[Question #4181] 27 years HPV free - came out of dormancy??

32 months ago

I got HPV 27-28 years ago. I had an abnormal pap, a colposcopy and finally, cryotherapy. I had external warts but raised/hard in the center more like pimples - what I always thought warts would be like. Had paps every 6 months, maybe one unusual result, but all others normal. Had 2 normal vaginal deliveries, no problems with outbreaks or babies. Married 14 years and only had sex with my husband for 18 years (99.9% sure he has been faithful). 

1-2 months ago I felt 2 bumps on inner labia. In the past, I've felt other bumps before, freaked out, run to GYN only to be told they were nothing or clogged sebaceous glands from sweating, and they eventually went away. So I ignored the bumps. I finally looked at my vagina and the bumps. But thought they 1) maybe looked like skin tags (floppy and pendular in appearance) and 2) did not feel like my warts from 27 years ago. 

I went to a GYN (midwife) the next day - *not* my regular GYN because no immediate appt. New doc declared genital warts upon first sight. Treated with TCA -1 day later they turned white. 3 days later they seem flatter, but I have little hope they will disappear quickly. They are still pretty big bumps.

1) Could this actually be dormant 27 years later? Was I active on and off, passing back and forth with my husband? (He has skin tags on his groin but doctors refuse to remove).

2) I see my regular GYN tomorrow. What’s the normal course of treatment in the US? I’ve looked and cannot find consensus.

3) I saw a Canadian treatment using a cocktail including salicylic acid. Why in the US is OTC salicylic acid not recommended as treatment for genital warts? 

Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Welcome to the Forum.  I'll try to help with this rather complex question.  My first suggestion is to make sure that the lesions you have noticed really are warts - your history makes for these lesions to be warts rather unlikely and what you describe does indeed sound  like skin tags.  Many clinicians are fooled by skin tags and other dermatologic conditions all to often.  Further, that your lesions turned white with TCA does not help to determine what the lesions are.  Many different types of lesions turn white with application of acids.  With that, let's consider your questions

1.  It sounds like your infection 27 years ago was detected at PAP smear and may not have been visible warts.  If so, for your current lesions to be visible warts does not suggest recurrence.  We do know that when persons have HPV infections, they can have multiple strains of HPV simultaneously.  Further we know that as we age, as sometimes as well take mildly immunosuppressive medications, warts or other manifestations of HPV infections can recur after years of latency but, in your case, this seems rather unlikely.  First step is to really find out what these things are.

2.  Visible warts are mostly a cosmetic nuisance.  They do not progress to cancer and do not cause complications.  They can be treated in a variety of ways.  The most common approaches involve destruction of the involved tissue with freezing (liquid nitrogen), with high temperatures (lasers), or with topical applications of a variety of substances including TCA and other acids or a drug called imiquimod which causes inflammation and helps the body eliminate the warts. 

3.  In the U.S. there are a variety of acids used to treat warts including salicylic acid.  Salacytic acid is the substance in the patches and gels used to treat plantar warts on the feet or warts at other locations but the skin of the genitalia is rather sensitive and can be damaged with topicals if not used properly.  I suspect the FDA is just being conservative related to approval of salacytic acid for topical therapy of genital warts.

Again, let me emphasize that before anything else, you need to find out of the lesions you noted are warts.  they may not be.  I hope my more general answers are helpful and information.  EWH
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32 months ago
Dear Dr. Hook
Thank you thank you thank you for the quick reply. You have certainly set my mind at ease.
When I wrote the original post I had not looked at my inner labia again. But since writing it, I have, and the white has most definitively disappeared along with the underlying pendular tissue. I think there may still be raised areas of tissue in the same spots but it all visually appears normal. As in - had I never seen the bumps to begin with, I'd never suspect anything out of the ordinary now.
Of course, I am keeping my GYN appt for tomorrow. I expect she either will see that the tissue still looks abnormal to her expert eyes or she will declare that she sees nothing.
If she does not see anything, I guess it will remain a mystery as to whether the bumps were actually warts unless more appear. To clarify though - 27 years ago, I am sure that I had external genital warts. I remember feeling them/seeing them. 
Truly - having your expert opinion state that after 18 monogamous years of marriage and 27 years of HPV-freedom it's unlikely I had warts and it's more likely they were skin tags has lifted the burden off my shoulders. Thank you and thank ASHA for having this forum!
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Thank you for your follow-up Lori.  It is appreciated.  Feel free to let us know what your GYN says tomorrow,  Take care and thanks again.  EWH
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