[Question #5320] HPV / HPV Treatment Query / HSV General Testing Query

21 months ago
I previously asked question # 5168. This is partially a follow-up to that question.

I have HPV / Genital Warts and taking treatment (Aldara) for GW. As per the most unreliable source, Dr. Google, Aldara is not working for me as I have not had any inflammation on the areas with super obvious genital warts. My scrotum is inflamed like anything but nothing on the area where GW exists.

1. Is it true that if Aldara does not inflame then it will not help treat GW and is useless?

2. Hypothetically, if GW is not treated for 2 years, will I always have HPV till I actually clear GW? In other words, if GW is not treated then HPV will remain. If GW is treated then likely that HPV will be cleared. Is there any science behind this? My understanding is that GW is a carrier/storage for HPV. If GW is not cleared then the HPV virus is still active and chilling in the wart?

3. I mentioned that I routinely test for STDs and my biggest fear is HSV even though I have tested and the results have come negative multiple times. I have a intermittent tingling feeling on the back of my penis and a small penile papule type spot appears but there is no pain. I got this swabbed and got IgG tests 4 and now 5 months after exposure. I get an IgG value of 0.6-0.785 non-reactive but the doctor believes that this is a "high-negative so HSV is still a possibility". Again, my understanding is that anything between 0.9-1.1 is equivocal and then HSV should be a possibility. Can the tingly feeling a symptom of HPV?

4. Just for understanding, my IgG value is 0.6-0.785, is this normal? I took an immunology course and studied that IgG will be detected as a response to a specific matching infection/virus. If my IgG value is 0.6-0.785 then can I assume that my immune system is fighting something off on the back-end? Is this IgG value specific to HSV tracers or IgG's are general antibodies?

I apologize for the long list of hypothetical and theoretical questions.

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome back to the Forum.  On this occasion I'll be answering your questions.  I did review your earlier exchange with Dr. Handsfield and agree with all that he said.  I'll go straight to your questions:
1.  I was interested in the fact that following cryo, Aldara was recommended.  More typically one treatment approach or the other is used, not successive Aldara following cryo.  As you point out, Aldra is thought to work by increasing inflammatory substances called cytokines in the area which it is applied.  Most often but not always, cytokine increases are accompanied by visible inflammation but the absence of visible inflammation does not necessarily mean that it is not working.  while there are no studies that I am aware of to specifically answer your question, since you already have the drug, were I you, I would probably continue to use it.  

2.  Most scientists now believe that in many persons with HPV that has resolved, residual viral DNA may still be present.  GW occur because skin cells are infected with the virus, causing the skin cells to grow abnormally causing a wart.  Once the wart is gone and there is no visible lesion, the virus is no longer transmissible and the longer it is gone the less likely it is to recur as a visible wart.  Using ultra-sensitive research tools, HPV DNA may still be detected.  Whether this is the "remains" of prior infection or quiescent but dormant infection is debated and probably not important for virtually everyone who has had warts successfully treated.  

3.  You do not say much about you sex preference or partner numbers but when I read your original post, I wondered why you tested relatively frequently.  Irrespective, I must respectfully disagree with your doctor.  The tests used to detect HSV antibodies never have a zero value as they detect and cross react with non-HSV directed IgG that everyone has.  Negative is negative.  At this time, with repeated negative tests, I see no need to continue to test unless you have an event which makes you worry that you may have contracted herpes.  It is normal for index values to "bounce around" in persons on a day to day basis and is not something to focus on or worry about.  Negative is negative.  The tingling you have experienced is more likely to reflect your detection of normal sensations that you normally overlook than anything else and is not suggestive of HSV.

4.  See my comments above.  this is normal variation which reflects multiple factors in the test, in the lab where the test is performed and in your body.  It does not signify that your body is fighting something.  Negative is negative.

I hope these responses are helpful to you. EWH
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21 months ago
1. I am now completing my first month of Aldara. I will be going back for a check-up and will get the advice of the doctor on how to proceed next as GW hasn't cleared. I think the wart has shrunk but it's better to get the docs opinion. I have to travel to another country for treatment so I usually go to my doc every other month. The doc said that in the case of cryo, it is likely that the warts will not all go away so in order to reinforce I should use Aldara as it will be a combined therapy and should be beneficial. 

2. Understood.

3. Straight. I'm a male. I've only had one risky sexual encounter. 3 partners in total. Sexual contact about 5 times in total. After I got a confirmed GW diagnosis, I became super conscious and started taking the slightest thing as a red flag. I read on previous posts that testing HSV IgG at 4 months is conclusive, not 100% accurate, but still conclusive. I've stopped the routine HCV, HIV, Hep-B, Chlamydia and Gonorrhea screen. I'll stop HSV as well. 

4. Understood.

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Thanks for your followup and additional information.
1.   I agree, getting follow-up from the doctor who initiated care is exactly the right thing to do.  Please remember, as you no doubt learned from reading other posts, HPV infections are innocuous health problems.  I understand the social concerns.

3.  Great,  you certainly do need more HSV tests at this time.  EWH
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21 months ago
3. I need more or don't need more? 
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
My apologies - typographical error.  You do NOT need additional tests for HSV.  EWH---
21 months ago
I don't know if I'm allowed to ask another follow-up question. 

I mentioned in my first post that my scrotum is inflamed (I applied Aldara on the other side of my penis so it obviously got in contact with my scrotum). Today, there was a "wet" spot on my scrotum, is this is a known side-effect of Aldara?
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
We provide up to three responses to each question.  this is my 3rd response. thus, as per Forum guidelines, this will complete this thread which will be closed shortly without further responses.

As you point out, Aldara is supposed to cause inflammation and inflammation of the scrotum can appear moist.  This may be the cause.  A fungal infection of the scrotum might also cause such an appearance.  My suggestion as a first step would be to dry the area and see if it recurs.  If it does, you may want a health care provider tot take a look.  EWH
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