Background: Male 20-28 age group, had genital warts, had the warts treated multiple times, 2 years are still not over since the warts originally started appearing

Since there are reoccurences, I'm assuming that it's still an active infection and the warts will continue coming back until the virus is cleared. Should I wait until more time has passed and the wart has stuck around for a bit before going from cryo or laser? 

Welcome to our Forum and thanks for your question.  You raise a good question and one that we do not get too often.  Indeed, there are some warts that do not respond well to therapy.  When warts appear to respond and then recur (typically within the next several months) there may be a need for more (i.e. a longer period of) treatment because there was a small bit of wart left behind or on some occasions, a different kind of treatment may be helpful.  In some such instances, the "warts" turn out to be something other than warts - have you gotten a dermatologist's opinion?

More directly to your question however, other than the cosmetic, emotional and social factor, there is little harm from visible warts.  Visible warts are typically caused by HPV types that have virtually no tendency to progress to pre-malignant lesions and are mostly a nuisance.

Finally, there is no reason to delay in treating warts should they appear.  In fact, treatment tends to work somewhat better in warts which have been present for shorter periods.

I hope this information is helpful.  EWH

1. My dermatologist and family doc are giving contradicting information. Dermatologist says wart, family doc says scar tissue from previous treatments. I'm more inclined towards the dermatologists advice.

2. Regarding the no tendency to progress to pre-malignant lesions - noted. Have there been cases where the clearance has taken more than 2 years and do these cases classify under persistent HPV / delayed or impossible clearance HPV? 90% clear within 2 years and only 1% are known to have persistent HPV - does that mean that the other 9% clear in 2+ years?

3. I haven't gotten the vaccine yet and I should go asap to get it. I have done some research and there is questionable evidence suggesting that it MAY help in fighting against current infections. Previously I was told by you that shaving should be avoided as it may irritate / allow the wart to shed and reinfect. Provided that I have the strain that is protected in the vaccine, will the re-infection be fended off from the vaccine at this stage?

In response:

1.  A biopsy is not as bad as it sounds and could resolve this issue.  This may be worthwhile since clearly it is on your mind.  With all due respect to your family doctor however, the dermatologist is the specialist.

2.  Yes, in some instances clearance can take more than two years.

3.  The vaccine will clearly offer protection against future infection with different HPV types and may enhance response to existing infections or re-infection with the same type (the vaccine induces a much stronger immune response than natural infection) but the latter point remains controversial and the subject of ongoing research.  There are no trials that relate to a protective effect for shaving but, were I you, I would not take the chance.  We do know that shaving over existing warts can lead to spread.

EWH