[Question #397] HPV Clearance

104 months ago

My Background:

- 36 Year Old Male

- Found first Genital Wart 8 months ago (I had that and two others removed within a month of discovery)

- I’ve had one other wart removed two months ago

- I think I contracted HPV years ago because at the time the first wart appeared I was in a multi-year relationship with a woman who had been vaccinated with Gardasil.

I was diagnosed with genital warts by a dermatologist. After the diagnosis I followed up with a different dermatologist. When I asked both of them about “clearance”, neither one had any notion of HPV clearing and said I would get warts for life. This seems to be counter to everything I have read about HPV clearing, for example from Dr. Handsfield’s podcast on this website. From my understanding it clears in most cases after two years, roughly 90%.

My question: I was wondering under what circumstances doesn’t HPV clear and why wouldn’t a dermatologist know such generic clearance information that seems readily available?

The first dermatologist, who I won’t be seeing again, went so far as to say that most cases of anal warts are from people spreading genital warts to them selves when going to the bathroom, by wiping. I found that devastating at the time but after some research I couldn’t find any mention of something like that anywhere.

Thank You

H. Hunter Handsfield, MD

104 months ago

Welcome to the forum. Thanks for your question.

The dilemma here is what is meant by "clearance". Biologically, many (most? all?) HPV infections may persist for life in that viral DNA is never cleared from cells in the infected area. However, it is also true that the immune system eradicates the actual virus and clears warts, most abnormal pap smears, and other evidence of disease, and usually the problem never recurs. In addition, the virus cannot be transmitted to others. Persisting DNA sometimes reactivates to produce overt infection with recurrent warts, abnormal pap smear, etc -- but the vast majority of people with these problems never have a recurrence and never transmit to their partners. What might trigger late recurrence? It can happen with immune system suppression, e.g. AIDS, chemotherapy, during pregnancy, and other immune deficiency states. But usually it appear random, with no obvious reason.

I can only speculate about your dermatologists' advice, but it may help to understand their likely perspectives. Among those uncommon individuals who develop late recurrences of warts, genital cancers, etc, where are they likely to go for treatment? No surprise, they often to dermatologists. Therefore, many dermatology practices practices have many such patients -- so their perspective may tend to emphasize the potential for recurrence. But it really is the exception, not the rule. The point is that equally knowledgeable health professionals or education resourcs may use "clearance" to mean no visibile evidence of disease and unlikely future recurrence, but others might emphasize biological persistence of DNA.

Some anal warts undoubtedly are acquired exactly as your first dermatologist said. They also can be directly acquired sexually. But anal warts are not a rare problem in strictly heterosexual men, women, and others whose anal areas have not been sexually exposed. The exact mechanism isn't known -- there hasn't been any research on it. But wiping practices, anal touching after genital contact, and direct spread from genital area infections (especially in women) all are plausible.

Finally as to your infection, I wouldn't necessarily attribute it to an HPV infection acquired years earlier. The large majority of genital warts show up 2-9 months after exposure, sometimes up to a year. That your partner was vaccinated may slightly increase the chance you were experiencing a late recurrence, but also remember that 10-15% of warts are caused by HPV types not prevented by Gardasil.

I hope this information helps. Let me know if anything isn't clear. Best wishes and happy new year--

HHH, MD

---

104 months ago

Thank you so much for your prompt reply.

Your explanation regarding my past dermatologist definitely makes sense. I’m pretty relieved that he wasn’t completely wrong, even though the truth isn’t the best. So it sounds like HPV is commonly self-transmitted to other parts of the body. Is there anything you recommend to avoid that? For example, I would assume that washing body parts in the wrong order might spread it to the anus or even mouth if not careful.

This brings up another point. What about hand-to-genital contact with another person? Is that fairly common? For example, what if I was touching my genitals and then touched a woman’s genitals with the same hand (assuming I considered my HPV infection “active”). Or is it possible to have gotten genital warts from warts on hands (mine or my partner’s)?

To clarify, it sounds like recurrence happens rarely but randomly barring serious immune suppression and doesn’t have to do with strain type or other factor. Does something like the common cold, flu, or use of antibiotics suppress the immune system enough to cause recurrence (or flare up an active infection for that matter)?

Also, as you stated, I guess my ex-girlfriend could have been the one who has given this to me. That sounds like a rabbit hole I don’t want to go down. For my own peace of mind I’ll let the “where/when did I get it question” rest. It sounds like it doesn’t matter in the long run anyway.

Thanks Again!

H. Hunter Handsfield, MD

104 months ago

Hand genital contact carries little or no risk for HPV. It may explain rare cases of genital HPV in people who haven't had intercourse -- but that's very rare and not something to worry about.

The illnesses you mention probably don't have much influence on HPV recurrence, but it's impossible to know for sure. If they have any effect, it probably is quite small. (And by the way, antibiotics have no effect on the immune system.)

Finally, I agree exactly with "it doesnt' matter in the long run". Ruminating on when and where someone caught HPV is no more useful than trying to figure out who infected you with a cold. You rarely can know, and who cares?

Thanks for the thanks. Take care.

---

104 months ago

Thanks again, Dr. Handsfield. Final questions on HPV clearance: How long after the last visible genital wart has been removed can I assume the virus has been cleared? And, if I am in a monogamous sexual relationship with a new partner, at what point would it be safe to have unprotected oral and vaginal intercourse with that partner (the same amount of time it takes until the virus is considered clear or a shorter time depending on when last visible wart was removed)?

H. Hunter Handsfield, MD

104 months ago

Unfortunately, there are no firm data on how long infectivity continues after resolution of warts. Probably there is a significant decline in transmission potential almost immediately, to the extent that viral load probably is highest in overt warts and lower in surrounding tissues. In my clinical practice, I generally told patients that they were unlikely to infect partners if there were no recurrent warts after 6 months, but this is only an educated guess.

If and when you may enter into a new, committed sexual relationship, your partner could be immunized with the HPV vaccine, Gardasil-9. Although full protection requires 3 doses over 6 months, protection is highly protective within a month after the second dose, i.e. 2 months.

That completes the two follow-up comments and replies included with each new question, and so concludes this thread. Thanks again for using the service and for your kind comments about it.

---