[Question #5130] HPV - Recurrence/Self Spreading/Fear/Disclosure of current warts

77 months ago

Dear expert,

Background info:

Male, heterosexual, 25, healthy, good diet and physically active/ First diagnosis 3 years and 3 months ago (2 red/flesh colored round bumps on the low left side of the penis’ shaft)/ Before diagnosis, used razors to shave pubic hair, what caused the warts to spread around the initial area/ After first removal, original warts (not confirmed by lab examination) reappeared within weeks, along with new ones. They all have been treated and didn’t return/ Since then, I started having new lesions in the neighboring areas once a year (1 or 2 tiny bumps), some confirmed warts by lab examination, others found to be polyps/ Life became a nightmare since then. I feel sad, doubtful and “radioactive”. There hasn’t been a single day without the fear of recurrence and the implications it causes (burning tissue, scarring, interrupting my already not so much promising sexual life for 1 month+ etc.)

Thus, my questions will be on recurrence and spread:

1. How does HPV auto-inoculation (i.e. the spreading of current warts to neighboring areas) work? Can it happen during masturbation, grooming (not shaving) pubic hair, general manipulation and others daily situations? Does it take a micro wound on the wart and another on the healthy area?

2. I understand HPV may remain latent and even active in the skin, without symptoms, after treatment (wart removal). In those cases, rubbing, tiny cuts (let’s assume the groomer accidentally slipped), scratching etc. can cause new warts to grow, either where there has been a previous wart or on the areas around?

Thank you very much.

Edward W. Hook M.D.

77 months ago

Welcome to our Forum and thanks for your questions. I'll do my best to help. Before I address your specific questions, allow me to provide you with our perspective on HPV infections and genital warts. Please appreciate that for virtually all sexually active persons (including most persons who are monogamous) HPV infection and warts are a part of being a sexual active person. Over 80% of unvaccinated, sexually active adults will have an HPV infection and most of those will have more than one infection. In over 99% of those persons the infections are self limited and/or merely a nuisance which will not lead to long term problems and should not negatively impact your sexual interactions with others.

In your case, at age 25, if HPV infections are of concern, my advice would be to get the HPV vaccine which is safe and provides a high degree of protection to the 9 most common HPV types, preventing infection and the consequences of those infections. that you have already had a HPV infection does not change the potential benefit of the vaccine for preventing new infections by other HPV types.

as for your specific questions:

1. Auto-inoculation is quite rare in the course of daily life except in instances such as the one you describe where warts are spread because they are scraped and abraded. Shaving activities of the sort you describe are the classic mechanism by which they spread. On the other hand, touching, masturbation, scratching do not lead to spread of warts for most people.

2. similarly, rubbing, scratching, masturbation, etc. does not typically re-activate warts that have been successfully treated and are no longer visible. Although there may be detectable HPV DNA present, if the warts do not recur for 3-4 months after treatment and resolution, they do not.

I hope these comments are helpful. EWH

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77 months ago

Dr. Hook,

Thank you for the quick response. I'd like to let you know how much I appreciate your work here.

Actually, I forgot to mention I've already taken the vaccine (unfortunatelly after the warts showed up).

Well, as to question n.º 2, in order to cover all my doubts, would you have anything to say about the neighboring areas to a former/active wart?

I once read in this forum a Dr. HHH’s answer stating that the genital tissue will be filled, all around, with HPV virus when there is an ongoing wart. In that particular case would I have HPV all over the genital area? What role would that fact play in the growth of new warts? That's my greatest concern! I'd like to "control the bleeding" in order to see if the warts stop showing up in diferent areas.

I also have two other follow-up questions :

a) When with an ongoing wart, do I need to stop receiving oral sex? Can I auto-inoculate my mouth if I kiss her immediately after she’s performed oral sex on me? What are the risks to the girl?

b) As to penetration without a condom, could its natural skin to skin rubbing spread an ongoing wart to other areas of the penis?

Edward W. Hook M.D.

77 months ago

Thanks for the additional information. Congratulations on taking the vaccine. The should help halt future acquisition of additional infections.

The base way to conceptualize your follow-up about sub-surface infection is to consider a visible wart as being like an iceberg in which sub-surface HPV may underlie normal appearing skin. This doesn't extend too far beyond the visible wart and most treatments impact this part of the infection as well. As for other tissues, auto-inoculation is not typically a problem.

Regarding your two additional questions:

Oral HPV infections do occur. They are less frequent than genital infection and rarely take the form of visible warts. Like genital infections, most are innocuous and self limited.

As to your other question, this is a bit redundant. Auto inoculation is not a problem with typical sex, just as for touching, masturbation etc.

Hope this helps. EWH

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77 months ago

Dear Dr. Hook,

Still about the neighboring tissues…

Your comment was very helpful in understanding how sub-surface infection works when it comes down do visible warts.

I may have not been clear enough and I apologize for that, but I was actually asking about neighboring tissues not directly committed to the wart. Let us imagine I have a wart on the penis’ shaft, my concerns would be about the presence of the virus all around other areas of my genitals (tissues other than the wart’s and the sub-surface area committed to it). Would that viral presence all around healthy areas, mentioned by Dr. HHH, play any role in the appearance of new warts, let’s say if scrubbed, cut, scratched etc.? What would make them appear, then?

Would you have any take home advices you think could be reassuring to my fears of recurrence and specially spreading warts to other areas?

In conclusion, do I need to inform my partner (casual or monogamous) about current warts, as to vaginal, oral or anal sex? Should I abstain of unprotected intercourses (considering I would engage in one) until I have the wart treated or until it disappears naturally?

Best wishes and thank you once again, your advice surely will play a huge role in my mental healing process!

Edward W. Hook M.D.

77 months ago

Thanks for the follow-up. In this final response (threads are limited to a total of three responses. This thread will be closed without further responses shortly after the response is posted). I think I understood your questions but my responses may not have been clear. I'll try again.

Sub-surface, non-visible infection surrounding visible genital warts in relatively small and does not involve all of the genitalia. Thus, there is not a lot of sub-surface infection present and what there is does not represent a potential site for new warts to develop following scratching, cuts (wondering how this might occur other than with shaving?), or other local trauma. New warts arise from DIRECT contact, not from local spread of infection with the exception of the sort of spreading that you described in your initial post, through shaving over existing warts.

Similarly, for the reasons I mentioned above, i.e. that most unvaccinated, sexually active persons already have HPV, even if they do not know it and that they are of little lasting health consequence if acquired, we do not necessarily recommend notification of either monogamous or casual sex partners of HPV infection. The decision is situation- and relationship-specific and depends on the level of understanding and potential for mis-understanding. Similarly, HPV or a history of warts is not a reason for condom use (although there are many, many other good reasons for condom use and we do recommend regular condom use, particularly for casual sexual encounters).

I hope this clarifies things. As I mentioned above, this completes this thread which will be closed without further responses shortly. I hope the information I have provided is helpful. EWH,

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