[Question #4034] Anal / Perennial warts recurrence/Infection worries

30 months ago

 Respected Dr’s EWH/HHH ,Am male 46 years from North India.Had Perineal/Anal warts during Nov-Dec 2017.Dermatologist planned Cyro. The warts developed 20th Nov 2017 and completely resolved by itself naturally by 30 Dec 2017.I used to visit massage parlours often earlier. Am not gay or a sexually active person. I have not had any anal intercourse anytime. The max. exposure should be hand job , the massager in nude. Testing for VDRL,came as Negative. Questions - 

1)It more than seven months since the Warts completely cleared in natural way and no re-occurrence happened till date. What will be the virus presence level & the chances of re-occurrence in future? 

2) I am in a non-sexual relationship with a partner since last six months and we plan to marry.  I am worried HPV be an obstacle and postponing the joint living. If we marry by October 2018 , Considering she HPV free, will it be fine if I have intercourse without fear of infecting her, ? I am very particular not to infect her any case

3)My dermatologist says that the Warts are prone to recur and also, minimal infection is possible to partner, even no warts, any time. This comment is very bothering and gives me restless mind. Pls adv on this. 

4)I have itching problem in anal perineal region since 2012, My Derm. tells Pruritus Ani gives ointments for relieving  . Otherwise, Will the anal itching be related to HPV?

5)Am in  abstinence past 7 months no sex exposure.Fearing,took HIV test also last month, came Negative. All Ok?

Thanks Dr

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Welcome to the forum. Thanks for your question.

My first thought is to wonder whether you truly had anal warts, which would be very unlikely to clear up on their own within 6 weeks (Nov 20 to Dec 30). If they were treated, it's possible they would clear that fast, but you don't mention treatment. Were your warts professionally diagnosed?

The rest of this reply assumes the diagnosis is correct, i.e. you did have anal warts. The first thing for you to know is that anal warts are not limited to people with anal sexual exposures. They are certainly less common in heterosexual men and others without anal exposure, but not rare. The exact mechanism of inoculation or transfer of HPV to the anal area is uncertain, but it probably involves both auto-inoculation (i.e. self transfer) of genital infection, by one's own fingers, during toilet, etc; and natural spread of HPV along the skin from the genital area.

To your questions:

1) The virus probably is usually gone 6 months after warts clear up, whether spontaneously or following treatment.

2,3) Your dermatologist is exactly right. Probably you no longer have an active HPV infection, and it's especially unlikely you have an active genital infection. However, I cannot guarantee it. There could be some risk for your partner. But also remember that if your partner has had previous sex partners (even if only one partner in a monogamous relationship), there is a good chance she already has had HPV and could still be carrying it. So if she should ever have an HPV problem (e.g. abnormal pap smear, genital warts), it would not necessarily be from you. 

4) Warts and other HPV infections do not itch and have nothing to do with pruritus ani.

5) All standard HIV tests are highly reliable if done long enough after the last possible exposure, i.e 6-8 weeks. So your negative test result is conclusive, even if your past exposures were high risk for HIV.

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

30 months ago

Respected Dr Hunter, Thanks for the replies.

 5a)  To clarify your doubt –  Small bumpy growths started not before than Nov 10th 2017. By Dec 6th 2017, It grown up to peak size, like a finger-nail length, mainly in perineal line and start of Anus.  I saw the first dermatologist who inspected the growths and told that its viral verrucas and need to be removed by cryotherapy. He referred to another Dermatologist who does this treatment. This Doctor said its HPV warts and planned that the treatment need to be in phased manner and to start the cryotherapy from December 10th 2017. But I went on December 15th to him, he and myself saw the warts reduced in size. He told to wait and come after a week. By December 25th 2017, the warts become one third of original size, and he told have a review by first week Jan 18. I went on 3 January 2018 and by now the warts disappeared and flat skin. The dermatologist said that no warts now exists and no treatment required and told to come only when any warts come in future. The warts cleared naturally without any treatment, within an end to end span of roughly 7 weeks, if not accurate 6 weeks.

  Just I require little clarification for your answers 2,3 –

6) I have read numerous posts of you and Dr EWH spanning a decade for HPV related answers. I can see commonly replies for queries that the HPV infections gets clears in 6 months’ time (for warts type 6/11) and little more time for other cancer HPV types. And also said that, may not be infectious after six months and can be considered cured and resolved, even though the HPV DNA will be still present in dormant state in cells without scope of replication. Some post replies I saw that some experts believe 3 months, some six months clearance time, after which non-infectious, and also some experts believe - no warts stage – no infection. This being the case, you have mentioned that my partner may have some risk of infection even after several months or at any stage later.

Being in this context, the above statement still holds good? Otherwise, it’s doubtful that mine is not a ‘Resolved’ case with your answer, but  can you please tell me what percentage or level like minimal, very minimal, or miniscule, that chances of my infection to her, if it is new infection from me?

7)Also, I have read that, the recurrence of warts differs person to person, and most likely to happen for HIV-P or chemotherapy patients. I have no smoking habit and live a healthy life style; can you please comment of my chances if reoccurrence.?

 8) With the dormant HPV presence, will affect the quality of life in any manner, like health issues? I am restless just because the constant fear of re occurrence and infecting a future partner.

2)    9)I am not sure of the other HPV cancer types whether I would have had infected other than type 6 and 11 as said that more than one types may be entering per episode. .  If so, such types will still available in the genital region? or all the types will be cleared over the time. ? ( Apart from 6 and 11 types)

3)    10)I had only peri-anal warts and not a single Penile wart. If in future  intercourse, will this be a factor of ‘less fearsome’ kind of , like the Vagina not contacting a directly past HPV infected penis , but somewhere else behind ?


Thanks for your valuable time Dr.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
6) You have seen all those previous comments. They are correct. I have nothing to add. If you are looking for more certainty, I am sorry that it just is not available.

7) The effects of smoking or healthy lifestyle are small. These factors do not help judge how long HPV clearance may require in any particular person.

8) No, this problem is unlikely to have any effect on your quality of life -- except to the extent that it's obviously causing substantial anxiety. If these replies don't resolve your anxiety, professional counseling might be helpful. I suggest it from compassion, not criticism.

9) Multiple simultaneous HPV infections are common, and people with warts often have other HPV types as well, including those that increase the risk of cancer. However, even with the high risk (cancer causing) HPV types, the large majority of infections do NOT lead to cancer -- under one chance in hundreds, maybe lower risk than 1 in a thousand. Your dermatologist may recommend periodic reexamination of your anus and rectum for early detection should cancer develop. But the odds are strongly in your favor and cancer is extremely unlikely.

10) I already said in my first reply that you probably do not have an active genital HPV infection at this time, but there is no way to be certain. Even if you do, it is unlikely that either you or your wife will ever have any problem from it. Every woman should have regular pap smears, to detect HPV before it causes serious disease. Your wife should do so, but with no more importance or urgency than in any other women. She should speak about it with her personal physician.
30 months ago
Respected Dr Hunter , 

I am clear with your replies , will take forward my life accordingly and no more specific questions to be added. Thanks for your valuable service and time.  Best Wishes to you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Thanks for the thanks. I'm glad to have helped. Best wishes, stay safe -- and really, don't let your HPV fears get the best of you. This is a minor inconvenience in your life, not an important health threat for either you or your future wife.