[Question #3161] Recurrent HPV/Penile Wart Infection of 3 and a half years

39 months ago
Hello,I would like to ask a few questions about my HPV/Penile wart infection that has mentally ravaged me over the last few years. Originally I had noticed 6 brown spots on base of penis and on my pubic hair region around July 2014 originally and didn't think much of it - I merely thought they were normal skin moles.

A year later (2015) going to the Urologist in my home country (Bahrain) for a totally different health matter he had noticed them and pointed them out to me - he had removed them surgically with a machine, however, he went on to give me total misinformation that unfortunately laid the foundations of a lot of mental rumination and obsession for a long long time to come, even up until now.

He told me that this was a Western world virus and not very common here in the Middle East (I live in the UK), he said that it wasnt dangerous for men but it could potentially cause cervical cancer in women (first wrong piece of information as wart HPV is not related to cervical cancer?). Anywho, I didn't fear much after he removed them, but two small ones returned two months later, and once they were removed I've had recurrences in the same pubic hair region quite a few times up until this day with my last one being removed December 2017.

This recurrence has seriously mentally damaged me for the following reasons..I already have an Anxiety disorder and would hate infecting anyone with warts, despite how common it is. I have read of stories where genital warts have been transmitted to mouth, throat and hands, I dont like the idea of doing that to someone else.This is really starting to get depressing, I have had a partner who I am not with anymore from 2016 to late 2017 - she did not care, after I informed her. I personally could not see any warts on her after a year and a half of unprotected sex. Although she never went to get a pap smear, she was not that bothered about it.

I am anxious & in a moral dilemma of informing casual and potential future sexual partners
39 months ago
It was always only one or two small ones recurring and usually on the pubic hair region rather than the base of the penis as it were originally.

All I can think of now is should I tell future casual and romantic (girlfriends) sexual partners about it? The barrage of mental images of me infecting them warts to their genitals, hands, mouth and throat is just too much.
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Welcome to our Forum. I will be glad to comment on your concerns.  I would also like to applaud your concern about the (tiny) possibility that you could spread an HPV infection to another person and do harm to them in this way.  I would encourage you to look through other past responses that Dr. Handsfield and I have made to other clients about HPV-related concerns.  In doing so, I think you will find a consistent theme: that for practical purposes, most sexually active persons should assume that they have or have had genital HPV infections whether they have had warts or not; that we recommend that HPV vaccine for persons under the age of 26 as a highly effective preventative measure for preventing both infection and the rare consequences of HPV infection; that past HPV or present HPV infections need not be disclosed to sexual partners because of the common and widely held mis-conceptions about the infection and its significance and the stigma that is associated with this STI;  and that HPV infections (warts) are frequently mis-identified.  With this more general background, let me now make a few additional comments which relate specifically to your questions:

Your earlier doctor was correct that HPV and cervical cancer in women are somewhat less common in the Middle East than Western Europe and North America but they are by no means rare and the prevalence of infection there appears to be increasing.

Unless some of your earlier "warts" were sent for pathology, I am not completely confident that you have had warts.  The location you describe is relatively uncommon, that they have "recurred" in different locations is not suggestive of a single, recurring infection, and dark coloration is not typical of HPV.  I cannot help but wonder whether you have been being treated for skin tags which are common, over hyper-pigments skin lesions which occur commonly in skin creases and the areas you describe.  Has the diagnosis of warts been validated by other health care professionals? 

We do advocate for a discussion of sexual health and possible past STIs and past STI testing as a good part of any new sexual relationship.  In some instances, inclusion of discussion regarding HPV is appropriate (situation and partner- specific).  OTOH, we do not encourage or recommend specific discussion or disclosure about past HPV infections as new relationships start

I hope these comments are helpful.  Please feel free to use your up to two follow-up questions if any part of what I have said is unclear or raises other questions.  Also, as I suggested earlier, I would encourage you to look at our responses to past clients regarding their questions about HPV.  EWH
---
39 months ago
Thank you kindly for your response, Doctor. I shall certainly read through some previous responses from you and Dr Handsfield

Before I ask further questions, let me just respond to some of what you said.

"that past HPV or present HPV infections need not be disclosed to sexual partners because of the common and widely held mis-conceptions about the infection and its significance and the stigma that is associated with this STI;  and that HPV infections (warts) are frequently mis-identified."

- Are you saying that I am OK not to disclose the possibility of a current HPV/Wart infection that I have to other sexual partners from here onwards? I understand the choice is mine, but this has just been something that morally and ethically bothered me. I am someone who is reassured by knowing cold hard facts and statistics - are there any statistics you can refer me to with regards to HPV/Wart infections? If these are in the other responses then I shall have a look.

"Unless some of your earlier "warts" were sent for pathology, I am not completely confident that you have had warts.  The location you describe is relatively uncommon, that they have "recurred" in different locations is not suggestive of a single, recurring infection, and dark coloration is not typical of HPV.  I cannot help but wonder whether you have been being treated for skin tags which are common, over hyper-pigments skin lesions which occur commonly in skin creases and the areas you describe.  Has the diagnosis of warts been validated by other health care professionals? "

Unfortunately when I've had recurrences I have seen another Urologist in Bahrain and then another Dermatologist in the UK, both of whom confirmed the recurrence in the pubic region (ie - not on penis) to have been a wart, one of them used a magnifying glass, the other (Dermatologist) was able to differentiate between one which was a wart as he said, and the other one being a mole. Both these doctors had remove the one wart recurrence in this pubic region. One choosing to Freeze it and another chose to scratch it off with a match stick.

I have not actually had a sample sent for pathology, ever. Not since initial diagnosis (6 brown colored ones, some on base of penis) nor for the supposed recurrences. I can say since the initial ones have been removed these recurrences have never actually been on the penis like I said, only the pubic hair region of the skin (pelvic where hair above penis grows).

Can you clarify what are the chances of after three and a half years of me first noticing and then having these removed time and time again, in terms of percentages, what are the chances of me infecting someone elses genitals, hands, throat or mouth with HPV and warts.

I am confused because I had thought genital warts are strictly for the genital region? I have come across conflicting information that says there is a little to non-existant chance of infecting someone else in other parts of the body (hands/throat/mouth) also.







39 months ago
Just in case my last response wasn't clear - I have not had any of them sent to pathology. Not the initial diagnosis nor the supposed recurrences that were confirmed to be a wart by other doctors. Like I said though, what were originally 5 or 6 that were removed two and a half years ago. These supposed recurrences have always only been one or two and always in the pubic hair region of my skin.
39 months ago
I have just looked up what a skin tag is - the intial warts and recurrences have been of the same color as brown skin tags going by Google images

They were very similar to these at the base of my penis - http://gurumagazine.org/wp-content/uploads/2013/07/skin-tags-300x172.png

I am pretty sure I have had a skin tag under my left armpit before, supposedly my aunt and grandfather have also.

The recurrences have also been brown but VERY small and at pubic area where the hair above my penis grows.  Unfortunately its impossible to know but going by the fact a few doctors have said warts, then that's what im going by. Although nothing has ever been sent to pathology.

Thanks for reading all my responses so far, I look forward to your response.
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
I am not in a position to contradict the diagnoses made by several or your health care providers and suppose we must accept that at least some of the lesions you have had were warts but I also think from the sound of things that a number of them have also been skin tags or common, non-HPV related moles.  I would add as an FYI, that a wart should not be able to be scraped off with a match stick and that surgery and freezing therapies are equally effective for skin tags and warts.

I also endorse your interpretation of my (our) comments that there is little to be gained from disclosure to future sex partners, particularly in view of the lack of clarity as to which were warts and which were not.  I appreciate that such decisions have moral and ethical dimensions and would also state that that such decisions must be made in the context of the situation (for instance, if future sex partners have had other sex partners before you, then statistically they are quite likely to already have HPV and this reduces that need for disclosure) and weighing the numerous pros and cons of disclosure.

I cannot provide you with precise estimates of HPV recurrence rates.  Studies of genital wart treatments indicate that no matter how they are treated, 25-35% of warts will recur, typically within 3-6 months and at about the same location as they were originally.  There are no good data for HPV recurrent in the mouth or throat.

There are well over 100 different types of HPV- some typically cause visible warts, others do not.  This that occur in the ano-genital region can be transmitted (inefficiently) during oral sex but they do not typically infect that hands, feet or other body locations  those sites are infected by different HPV types which, in turn, do not infect the ano-genital region. 

I hope these responses are of further assistance.  EWH
---
39 months ago
Thanks Doctor.

Seeing as I am extremly likely to only have sexual contact and romantic relationships from this point in my life onwards with women who have had sexual contact before me, then I will not disclose anything.

The fact that it is merely nothing more than a cosmetic nuisance at worst for the other person which can go away on its own, or can be removed via therapy (as im aware) if it doesnt go away on its own, then I will not disclose anything to all future sexual partners both casual and perhaps even romantic. I am unsure if there is a low risk of cervical cancer from wart related HPV or not, was something I have only read once.

My issue was never me having this the warts or HPV because I know it poses next to no threat for men; it was the moral dilemma of telling or not telling other sexual partners and not wanting to infect them with it. However, if a medical professional advises me not to tell, then I am happy not to, you know more than me on this topic and you are in a better position than me to make that judgement.

I am testing negative of any other STD's.
39 months ago
After three and a half years of and maybe 5 removals or so, all of which were 1-2 very small ones since the initial removal back in 2014. I am considering not bothering to check and remove anymore from this point, hopefully it will just go away on its own if I stop stressing about it as much as I do.  If it is that common and only cosmetic.

Unless you advise of still checking every now and then and removing if any pop up again? Like I say Doctor, they have only ever been 1-2 very small ones recurrent each time since the original removal of 6-7 back in 2014 (some on base of penis, bigger than what has recurred, and rest on pubic hair skin region).


Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
I support your decision to not proactively disclose your history of genital,warts to future sex partners.  I also support your decision to work to stop aggressively examining yourself and, should you note additional lesions to not seek removal.

I think you have made the right decisions and congratulate you.  As I suspect you know, we provide up to three replies per question.  Hence this thread will be closed in a few hours.  Take care.  EWH
---