[Question #2660] Genital warts - future partners, disclosure, recurrence?

45 months ago

This week, I was diagnosed with GW. I had 2-3 tiny warts (and one larger one that developed on an existing cut), had cryotherapy and they are healing. They are positioned far up on the labia almost where the pubic hair begins (nowhere near vaginal opening).

1. When the warts are fully healed, when is it safe to engage in sexual intercourse with a new partner, without putting them in unfair levels of transmission danger? I understand HPV generally lies dormant in the system, with risk of transmission greatly lowered with no active warts (& considering most people have some strain of HPV already).

- I mean sexual intercourse with a condom, no skin to skin contact/rubbing

- Is it safe to receive oral sex?

- Do I need to tell new partners about the warts once healed, if all genital contact is with a condom, but unprotected oral sex?

I want to be responsible to future partners. I will be checking myself regularly with magnifying mirror, + using condoms, no genital skin-to-skin contact. But should I still disclose?

If my warts heal & don’t return, is it true I don’t carry any more risk than any other person who has had multiple sexual partners and so likely has some form of HPV?

2. How likely is it that warts recur? What % of people get warts only once?

3. I always use condoms for penetration, but my last partner rubbed his penis on me in exact spot where the warts appeared. Will they also appear in the other spots he rubbed himself on? He is the ONLY partner who has ever done this.

Edward W. Hook M.D.

45 months ago

Welcome to our Forum and thanks for your questions. Your questions are familiar ones and I congratulate you on your concerns for future partners. Your recent diagnosis of warts is not an uncommon problem- 10-15% of American adults will know that they have genital warts and many others may have warts but not know it. Our approach to warts, and HPV infections in general, like that of many experts is rather different than for other STIs.

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. Thus it is in no way surprising that you were found to have HPV. Virtually all sexually active persons get this chronic viral infection so, unless you are feeling guilty because you have had sex with more than a single partner in your life, for practical purposes, this is just part of being a sexually active person. It is for these reasons that we continue to urge our clients not to get overwrought by the possibility of an HPV infection and to not feel a need to disclose of their infections to current or sexual partners who are likely to already have HPV.

Thus in answer to your specific questions:

1. Treatment of warts certainly reduces the likelihood of transmission. Condoms likewise reduce but do not eliminate the possibility of transmission. HPV infections do occur in the throat but are less common than genital infections, are likely to be less transmissible. I would not worry about oral sex (giving or receiving). As noted above, we do not feel that disclosure is necessary.

2. Following treatment warts recur in about 20-30% of persons. If no recurrence occurs at three-six month following treatment, you can have confidence that your infection treatment was successful.

3. Warts typically take 3-6 months to appear following sexual contact. it is dangerous to point to one partner or another as the possible source or infection unless you have been monogamous for years. I would not worry about warts appearing at other sites.\

I hope these comments are helpful. The is much good additional information at the ASHA website on HPV and genital warts which you might want to review. EWH

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45 months ago

Thanks so much for your detailed response, and your reassurance. It is hugely appreciated, particularly as I had been struggling both with guilt and with the decision of whether to disclose to every potential future partner – while I really want to be responsible and fair to anyone I sleep with, I am starting to feel that much of the information online that insists that anyone with any form of HPV warn every partner is perhaps something of an overreaction, and even a way to perpetuate the stigma of having a low-risk, non-harmful STI (demanding that past sufferers identify themselves, even if there is no additional risk than in being with someone else, who likely has at least one strain of HPV).

Anyway! I had a couple of quick follow-up questions:

1. Is there a particular time period after which it is relatively safe (or low-risk) to have sex with a condom, and oral sex (probably without a condom/dam)? Is there a particular time period after which it is relatively safe (or low-risk) to have sex without a condom (not planning on it, but in case of a future serious monogamous relationship, in which we would both be tested for all STIs).

2. I am considering getting the HPV vaccine. I know it will not cure my existing strain of HPV, but hope to protect against future infections. However, I am 28 and have had 12 different sexual partners. In this case, is there any point?

3. Is there anything I can do to promote my body clearing the virus, and the warts not recurring? What is the best way to check if they have fully gone away (after the sores from cryotherapy heal), and the best way to check if they have come back?

Many thanks for your time – this is really such a valuable service that has allowed me to inform myself from medical professionals rather than panic by reading the worst-case scenarios of the internet.

Edward W. Hook M.D.

45 months ago

I think you heard my message loud and clear. While in a perfect world disclosure would be a reasonable and appropriate thing, the infection is too widespread and too poorly understood for this to be a good way forward. We agree that demands for complete disclosure is an over reaction and problematic. As for your follow-up questions:

1. In the case of visible warts, once they have been successfully treated, the risk for transmission to others is thought to be substantially lower. Personally, I would not worry about unprotected oral or genital sex going forward for the reasons mentioned above.

2. There is no harm in receiving the HPV vaccine. Current versions of the vaccine offer protection to the nine most common HPV types and would be protective for any viruses that you do not have (no way realistically to know which ones you might or might not have, other than 6 or 11 which are almost certainly the causes of your visible wars). Because of your age, you would likely have to pay for the vaccine. Prices may vary so I would shop around if you choose to get vaccinated. I would expect the vaccine to cost you about $500 for the entire series.

3. Other than following for resolution of visible warts, there are not good ways to follow or check for infection.

Hope these additional answers are helpful. Please let me know if they are not. EWH

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45 months ago

Thank you so much for your time and expertise.

These are the last questions:

- I found some warts at the entrance to the vagina about 8 days after the initial few. I have now had those treated, too, and they are healing.

o Does this in any way change your original response, ie. because I had the outbreak in two different places am I any more likely to pass it on? Or because of the specific location – is this a higher risk spot for transmission?

o Is this relatively normal, that all the infected tissue had not shown itself at the beginning of the infection? Does this mean that I have a particularly “bad”/severe case, or does it affect the probability that they will return, ie. are they more likely to recur because I found more this time (or is this part of the same outbreak)?

o I want to confirm: when I have healed and my gynecologist says it is physically okay for me to have sex again, you said that I should have lowered the risk of transmission, and that you don’t recommend the necessity of disclosure or undue concern about passing them on. Is this correct? Or, do I need to wait some months after they have healed before the risk of transmission is lowered to low-risk levels, and before I should have sex/oral sex without informing a partner of any risk to them?

Thanks again. I hope I am not being too repetitive or wasting your time, I just want to make sure I have everything straight before this thread closes :)

Edward W. Hook M.D.

45 months ago

That you had warts in two different locations, IF both set of lesion were warts in no way changes my assessment or advice. Warts can certainly occur in more than one place on the genitalia. The reason I said IF each group were warts was because there are many other "bumps", skin tags, and other irregularities of genital skin which can be mistaken for warts. Sometimes when persons do receive a diagnosis of GWs they begin an exhaustive hunt for additional or new lesions and we have seen numerous patients who have embarked on such hunts who wind up treating normal skin irregularities. Since treatment is essentially a destructive local process with few local side effects other than discomfort, physicians do not hesitate to tend towards overtreatment of lesions which might be warts. For them it is the path of lest resistance. I did not examine you and in no way mean to criticize you or your doctor, just a cautionary comment.

Having warts on more than one place does not mean that your case is unusual or especially "severe/bad". Similarly, it does not impact the likelihood that they will recur.

Your summary of my earlier comments is correct. I see no need for disclosure and have explained the rationale for this. Similarly, there is no reason for you to abstain from unprotected sexual contact because you have, or have had warts.

I wish you the best. As you know, or Forum permits up to three responses to client questions. As this is my third response, the thread will now be closed later today. Take care. EWH

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