[Question #2549] HPV/genital warts follow-up

44 months ago
Hi Drs, 

I'm sorry if I'm asking you to repeat yourselves, but I just wanted to get some clarification/reassurance after a recent medical centre visit. 

I went back to get another round of cryotherapy (for some small warts that were missed the last time/new ones that have emerged).

After the treatment, the Dr advised that I would have HPV for life and that although my immune system would likely clear the virus, warts would likely recur throughout my life when my immune system is stressed/not working as it should, and I would be infectious in those instances. 

I know much of HPV advice is semantics, but it did scare me as it seemed to contradict your previous advice that once your body clears the virus, overt infection no longer occurs. 

Have I misunderstood something here?

Again, I'm sorry for asking a similar question again - it was just deflating to hear. 

Thank you.   
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Welcome back to the Forum.  On this occasion I happened to pick up your question.   I have read your earlier interchange with Dr. Handsfield and agree with all that he has said.  I also think you have correctly said much of the variation of HPV advice is semantics and reflects the continued evolution of our knowledge of this widespread infection.  It is because of the fact that our knowledge continues to accumulate that it is easy to get out of date on such things.  

As Dr. Handsfield implied in his earlier response, I will respectfully disagree with the health care provider who told you that once resolved, your warts are likely to recur.  That is simply not the case.  As Dr. Handsfield also mentioned, vestiges of the virus, in the form of detectable DNA is likely to be present for years into the future but there are no data to suggest that recurrence of the visible warts are frequent (there are not good numerical data on this but I would estimate the risk of recurrent visible warts following successful treatment, i.e. the warts have not recurred in the first 6 months following treatment, is less than 1-2%) or that the detectable DNA is transmissible. 

I hope that this clarification is helpful.  Please feel free to seek clarification if I have missed something.  EWH
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44 months ago
Hi Dr Hook, 

Thank you - that does help clarify things. 

If you don't mind another follow up... 

Since HPV DNA remains after clearance.. Do you mean the virus and, in turn, genital warts can reactivate after being cleared?

Thank you again.. I'm sure this would get very repetitive for you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
The answer to your question is complex.  Since the virus cannot be grown (cultured), the only technique we have for detecting the virus is detection of DNA.  DNA can be present and represent live or dead virus and among live viruses, can represent "latent" non- replicating and non-infectious virus.  The vast majority of all the virus that "persists" for years after treatment is this latent, rarely infectious virus.  On rare occasions, this latent virus can re-activate.  Hope this makes sense.  EWH
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44 months ago
Thanks again Dr Hook, 

I guess my final question is: can I still be confident there will come a time when the warts will be gone for good?
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Yes, be confident that your visible warts will be gone for good (although, as per the discussion above, latent, residual DNA may still be detectable).  Finally in closing (as this is my 3rd response to this series of questions) like Dr. Handsfield, I do not regularly counsel my patients to disclose their HPV infections as a result of the high levels of misunderstanding.  Once your warts have been gone for 6 months, you can consider yourself non-infectious.    Take care.  EWH
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