeed clear the infection. Some data suggest the high risk (cancer-causing) HPV types are more likely than others to persist or recur, but not necessarily.

2) I agree that people with diagnosed HPV infections -- usually that means warts or, for women, and abnormal pap smear -- are not obligated to tell future partners. The risk any one of those partners will ever have an HPV problem is not elevated because of sex with someone known to be infected. For every potential partner with a known/diagnosed HPV infection, there probably are 10 others who have (or have had) the same HPV types but don't know it.

3) Warts are highly variable, so I would never say never about their appearance. But usually they are no more darkly pigmented than the infected person's natural skin.

4) All HSV infections are permanent:  live virus persists for life, usually recurs (with or without symptoms), and is potentially transmissible for the life of the infected persons. As noted above, most HPV infections are cleared and do not recur. The immune response to both viruses is quite complex, but at a simplistic level, it can be considered that the immune system is more effective in eradicating or limiting HPV than HSV.

I hope these comments are helpful. Let me know if anything isn't clear.


45 months ago
Thank you for that - it helps a lot!

I guess the confusion - and fear - for me is I've read and heard quite a bit about warts possibly coming back years later from a "latent" infection. 

The hard thing to reconcile has been comparing that to other advice saying you can consider yourself clear after no visible warts after 3/6 months or a year. 

The worry for me is eventually infecting someone Because I've wrongly considered myself clear after a reasonable amount of time has passed.

Sorry, I know there is a lot of unknown with HPV, but any reassurance would be welcome! 

Thank you again..

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Delayed recurrence of warts occurs, but it's not very common. Don't be misled by what you see online from persons with such experiences. Of course the much larger numbers of people without recurrence don't go online to post that experience.

My advice is exactly that:  consider yourself clear of warts after no visible recurrence after about 6 months; a year if you want an extra margin or safety.

Don't make out genital warts to be more important than they are. They are an unpleasant inconvenience, not an important health threat. It wouldn't be a big tragedy (or shouldn't be) if a future partner gets warts (or any other HPV infection) from you. And delayed recurrence is even less important when you consider the years it may take. The older you and your sex partner(s) are, the more likely they've already been exposed and infected and are now immune to new infection with the same HPV type.