[Question #457] HPV
40 months ago
I know pinpointing the date of acquisition of HPV can be tricky, but I am confident I acquired it in October of 2014. I was diagnosed with genital warts in February of 2015. I used the gel the doctor gave me to take care of them. To the best of my knowledge, I do not think I have had any recurrences. My doctor seems to agree. Based on the statistics I have read, at this point there is about a 75% percent chance that the virus has cleared my body (since it has been about 15 months since I got the virus). I have also read that some warts may not be visible to the naked eye. My concern is primarily with these types of small warts. Say I did have some of these small warts. Once the virus clears my system, would these warts just go away on their own? Or do they persist even after the virus clears? If I did have any, what could be done considering they may not be easily detected? I just want to avoid operating as if I have nothing to worry about when in fact I do. The uncertainty of all of this is perhaps the most frustrating part. I am not sure if this helps you address my concerns, but I am a 29 year old male.
H. Hunter Handsfield, MD
40 months ago
Welcome to the forum. Thanks for your question.
Appearance of new genital warts certainly is consistent with an exposure 4 months previously. As for 75% likelihood of complete clearance, there really are no good data. Most people probably are clear of transmissible virus if visible warts have resolved and no new ones have appeared 6-12 months after outwardly successful treatment or spontaneous resolution. At 15 months since acquistion and nearly a year since treatment, I would think 75% is low -- maybe more like 90% likelihood your infection is entirely gone. (Viral DNA may persist longer, maybe indefinitely, in most individuals.)
Invisible warts, also called flat warts, are poorly studied. As implied by "flat", it is likely that most are not simply too small to see, but do not produce built up wart tissue, and it is rare that magification reveals warts missed by the naked eye. Whatever the exact mechanism, your notion probably is correct that treatment of visible warts often (usually?) leaves behind infected but invisible and thus untreated lesions. OTOH, it is generally believed that the viral load is lower in such lesions, and that resolution of visible warts reduces infectivity -- but how completely isn't known. But presumably even such flat, invisible lesions eventually are cleared by the immune system, probably over a period of several months in most cases.
At this point, it is likely that you no longer are infectious with the HPV strain that caused your warts. There is no guarantee, but in my opinion you are not obligated to mention your past warts to future sex partners. To put it another way, HPV (with both wart and non-wart types) is so common among sexually active persons that sex with you is statistically no more risky than any other men your future partners might choose. For those reasons, for practical purposes going forward, I suggest you look at your warts as a past event, now done and resolved.
Please let me know if anything isn't clear -- but also understand that a whole lot about HPV transmission and prevention is unclear! I'll do my best, though.
Best wishes-- HHH, MD