[Question #3733] Genital Warts

33 months ago
Good Afternoon,  I am late 50's male.  At my annual Urology exam last August an approximately 1/4" wart was  on the shaft.  I noticed the bump several months prior to the visit and ask him about it.   This was acquired about 5 years ago without any penetration, only genital contact.   It was treated with podofilox over a 3 week period and was gone.  The Urologist said it would likely never come back.  During my visit to dermatologist this week, I ask him to examine me for any sign of return of warts.  He said there was no sign, other than slight scaring.    It has been nearly nine months since original treatment.

Is  it possible to only have one outbreak of warts and that I may have cleared this from my system or am I likely to have another in the future?  The dermatologist was non committal on this.   I know Dr Hansfield says six months without return is positive.  Has his opinion on this changed?

Do people actually resolve the warts and never have another occurrence? 

When is it safe to have relations with new partners without discussing? 

This has caused an enormous amount of angst and stress in my life.  I am obsessed about it returning to the point of sleep and eating issues and the fear of never having a relationship again.

Thank you.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Welcome to the forum. Thanks for your question. You're a good man and seemingly a kind soul:  I like the evidence of your concern for the health of your future sex partner(s). But the risk is not as high nor the consequences as potentially dire as you might be thinking.

There's not a lot of research or other formal knowledge about your situation. Some HPV infections, including those that cause genital warts, can persist for years (maybe for life) and then flare up to cause overt disease. That's what happened here. Rather than being acquired about 5 years ago, especially from a non-penetrating sexual event, that episode, like the current one, probably was a recurrence of a long distant earlier infection. The majority of HPV infections are acquired before age 26, whether or not they cause symptoms at that time. That said, we'll never know:  I can't say the infection was not acquired 5 years ago, only that it is statistically unlikely.

In any case, the recent wart almost certainly is a recurrent event, i.e. reactivation of a past infection, not a newly acquired one. The unknown part, and the main point of your question (I think) is whether it is now gone for good, i.e. what is the potential for continued persistence or future recurrence, either for a visible wart or for transmission to a partner. This is where we really lack sophisticated knowledge. The expert consensus is that the large majority of treated warts that do not recur within several months are gone for good. But there are really no studies on this in men your age. And in your case, we have to consider the likelihood that your recent wart was itself a recurrence. We have no data to show that having one recurrence implies greater likelihood of still more such events, but we cannot say it might not happen.

That said, I'm less concerned about your infectiousness for a current or future partner than I am about wart recurrence per se. First, assuming you're relationships are mostly age matched -- at least that you're not likely to be dating women in the teens and early twenties -- new infections are uncommon beyond age 26, largely because so many more mature women have already been exposed to and infected with the most common HPV types. In any case, given no recurrence of your wart in the past 8-9 months, it  is likely the underlying HPV infection is gone, regardless of the comments above. I can't prove it, but if somehow I were in your situation, I would assume it. Persons with past treated, cured warts have no obligation, in most experts' opinion, to discuss those past events with prospective partners. (Some couples in new relationships discuss past partnerships and STDs, but that's as much a relationship issue as it is with disease prevention.)

Finally, remember virtually all sexually active people acquire HPV, usually more than once. So assuming your future partner(s) are unlikely to have been celibate, their increasedHPV risk on account of sex with you will be trivial, probably nil.

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

33 months ago

A point of clarification.  This was not a recurrence of a wart, at least one that I was aware of.   The only one was  treated in August.  The only opportunity for infection was the incident  5 years ago.  I assumed I got it 5 years ago, but only surfaced in late 2016 or early 2017 when I noticed the bump and didn't know what it was.  Partner of 20+ years was and is free of HPV. 

That said, does your opinion change any?

My urologist check up is the end of this month, so will be checked again then.  I will reserve my final follow up for after that appointment.

For peace of mind, your feeling is that I am not likely contagious now and safe to have sexual relations?

Thank you for your response,  it was a tremendous help.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Thanks for the clarification. First, your story made me think you had a diagnosed genital wart 5 years earlier, not only a sexual exposure back then. Second, I also assumed that event, when you were in your early to mid 50s, was not your only lifetime sexual exposure -- i.e. that, like most men, you had other partners (perhaps several of them?) when you were young, e.g. in your teens to early thirties. If you did not, and also have had no sex with anyone from 5 years ago until now, that's when you acquired your recently diagnosed wart and HPV. But if you did have a more typical sexual lifestyle with past exposures, I would still suspect that's most likely when you were infected.

Or perhaps your ongoing (20+ year) partner is infected. That she is not known to have HPV, or that she has had (for example) consistently negative pap smears, does not prove she doesn't have HPV. 90% or more of all sexually active people get genital HPV, often more than once, and lifelong (or 20+ years) of monogamy does not exclude the possibility.

Seeing the urologist again is smart and his reevaluation will be important. However, there's nothing magic about diagnosing warts:  you just look at them and recognize what they are. If the previously treated spot doesn't look to you like a wart is persisting or has recurred, then most likely it is gone.

And yes indeed, your "peace of mind" statement is correct:  that's exactly what I meant you to understand. And if your 20-year partner are still together, or have sex again in the future, you certainly needn't worry about infecting her. Assuming regular sex over the years, you can be sure she has already been multiply exposed and likely infected with the HPV that caused your wart (and could have been the source of it). If so, she is immune to a new infection and won't get it again.

My final comment is to remind you of the uncertainties here. HPV has many mysteries, and atypical cases abound. What I have said is a reasonable interpretation of the available science.

Thanks for the thanks. I'm glad to have helped. Let me know if anything still seems uncertain.