[Question #474] HPV Infection

91 months ago
Hello Doctor,
Thank you for taking the time to answer my questions. This website has been very helpful and it is a great asset for the many people dealing with infections.
To get to my questions; I have been dealing with and treating and HPV Genital Wart infection since June of last year. I started treating the initial breakout with Aldara, but that did not provide complete clearance. It worked on the larger warts, but not very small ones. In september I began using freezing treatments which has been successful in removing any growths. I have, however, had several small breakouts in the time since I began freezing. Many breakouts, if not all, have been new locations and not the same ones that had been treated. I am wondering if in time I can expect recurrences and new breakouts to cease? It has been discouraging to keep treating this infections for such a long period of time, especially when I hear of people dealing with one or two outbreaks and never seeing this again. I know this is not a serious condition, but I have developed serious anxiety and depression from this but I am in therapy and on antidepressants so I can feel normal again.
On that note, normal for me was being a very active endurance athlete. I have been quite nervous about training and working out in worry of causing more breakouts and impairing my immune system, so my level of activity has been quite lower than I was accustomed too. Is this a valid concern?
I believe I have a healthy immune system, I sleep well, eat well, take a multi vitamin, and try to workout often. I just fear that I am struggling to clear this virus, and I do not know what "normal" is.
Also, have I spread warts myself? I worry about getting a breakout and it spreading further on my skin unless I treat it immediately.
Thank you kindly!
H. Hunter Handsfield, MD
91 months ago
Welcome to the forum. Thanks for your question.

My first advice to everyone with genital warts is to not freak out (not that you have done so, apparently) and to know that at least 90% of sexually active persons acquire HPV at least once, and probably 20-25% of Americans are diagnosed with genital warts somewhere along the line. So you're not exactly alone!

Some of the things you describe about your warts and their treatment are questionable. The notion that larger warts respond better to treatment than small ones; usually it would be the opposite. I have to wonder whether the "very small ones" you have observed aren't warts at all. This can be tricky for medically untrained persons, because inflammation from treatment, including both imiquimod (Aldara®) and freezing, may make normal skin texture or sweat glands stand out and appear wart like. Presumably the freezing treatments (liquid nitrogen or cryoprobe?) are being done by a health professional. What does s/he say about all this? Is s/he convinced the "several small breakouts" recently are indeed new warts?

If my last assumption is wrong and you are not in ongoing care, for sure see someone, preferably a dermatologist, to confirm the diagnosis and consider still other treatments, such as laser cautery or electrocautery. Also, simultaneous combination treatment -- e.g. with both freezing and imiquimod, or freezing plus podofilox (Condylox®) -- often is remarkably effective when a single treatment isn't working well. The point is that treatment resistant warts always should be managed by a an expert, which usually means a dermatologist.

Autoinoculation (self spread to a new part of the body) can occur with genital warts, but it's not the norm and doesn't mean you need to react immediately if and when new warts appear. Just use common sense hygiene, e.g. avoid scratching yourself somewhere (especially the anus, for example) after handling your warts.

There is no reason to worry or assume that your immune system isn't reacting or that warts will keep returning indefinitely. This problem will end, probably soon. I wish I could reinforce your assumption that being generally healthy will boost your immune system and help clear your HPV infection more rapidly. Unfortunately, there are no data to support it. Healthy lifestyle, common sense diet, and adequate rest of course are good things and can't hurt anything. (And there is evidence that smoking may delay resolution of HPV, but from what you say, I doubt you use tobacco.) Just don't blame yourself for somehow not doing something more to move this along.

I hope this has helped. Feel free to fill in any more potentially relevant information or let me know if anything isn't clear. Best wishes--  HHH, MD

91 months ago
Thank you kindly for getting back to me so quickly.
I had been seeing a PA at my University and often he was unsure if something was in fact a wart, other times he was fairly sure. They have been quite small in size and I admittedly have been quite obsessive about checking. As a result, he would just freeze anything I was concerned about. He was very sympathetic to my obsessiveness and emotions, and worked with me on finding an antidepressant to help with my anxiety and obsessiveness. The freezing has been very effective on warts/lesions and I do not believe anything has ever recurred in the same spot. My reaction to Aldara was difficult and I had really bad ulceration, so freezing has felt ideal.
I did leave my University to move home and I will be seeing a dermatologist in a few weeks. 
In addition, is there any reason to think exercise would hurt anything? And do you think caffeine (2 or so cups of coffee a day) would hurt anything as well?
Thank you for your time, it is easier in this setting to formulate questions I have wondered for a long time!
91 months ago
I apologize, but one last addition. Does masturbating or sex spread the infection on myself?
H. Hunter Handsfield, MD
91 months ago
In a respected academic health center, it is fair to assume a PA is highly qualified to provide this sort of care. However, it doesn't change my advice about seeing a dermatologist, so I am glad you are planning that. I would advise you not have any further wart treatments at all until you have done so, even if new warts seem to appear. The dermatologist will be able to better evaluate you if recent treatment hasn't altered your warts or nearby skin.

I doubt there are data on the effect of exercise or caffeine on clearance of warts or HPV, but I see no reason to suspect they would be either harmful or helpful.

Probably neither masturbation nor other sexual activity are important means of auto-inoculation, but I can't say it doesn't happen. OTOH, several months after acquisition, you probably have a pretty strong immune response to your HPV that might limit both local spread and distant auto-inoculation.

Thanks for the thanks about our service. Take care.

91 months ago
Thank you Dr. Handsfield. Not sure if one more reply is allowed, but I figure I will fire away one last time. Do you think my stress/anxiety about this could prolong things, or will this just resolve regardless of what is going on in my mind? Again, thank you for your help. If you cannot answer this, no problem. It has been nice to get all of my questions off my chest. Hopefully soon I can put my anxiety and this virus to rest for good!
Kind Regards,
H. Hunter Handsfield, MD
91 months ago
Although stress and anxiety are often touted as having negative effects on the immune system and recovery from various health prolbems, in fact the data are weak at best. I doubt your stress is having any effect on how well your warts respond to treatment or how soon they will stop recurring. The biggest effect, it seems to me, is that your anxieties may be affecting your judgment about what's actually going on. As sort of implied in my initial response, I'm not positive you actually have continuing warts, especially since it seems the PA was also unsure. It's also one of the reasons I think you should hold off on further treatment until you see the dermatologist, no matter how certain you may be that warts are continuing to appear.

My final word is that warts are a trivial health issue. Try to not let such a thing loom so large in your life's worries. It really shouldn't be such a big deal.

And that completes the two follow-up comments and replies included with each new question, and so ends this thread. Thanks for the thanks; I hope these final comments also are helpful. Best wishes.